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FRONTISPIECE. 



A DICTIONARY OF POPULAR MEDICINE AND HYGIENE. 



AMERICAN 

DOMESTIC MEDICINE 

AND 

HOUSEHOLD PHYSICIAN. 



A COMPANION FOR THE TRAVELER, 

EMIGRANT, CLERGYMAN, AND MINER, AS WELL AS FOR THE 

HEADS OF ALL FAMILIES AND INSTITUTIONS. 



/ EDITED BY 

EDWIN LANKESTER, M.D., F.R.S., etc. 

ASSISTED BY DISTINGUISHED MEMBERS OF THE COLLEGES OF 

PHYSICIANS AND SURGEONS OF AMERICA, GREAT BRITAIN, 

FRANCE, AND GERMANY. 







WITH THIRTY-THREE FULL-PAGE PLATES. 




AUGUSTA, ME.: 
TRUE AND COMPANY. 



w 



v^ 



PREFACE. 



Appkeciating the great importance of the general public health, 
and understanding the necessity of general information in relation to 
the prevention and treatment of disease, embodied in such form that 
the masses may reach it and profit by it ; also well knowing that for 
such a work the field is boundless, we decided to undertake the pub- 
lishing of a Dictionary of Popular Medicine and Hygiene, superior to 
anything of the kind heretofore attempted. The rapid progress of 
medical science has rendered antiquated much of that which the pub- 
lic, as contradistinguished from professional medical men, have been 
taught by the various books of the kind now before them. And it is 
to be further noted that no work whatever which deals with the pres- 
ervation of health, that is to say, Hygiene, is now available for the 
use of the masses, — the common people. With a view to the produc- 
tion of a work which will provide for these deficiencies, the various 
subjects here treated have been referred to the most competent author- 
ities, men specially skilled in the departments of medical science of 
which they treat. By this means the most recent acquisitions in medi- 
cine and surgery have been made available for popular use, — it being 
the aim of the writers, whilst avoiding all technical phraseology, to 
expound their subjects in such a fashion as to be intelligible to all, 
but still retaining the most rigorous scientific accuracy. By this means, 
further, a knowledge of that all-important matter, the maintenance of 
personal and public health, may be generally communicated; for as 
day by day the mode in which diseases are spread becomes clearer, so 
day by day the plans for arresting their diffusion become more defined 
and more readily applicable. It has, for example, been tolerably 
clearly made out that overcrowding, bad ventilation, and improper 
nourishment are the main, if not the sole, causes of typhus fever- 
that bad drainage and the mingling of sewage with water are the ori- 
gin of typhoid fever, and the chief means of spreading cholera ; that 



Vi PUBLISHERS' NOTE. 

by the vigorous carrying out of vaccination and re-vaccination small- 
pox may be stamped out, and so on. These matters, of vital impor- 
tance to the public, which, if not hid from, have certainly not been 
made plain to them hitherto, are here discussed. Aimed as it is at an 
intelligent public, the book will contain special references to those 
exigencies which may daily befall any of us, where immediate help 
makes all the difference between life and death, but where no skilled 
medical aid is at hand. On such occasions an intelligent man or 
woman, with some knowledge of the healing art, may be of immense 
service. So also there are times in family life when a knowledge of 
the signs of incipient disease may warn an anxious parent in time to 
save the life of a beloved child, whereas, did no such knowledge exist, 
the malady might be allowed to drift onward till past all remedy. 
Instances might easily be multiplied, — let us be contented with refer- 
ring to a ruptured blood-vessel and the onset of croup. Briefly, then, 
to diffuse a knowledge of medical matters in a manner intelligible to 
all, but in matter strictly accurate, is the aim of this book. 



PUBLISHERS' NOTE TO THE NEW EDITION. 

The favorable reception met with on every hand by the American 
Dictionary of Popular Medicine and Hygiene has encouraged 
the Publishers to put forth fresh efforts to increase its utility and 
attractiveness. They have therefore added an Appendix, containing 
exhaustive articles by a competent medical authority on the subjects 
of Sick-Nursing and Mother's Management. Numerous plates have 
also been inserted throughout the work, and from these the reader 
will obtain clear ideas about many points which would otherwise be 
left in obscurity. A full description of the plates will be found in 
the last article of the Appendix. 

Instances have not been wanting to show that the American Dic- 
tionary of Popular Medicine has already done good service, not 
only at home, but abroad ; and the Publishers feel themselves justified 
in hoping that this new and improved edition will meet with a wel- 
come even more cordial than that accorded to its predecessor. 



EDITOR'S PREFACE. 



The Publishers have kindly permitted me to say some words by 
way of preface and explanation. It was not till the plan of this 
work was arranged, and its contributors engaged, that I was asked 
to become editor. I agreed, however, to look over the articles and 
arrange them for the press. My task has been, therefore, confined 
to making good or verifying all references, looking over proofs, the 
general approval of the articles written, and writing a few contri- 
butions on Food and Hygiene. I should not have undertaken the 
editorship of this work had I not been fully assured that the profes- 
sional gentlemen who have written the chief part of the articles were 
fully competent to the task. They all possess the highest qualifica- 
tions, and some of them are attached to public institutions, so that 
their individual opinions may be regarded as of importance. 

Being especially anxious that the public should be instructed 
on the subject of the laws of health, I have not hesitated to con- 
nect my name with this book, for I am deeply convinced that it 
is for the benefit of the public that they should be instructed in 
the laws of life. 

It is especially in the present management of children that we see 
the necessity of instructing women in the elements of those branches 
of science which deal with the feeding and health of children. From 
the ignorance of their mothers a larger number of first-born children 
are sacrificed under one year of age than at any other time of life. 
I calculate that in America, England, and Wales this death-rate is as 
high as 36 per cent, of all first-born children. Again, a large number 
of children are annually suffocated in bed, and if there are as many 
found dead in bed in other parts of the United States as in Penn- 
sylvania the number of deaths will amount to four thousand in the 
United States alone. Take the group of zymotic diseases — typhus, 
typhoid, scarlet fever, and measles. These diseases spread and de- 



viii EDITOR'S PREFACE. 

stroy life mainly through, the ignorance of all concerned of the sim- 
plest laws of the nature of disease and the cause of its spreading. 

In as far as the prevention of disease could be dealt with in this 
book it has been done. 

There is a large class of persons, including missionai'ies abroad, 
sailors, travelers, and all living in the country, who are so situated that 
medical aid cannot be had directly, or even at all in some cases, who 
are sufficiently intelligent to understand what is written about dis- 
ease, and to apply it ; and for such persons it seemed desirable that 
the treatment of the more common forms of disease should be entered 
into with a degree of detail. 

On the whole, I believe the book will be found more up to the 
science of the time than any previous attempt made to popularize 
the practice of medicine and surger}\ Should reference to this 
Dictionary lead persons to read some of the scientific treatises on 
Physiology, or to interest themselves in introducing into schools the 
study of this the most important branch of human knowledge, it 
would be the highest reward and the greatest gratification I could 
obtain in having connected m}^ name with it. 

EDWIN LANKESTER. 



CONTENTS. 



PAGE 

Preface v 

Publishers' Note to the New Edition vi 

Editor's Preface vii 

Introduction 11 

Dictionary of Popular Medicine and Hygiene, A to Z . . . 23-827 

Appendix I. Sick-Nursing 829-899 

" II. Maternal Management 901-979 

" Practical Suggestions 980-986 

" III. Matter Illustrative of Plates 987-1005 

Tabular View 1006-1008 



LIST OF PLATES. 



Frontispiece facing Title-page 

Plate I. Figs. 1— 9 facing page 44 

II. 10—15 86 

III. 16—21 108 

IV. 22—25 130 

V. 26—30 152 

VI. 31—35 176 

VII. 36—39 220 

VIII. 40—42 240 

IX. 43—46 262 

X. 47—49 308 

XL 50—56 330 

XII. 57—61 352 

XIII. 62—65 394 

XIV. 66—73 414 

XV. 74—79 440 

XVI. 80—83 482 

XVII. 84—89 506 

XVIII. 90—93 526 

XIX. 94-100 572 

XX. 101-106 594 

XXI. 107-110 618 

XXII. 111-113 654 

XXIII. 114-123 676 

XXIV. 124-130 700 

XXV. 131-134 722 

XXVI. 135-143 746 

XXVII. 144-150 788 

XXVIII. 151-158 810 

XXIX. 159-167 864 

XXX. 168-176 890 

XXXI. 177-183 948 

XXXII. 184-188 972 



INTRODUCTION. 



Were it required to write an " apology " — to use the word in its oldest 
and best sense — for every book which conies from the press, few would pos- 
sess a better claim to attention than this " Dictionary of Popular Medicine 
and Hygiene." Its title constitutes its raison d'etre. To one generation Cul- 
pepper's " Herbal " constituted the mine of wisdom in all relating to the aches 
and pains of the human body. In the eyes of another, Buchan's " Domestic 
Medicine " was only of less authority than the Bible. But in those days men 
tried only to cure diseases ; it remained for later times to make the discovery 
that they could be best cured by being prevented. This new branch of med- 
ical science then — Hygiene or Preventive Medicine — is but of comparatively 
recent origin. Indeed, it was not possible, until the causes of diseases were 
fairly traced out, that these could be arrested in their action and the disease 
nipped in the bud. Now it is desirable that all men, and women too, should 
be in a position to face death intelligently on an emergency, though the com- 
bat had better be carried on by those trained to the fight ; but emergencies do 
not occur every day ; help is frequently at hand, whereas in that other com- 
bat between health and disease, which may mean death, on special occasions 
special services are sometimes called in ; ordinarily, however, each man has to 
look after himself. Further, the ignorance of one may endanger the safety of 
many ; all should therefore be instructed in sanitary affairs. But it is im- 
possible to make one's self acquainted with any branch of science where the 
means have been entirely wanting, and this has been notoriously the case with 
regard to sanitation. To supply this want is in part the aim of this book. Its 
object is to enable any intelligent man or woman to make use of the means 
best calculated to prevent or arrest disease, and in the absence of more skilled 
assistance to use most wisely those remedial agents which may be at hand. 
Sanitation has been the offspring of great plagues. Modern medicine takes 
its stand on the careful observation of disease. Ignorance and carelessness 
have been the staunch opponents of sanitation ; rashness and dogmatism, of 
medicine. To prove this it is but necessary to trace the history of both in 
past times, and if we wish to avoid error there can be no more instructive 
study. 

For our purpose it is unnecessary to go back to the days of Greece and 
Rome, or to quote Hippocrates, Galen, or Celsus. We shall begin with the 
Middle Ages, before the discovery of America, when epidemic influences 



12 INTRODUCTION. 

seemed all pervading, when the Black Death, Sweating Sickness, the Plague, 
and the like devastated Europe ; hoping thereby to learn some useful lessons 
as to the prevention and cure of disease. 

The origin of the Black Death is unknown ; it has been assigned to Egypt, 
and some have thought they could trace it to China. The one thing certain is 
that in 1348 it reached Europe, and raged there with unparalleled violence. 
Of its nature we know more, for it has been most accurately described by the 
imperial Kantakusenos as it prevailed in Constantinople, then the capital of 
the Eastern Empire : by Boccaccio as it appeared in Florence ; and from a 
physician, Guy de Chauliac, who was attached to the then sovereign Pope, 
Clement VI., ruling at Avignon. In its essence it resembled the Oriental 
Plague, in some respects the worst forms of typhus, and was specially marked 
by inflammatory swellings of the glands in the groins and armpits. These, 
though the characteristics, were not the most dangerous symptoms of the 
malady, which in the earlier portion of its prevalence caused a fearful mortality 
by a peculiar and intimate change in the blood itself, such as, in kind at least, 
is not unknown to us now. For there were frequent bleedings, especially 
from the lungs, and the blood discharged was foul and putrid. Even now, in 
diseases like small-pox, or others we could name, life may be destroyed by 
profound alteration in the blood and its containing vessels, so that repeated 
and finally fatal bleedings take place. And just as in small-pox death from 
this cause may result before the characteristic eruption has fairly manifested 
itself, so in the Black Death (ihe name itself implying this blood change) life 
might be destroyed at an early period by this change in the blood. The en- 
largements of the glands came later on in the history of this malady, when it 
had spent its first violence. In that form of the malady where the blood 
change was the prominent symptom, death commonly resulted in three days. 
When buboes and swollen glands in the armpits occurred, death usually took 
place in five days. In treating of the history of epidemics, certain general 
conclusions should ever be borne in mind. The first is that a certain num- 
ber of people, be it greater or less, is sure to die : for them there is no help. 
Further, iu many instances a few scattered cases may occur before the plague 
breaks out in its full force, or some of its peculiar symptoms may engraft 
themselves on other diseases, and so modify their character. To take an 
example : during cholera time, or just before it, we encounter an unusually 
large proportion of cases of what is called choleraic diarrhoea ; this by many 
is looked upon as the immediate precursor of the more dangerous malady, and 
to be arrested at all hazards ; being so, no cholera follows, whilst injudicious 
treatment hurries on that disease. But when the plague-wave bursts upon us 
with full force, death is fearfully rapid and awfully certain ; none, it may be 
said, recover. By and by, when it begins to abate its force, more and more 
recoveries take place, until death becomes the exception, and finally the malady 
disappears. It is at their first outbreak, therefore, that plagues are most 
deadly, and so was it with the Black Death ; for as the form accompanied by 
spitting of blood was more speedily fatal than that associated with boils, so 



INTRODUCTION. 13 

did the one precede the other in point of time ; and in like manner it might be 
said that the former was more infectious than the latter, insomuch that it was 
reported that looking on one affected was enough to communicate the disease. 
At first all died, and the numbers who thus perished are hardly calculable. 
Exact statistics, of course, were not at that time, and so rough computation 
took their place ; but some idea of the virulence of the plague may be formed 
when it is asserted that only one tenth of the inhabitants were left alive. 
Europe is supposed to have lost forty millions of souls. In London 100,000 
died, and in one burial-ground alone 50,000 were interred, in layers, one body 
above another, in large pits. Nor were its ravages confined to the land : 
sailors, who had caught infection on shore, were attacked at sea, and in this 
way whole crews perished, leaving their vessels to drift about at will, spread- 
ing the plague wherever they went on shore or were boarded in hope of gain. 
It might be supposed that vain hankerings after wealth would have been 
quenched in the general danger impending over all, but not so. Hardened 
and careless men were glad to live at their ease in constant dissipation by 
robbing alike the living and the dead. 

The Black Death prevailed in England from August, 1348, till August, 
1349, and when it disappeared did so only that a new form of distress might 
prevail ; for the cattle died, and there were none to gather the harvest, so that 
great scarcity followed. This may seem strange to those who think only of 
England as it now exists, densely populated and richly cultivated, but in those 
days much of the country was woodland but sparsely inhabited. Where people 
dwelt they were compelled to herd closely together for protection, the lord as 
well as the serf, and if the sanitary condition of the former was miserable, that 
of the latter was dreadful. One has but to contemplate one of the castles of 
this date, however magnificent, and the difficulties in the way of preserving 
health and preventing the spread of disease become apparent. The cities were, 
if possible, worse, since in them were crowded greater multitudes of people, with 
little or no water supply, no drainage, and altogether inadequate ventilation. 
Associated with the history of the Black Death is that of a curious set of 
fanatics who exercised no small influence in spreading the malady. These were 
the Flagellants, a company of religious fanatics, who, prompted to atone for the 
sins of a district by their own sufferings, tried to avert the divine displeasure, 
and so the dreaded mortality. This they sought to do by violently scourging 
(flagellum, whip or scourge) each other in public places, and from their re- 
puted sanctity were eagerly received and welcomed by the people wherever they 
went. But as they passed from city to city they carried with them the seeds of 
the disease they sought to repress, and so added to the number of its victims. 
Latterly this mode of living became so attractive, that many men of irregular 
lives joined the processions, and boldly demanded whatever they desired wher- 
ever they went, till at last the processions themselves had to be put down 
with a high hand. 

Nevertheless, it is to the terror inspired by this fearful plague that we must 
ascribe the first efforts at sanitary legislation, which, crude though they were, 



14 INTRODUCTION. 

already involved certain of the propositions we have made with regard to 
plagues. It was early seen that such maladies must be met by means limiting 
their spread rather than by any exercise of curative art. It was therefore de- 
creed by an Italian prince — Italy being then the headquarters of the arts and 
sciences — that all plague-stricken patients should be at once removed from the 
city to the fields, and there remain until death or recovery. The priests (the 
physicians of those days) were to examine the people and point out the infected, 
who were at once removed. Certain attendants were appointed to look after the 
sick, who were bound to remain apart ten days after their patient had died, and 
no one save those thus appointed was to attend on plague patients. The 
penalties were simple — death and confiscation. In 1399, a successor of the 
prince, Viscount John, instituted further rules, many indicative of great wisdom 
and sound judgment on his part. The most important referred to the admission 
of none but sound men within the walls, all coming from infected places being 
strictly prohibited from entering, the disinfection of plague-stricken houses, of 
clothes worn by the sick, of bedsteads and bedclothes, and the destruction by 
fire of articles of little value. Such were the first sanitary arrangements, if we 
exclude those enforced by Mosaic law, and these were the direct and immediate 
outcome of the terrible Black Death. But though these modes of arresting the 
plague, once it had made its appearance, were enforced by enlightened princes 
abroad, in England, as elsewhere, the daily mode of life was such as to encourage 
continual outbreaks of epidemic disease, and, having broken out, to foster their 
spread and virulence. It would be out of place here to enter into minute details 
of daily life in England in those days, of their rank feeding and foul living; 
enough it is to say that these bore fruit upwards of a hundred years after the 
Black Death had passed away, when, for the first time, in 1485, there appeared 
a malady so peculiar to the country as to be known alike by the names of the 
English or Sweating Sickness. Nay, more, even abroad it seemed in great 
measure to limit its attacks to Englishmen. 

Five separate times did the Sweating Sickness visit the British Islands, each 
time carrying speedy death ou its wings. The exceeding fatality of this malady, 
and the extreme rapidity with which death supervened, were its most peculiar 
characteristics. It killed people in the streets, in performing simple domestic 
duties, some in one hour, some in two, at most in four or five (for after 
twenty-four hours' illness they were presumed to be safe), wherever and however 
they were engaged, so that out of a household thus attacked few or none would 
escape. In its nature the disease was peculiar; we have nothing now resembling 
it at all closely. It does not seem to have been contagious or infectious, but 
rather to have prevailed, as does remittent fever in certain tropical countries, as 
a result of certain atmospheric conditions. Then, again, it was not the lowly 
whom it attacked, but rather the full-fed upper classes, and to their gross habits 
did the physicians of the time in great measure assign the origin, certainly 
the fatality, of the disease. It began with pains throughout the body, especially 
in the back and limbs, and terminated with an exceedingly copious and most 
offensive perspiration ; the face was livid, and breathing was difficult. Some- 



INTEODUCTION. 15 

times diarrhoea set in, and in all cases there was considerable danger of relapse. 
As to the immediate causation of the disease, that could be partly accounted for 
by peculiar atmospheric , conditions, still more by the condition of the streets 
and houses. The streets were deep in the accumulation of every kind of filth 
from the adjoining houses, never removed, but only covered over with dirt, 
whilst the floors of the houses themselves were built up in like manner, the 
topmost layer being strewed with rushes, which, when they had been well 
trampled clown, were without removal replaced by fresh ones. Feeding was 
gross and abundant, drink plentiful and largely indulged in, the dress close and 
hot, the rooms hideously ill-smelling, impossible to ventilate. Such were the 
conditions of the English Sickness. Neither does there seem to have been any 
directly beneficial outcome from these outbreaks, although plague succeeded 
plague throughout the century; the lessons they taught appear to have been left 
unlearned by all save a few, or if learned they remained unapplied. Perhaps, 
indeed, it was the multiplicity of epidemics and the multitudes of causes which 
could be assigned to them that prevented the conditions above enumerated 
from being duly appreciated and vigorously attacked. 

Before speaking of the next great epidemic which attacked England it might 
be as well to allude to a scourge which, if at the time less virulent than some 
we have named here, in the long run destroyed many more directly or indirectly 
than all put together, seeing that it has persisted, though in a mitigated form, 
to the present day. The exact history of the origin of Syphilis is buried in 
darkness. Some would have it that it existed of old in Europe and Asia, others 
that it was introduced into the former by the voyagers of Columbus oh their 
return from the discovery of America. This much is certain, that shortly after 
that period it raged throughout Europe, especially in its southern parts, with 
a virulence which is now unknown, and was at least accredited with many 
modes of transmissal now scarcely assigned to it. One of the charges against 
Cardinal Wolsey was that, being affected with this disease, he endangered the 
safety of Henry the Eighth by approaching him and breathing on him. The 
deaths at the siege of Naples, where by some the disease is supposed to have 
originated and to have proved inordinately fatal, were mostly due to an outbreak 
of typhus, then as later the scourge of armies, the product of famine and 
exposure. Of the subsequent history of the disorder nothing further need here 
be narrated. 

In 1499 the Plague reached England, and again and again it invaded her 
shores until 1665, when it made its fifth, last, and most fatal visit. In its 
essential characters the Plague resembled the Black Death, but seems on the 
whole to have been less virulent, and to have carried off during a longer period 
of visitation fewer victims. The Plague differed from the Black Death, in- 
asmuch as there appears to have been no period in which it carried off so 
many people ; its specific symptom was spitting of blood, but in both boils, car- 
buncles, and buboes were characteristic; in both also there was considerable 
effusion of blood, or of blood-coloring matter, under the skin. Of the charac- 
teristics and of the fatality of the Plague less was noted during the four first 



16 INTRODUCTION. 

epidemics than during the last, of which it has been computed that 80,000 
people perished in London alone. Of this outbreak, which is commonly called 
the Great Plague of London, we have tolerably full details. Its early symptoms 
were those common to most fevers, shivering headache, sickness, and malaise : 
as the fever advanced there was heat at the pit of the stomach and palpitation, 
but the certain indications of the disease were Mains and boils, sometimes 
becoming carbuncles, buboes, and certain vesicles called tokens. The blains 
were blisters of various sizes and in varying numbers ; the liquid they contained, 
which was yellow or black, was also highly corrosive. If they became carbuncles 
their edges became livid or black, their surface covered with a dried crust, and 
the liquid which exuded from them formed new sores wherever allowed to touch 
the skin. The buboes appeared either in the groins or armpits, sometimes 
in both, being most numerous where the case was most dangerous ; they did not 
always suppurate, but sometimes faded. The tokens were minute pyramidal 
blisters, appearing either on the skin or on the inner parts ; when seen, especially 
when deep, they were considered to be sure presages of death, even when every 
other symptom was favorable. 

The way in which the Plague appeared in London for the last time was 
highly characteristic. Some persons had died suddenly in Westminster with 
symptoms supposed to be those of the Plague. Immediately the neighbors 
took fright, and forthwith certain of them removed to London, carrying the 
disease with them ; and from there it spread, becoming more and more fatal, 
and striking terror into all, until about the beginning of September, 1665, 
when the disease was at its height. The air was stagnant, so fires were 
kindled in the streets to excite currents, but they were extinguished by a 
violent rain, after which came the most fatal night of all, upwards of 4000 
deaths being recorded. In November the town began to grow more healthy, 
and by December those who had tied and had survived — for flight did not 
always bring security — began to crowd back as thickly as they had fled : the 
Plague had to all intents and purposes ceased. A few cases occurred the year 
following, but from that date to this it has not again appeared in England. 

From what has been said, it will be perceived that this disease differed from 
the Sweating Sickness, and resembled the Black Death, in being eminently 
contagious; and whereas during the former malady there does not seem to 
have "been any restraint on the movements of the people, no sooner had the 
full virulence of the Plague manifested itself, than those houses which were 
infected were marked with a great red cross, and all access and egress denied 
to the inhabitants. A guard was set to enforce this, and to hand the neces- 
saries of life to the inmates ; those who died were removed by the dead-carts ; 
those who recovered were still confined for forty days thereafter (quarant, 
forty, whence quarantine). Thus they attempted, but in vain, to limit the 
disease ; for, seeing what a declaration of having the Plague within their doors 
implied, people were fain to return their dead as having perished of any dis- 
order save that. The lighting of the fires, to which we have alluded, was 
another measure intended to promote the circulation of air, and so the dis- 



INTRODUCTION. 17 

persion, if nothing else, of the disease ; but that, too, proved useless. The 
College of Physicians, being appealed to, invented a harmless plague-water, 
in the face of such an epidemic altogether useless. Finally, as we have seen, 
the Plague went almost as suddenly as it had appeared, and apparently might 
have gone only to return, and left no permanent memorial in the shape of 
sanitary effort behind it, had it not been for another devastating agent, the 
Great Fire of London, which followed, not, as is commonly supposed, ac- 
companied or terminated the Plague. Several incidents prove plainly to us 
that the Plague was chiefly propagated by personal contact or indirect con- 
tamination by clothes or merchandise. Thus it was said to have been intro- 
duced into England from Holland in bales of merchandise, and to have been 
previously imported into Holland from Turkey in bundles of cotton or silk ; 
but in all cases contagion was believed to be at the root of the evil. 

The Great Fire broke out in Fish Street Hill on the night of Sunday, Sep- 
tember 2, 1666, and thence proceeded westward, destroying old St. Paul's, 
and laying waste everything before it as far as the Temple. Old London was 
destroyed, and the new city might have risen in unparalleled splendor, had not 
the citizens, eager to resume business, too often preferred narrow and irregular 
streets to the broader and more commanding thoroughfares projected in Sir 
Christopher AYren's plan for the rebuilding of London. Nevertheless, the fire 
was not without its uses : the old buildings it had consumed, and which were, 
saturated with impurity, were mostly of wood ; those built in their places, and 
which would have at least the merit of being new, were mostly of brick, and 
were constructed with some regard to improved ventilation. Above all, the 
ancient masses of garbage, which constituted the floors of the houses and the 
pavements of the streets, were thoroughly got rid of, and with the new city 
were formed regulations which necessitated a certain degree of cleanliness. 
Moreover, the refuse formerly thrown into the streets, and allowed to accumu- 
late there, was now ordered to be carted away, and the drains, which ran in 
the middle of the street, were covered over, and restricted to their proper 
uses. But though the fire gutted the city, it left untouched many parts which 
for long after were plague and fever traps, especially the rookeries of West- 
minster and St. Giles's, portions of which still remain. 

From the day when the Plague left its shores never to return, until our 
own time, no famous epidemic, such as those we have described, has raged in 
England ; nevertheless, during that period more people died from what we 
may safely call preventible disease than perished by the terrible Black Death. 
For though the chief agencies at work since that time have been such well- 
known ones as fevers, ague, dysentery, and small-pox, yet their evil effects 
were so aggravated by bad sanitation that their mortality was increased more 
than tenfold. Besides, there were two maladies, both very deadly, of which 
we now hear only occasionally, and rarely as proving fatal, but which we will 
do well here to mention ; we allude to Influenza and Scurvy. 

To begin with ague (and dysentery, which is somewhat allied to it), we 
may safely affirm that nowadays the disease is comparatively rare, and where 



18 INTRODUCTION". 

still prevalent, very seldom fatal. Formerly the disease was very prevalent, 
and even now it will sometimes break out in the Fens almost like an epidemic, 
but in districts where once it was common it is now unknown. This is due to 
drainage. Then, again, its fatality, which when aided by unhealthy surround- 
ings, food, and such like, was sometimes very great, is now reduced to a mini- 
mum by the discovery of the healing virtues of bark, and its active principle, 
quinine. Dysentery is now also rare in Great Britain ; its diminution being 
due partly to better sanitary arrangements ; partly also, undoubtedly, to the 
better food now in general use, — for in times past the so-called bloody flux, 
indisputably in many instances, depended on the scorbutic condition of the 
patients. 

Of Fevers something more must be said, and especially of that most fatal 
distemper, the Jail Fever. The condition of prisoners, up to comparatively 
recent times, was something horrible. The unfortunate prisoners, crowded 
together like cattle, had neither food, air, nor water in sufficiency, still less 
in purity. Under such circumstances, what we now know to be the natural 
sequence of events, fever broke out among them, and not limiting itself to them 
attacked those who came to try them. One of the most notorious of these 
outbreaks occurred at Oxford in 1577. This was called the Black Assize, for 
almost every one present, including judge and jury, perished — most within 
forty hours. The disease in this case would seem to have been more allied to 
acute dysentery than to typhus ; but a true outburst of the latter occurred at 
Exeter in 15.SG, another at Taunton in 1730, a third at Launceston in 1742, 
and the last at the Old Bailey in London in 1750. In each of the four last 
instances the disease spread beyond those originally affected, which was not the 
case at the Black Assize of Oxford. To many the true cause of this malady 
was patent, nevertheless no satisfactory efforts were made to improve the con- 
dition of prisoners until John Howard took the matter in hand. But the evils 
thus originating were not limited to jails and their inmates, for sailors being 
scarce, convicts were often drafted into the navy, and with them carried the 
infection. In the navy of that date the distemper found a too congenial soil, 
so that it became a scourge of both fleets and armies ; for the disease was iden- 
tical with the camp fever, so often spoken of in connection with armies in win- 
ter quarters during the last and preceding centuries, and by which they were 
sometimes decimated. But if the disease originated in overcrowding and foul 
air, its fatality was increased and its ravages fostered by the food supplied to 
these two forces, and by the scorbutic condition of body consequent upon these. 
But the origin of the distemper was seen and appreciated, and with improve- 
ments in jails, though typhus fever did not cease throughout the land, jail 
fever did, leaving, as its last relic, the bunch of sweet-smelling herbs still laid 
before the judges, and once supposed to be efficacious in warding off the fell 
distemper. 

It is heart-breaking to take up such a subject as small-pox; to consider the 
state of things a century ago, to compare it with that now prevailing, and yet 
to know that there are fanatics who would thrust us back into our former 



INTRODUCTION. 19 

state, and are willing to spend their money to that end. During the first 
three-quarters of last century the annual deaths within the London Bills of 
Mortality were upwards of 2000 from this cause alone, and if to this we add 
the number of those whose eyesight was destroyed, or who were generally 
disfigured, we may form some conception of its ravages. But this was not all ; 
one fifth of all men enlisted as soldiers or sailors died of it, for, going hand in 
hand with jail fever, they were introduced together — they raged side by side ; 
what the ©ne spared the other took, and so our defenses were rendered value- 
less. In all Europe about 494,000 died annually of small-pox. Turning to 
the West, we see whole tribes of Indians swept off the face of the earth by it, 
not one being left behind. Compare such a state of things with even the most 
fatal epidemics of small-pox which prevail among us, and we cannot help being 
struck with the difference, especially in the number attacked who survive ; 
formerly one in every five who were seized perished. If we ask how this 
change has been brought about, the answer is, by Vaccination. About the 
beginning of last century a process which had long been in operation in the 
East for the mitigation of small-pox was introduced into Europe and America. 
The process was Inoculation, and it was brought to England by Lady Mary 
Wortley Montagu. Its principle consisted in selecting the time for having 
small-pox, and also perhaps in some degree the kind of the disease ; for if an 
individual was selected who had the small-pox in a very mild form, there was 
a chance, at least, that the individual inoculated would take the disease in 
similar fashion. There can be no doubt but that the practice was in a certain 
measure successful, but the prime objection to it lay in the fact that each indi- 
vidual thus inoculated constituted a new focus of disease from which in certain 
cases it was directly propagated. Close upon the end of the century, Jenner's 
attention was drawn to the matter by a milkmaid, who said that, having had 
the cow-pox, she was no longer liable to small-pox. The general opinion of 
the neighborhood supported this assertion, and experiments were made by in- 
oculating with cow-pox instead of small-pox. They were completely success- 
ful, and though much opposition had to be encountered and overcome, nay, 
has still to be encountered, Jenner had his reward, and saw vaccination uni- 
versally introduced, to be finally rendered universally compulsory. This is 
the grandest triumph which sanitation (for the process belongs to that) has ever 
yet experienced. 

The two other maladies mentioned — namely, Influenza and Scurvy — are 
in such marked contrast that they well exemplify two sets of diseases ; the one, 
as far as we know now, unpreventible, the other entirely under our control 
both as to prevention and cure. 

Influenza has more than once appeared as a fatal epidemic in England, 
generally speedily attaining its maximum of fatality and more slowly fading 
away. In September, 1729, as many as a thousand died weekly in London of 
this disease alone ; and, in 1732-3, it broke out still more violently, running 
the Bills of Mortality of London in the latter year to a weekly total of 1588, 
such as had not happened since the days of the Great Plague. Other epidem- 
ics occurred in 1737 and 1743 ; but the one which concerns us chiefly, and is 



20 INTRODUCTION. 

vet within the recollection of many, occurred in 1847-8. The outbreak was 
sudden. On October 30, 1847, one death was recorded, and in seven weeks 
the malady had reached its maximum intensity, thereafter gradually declining 
in severity until it reached its normal limits, that is to say, occurring now and 
again, especially in certain seasons, but never with great fatality. 

In marked contrast is Scurvy, and yet it is only in comparatively recent days 
that we have been able to trace it to its true cause ; so recently, indeed, that 
even now ships are compelled by Act of Congress to carry, not that which 
effectually prevents the disease, but that which at best is but a substitute. 
Insufficient and improper food, no inquirer can have any reason to doubt, is 
the cause of scurvy ; but when inquiry is made as to what element is want- 
ing when the disease follows, the answer is not quite so plain. At one time 
the salt junk, which constituted the bulk of seamen's food, was credited with 
the origin of the complaint, but it turned out that when the crews were sup- 
plied with fresh meat scurvy still followed. Of all substances, green vegetables 
seem to be the most powerful preventives and the most speedy remedy ; but 
potatoes, which are not green vegetables, would seem to be hardly less so; and 
in foreign ships, wliere the crews are, perhaps, fed on beans and are supplied 
with rough red wine, no scurvy occurs. In American ships apples are largely 
consumed, and where this is the case no scurvy occurs. If we argue from 
what we see ashore, vegetables of some kind, fresh or preserved, would seem 
to be necessary ; that fresh meat tends to obviate the disease, but is not in itself 
sufficient to prevent it; and that the conditions which specially favor its onset 
are bad and scanty food, especially if salted, fatigue, exposure, cold, and damp. 

During the present century a terrible malady has several times invaded 
America and England ; we mean Cholera. It and an outbreak of fever in Eng- 
land consequent on the potato failure in Ireland are the only epidemics we shall 
further discuss. Originating in the swamps of the Ganges, where it would 
seem to be endemic, that is to say, a constant inhabitant, cholera spread all 
over India, and thence it passed overland to Russia, thousands perishing before 
it ; its spread, apparently consonant with no known laws, propagating as rapidly 
against the winds as when driven before them, filled the minds of men with 
diead. Its outburst was terrible, for the sanitary teachings of former epidemics 
had been forgotten, and the disease found all that filth and uncleanness in 
which it revels. The scenes of the Middle Ages were reproduced over again: 
in face of the danger, men seemed stricken with madness: but like other 
epidemics of the kind, uninfluenced by man's intervention, it gradually passed 
away. 1 but only to return again and again, each time, however, finding men 
better prepared to receive it ; for it is from the time of the cholera coming 
among us — although something had been done beforehand — that we must 
date our persistent efforts towards improved sanitation. 

We have but to speak of three more diseases and we have done. Up to a 
comparatively recent date the physicians of this continent and those of certain 
portions of England were mutually amazed at each other; they both alike 

1 For a powerful if overdrawn description of its first outbreak at Paris, see Eugene 
Sue's " Wandering Jew." 



INTRODUCTION. 21 

talked of a disease called Typhus Fever, but whereas on this continent it was 
said to be almost invariably accompanied by diarrhoea, in England constipation 
was the rule ; and whereas abroad, after death, the intestines were found to be 
ulcerated, no such appearance was discoverable here. By dint of careful ob- 
servation, Stewart, Jenner, and Murchison were gradually able to evolve from 
this composite mass of phenomena two distinct diseases, which are now univer- 
sally recognized. They are Typhus and Typhoid Fever. Furthermore, they 
were able to- make out that whereas typhus seemed invariably (except when 
epidemic) to accompany overcrowding and bad food, typhoid seized rich and 
poor alike, affecting in point of fact rather the mansions of the rich than the 
cabins of the poor. It was dangerous alike to both. But though the causation 
of typhus seemed clear, that of typhoid long remained hidden, until at last, one 
fact being added to another, and shedding light on those already noted, it 
became clear that drinking-water was at the root of the evil, and by and by it 
came out that sewage impregnation was the cause of the malady. 

Yellow fever, which counts its victims by hundreds of thousands in the 
Southern States, and from which some of the Northern States have at times 
severely suffered, develops its full strength under conditions of filth and heat. 
It seldom appears at an elevation of 3000 feet above the sea ; its death trail 
is in the lowlands. A certain amount of heat is essential to the development 
of this fever ;. few cases are observed where the temperature is less than 72° F. 
Dr. McLean, who has had much experience in the tropics, thus lays down the 
differences between yellow and remittent fevers : Yellow fever is specifically 
distinct from remittent fever. Yellow fever is unknown in India, where true 
malarial fevers abound. There is in yellow fever an absence, for the most 
part, of that periodicity which is so characteristic of true malarial fevers, — 
that is, the remissions and exacerbations. Men do not pass from recovery to 
health, as is the case in such a marked degree in yellow fever, after which there 
is little or no evidence of the existence of any cachexy. Malarial fevers exist 
and are destructive at a temperature at which yellow fever is at once destroyed. 
Men suffer from malarial fevers again and again, but second attacks of yellow 
fever are rare. Good sanitary conditions, if not sufficient to keep entirely in 
check this deadly foe in all climates, in a great measure break the power of 
the disease. 

From the various considerations we have above detailed, drawn from the 
history of the past, we may conclude that health rests on a double tripod : — 

Light and Air. 
Food and Drink. Clothing and Housing. 

But neither will these suffice if the refuse which we do not want, and the waste 
of our bodies, which is as poison to us, be not destroyed or otherwise effectively 
removed. Successive epidemics of preventible and unpreventible disease have 
taught us this lesson, that if we are to preserve our bodies sound and safe we 
must secure the necessaries of life in due proportion and of proper purity ; if 
we are to prevent disease we must get rid of all human waste as speedily and 
as effectually as possible. 



AMERICAN DICTIONARY 



POPULAR MEDICINE. 



A. 

Abdomen is the name given to that large cavity situated in the lower part 
of the trunk, and bounded above by the chest, from which it is separated by a 
muscle called the diaphragm, and below by the pelvis: All around are various 
muscles and membranes, and most superficially of all the skin ; these various 
layers are called the abdominal walls. The cavity is lined by a smooth mem- 
brane, the peritoneum, which enables the different viscera to move freely upon 
one another. The contents consist, 1. Of those organs which are essential 
for the absorption of the food which is swallowed by the mouth ; namely, the 
stomach, intestinal canal, liver, and pancreas. 2. Of the kidneys needful for 
the removal of different materials from the blood which flow away in the urine. 
3. Of various blood-vessels which convey blood to and from a part, and of the 
spleen which seems to play a part in the proper formation of the blood. It is 
artificially divided into nine compartments, thus — ■ 



Eight Side. 

Hypochondriac. 

Lumbar. 

Inguinal. 



Centre. 

Epigastric. 
Umbilical. 
Hypogastric. 



Left Side. 

Hypochondriac. 

Lumbar. 

Inguinal. 



The liver occupies the right hypochondriac and the epigastric regions, and in 
some cases may be so enlarged as to reach into the lumbar and umbilical re- 
gions. The stomach is found chiefly in the epigastric region, but its extent 
varies with the amount of distension of the organ. The spleen lies in the left 
hypochondriac region. The kidneys lie one on either side of the spine, far 
back in the lumbar regions. The large and small intestines are coiled up in 
the remainder of the cavity and move freely upon each other. The food after 
entering the stomach passes down the small intestines and then down the large 
bowel into the rectum, whence it is evacuated. In the stomach the food is 
acted upon by the gastric juice, and all the albuminoid substances are dissolved 
and prepared for absorption. The liver and pancreas pour their secretions 
into the upper part of the small intestines, and mix with the food after it has 
passed the stomach ; they act upon the fatty or oily part of the food, and 
enable it to be afterwards readily absorbed. The whole of the intestinal canal 
is freely supplied with vessels which absorb the soluble parts of the food and 
supply the blood with new material, which is essential for the human economy. 
The walls consist partly of involuutary muscular fibres, arranged in a circular 



ABL 24 ABO 

and longitudinal manner round the bowel ; when these fibres contract, the 
food is propelled along the whole length of the intestines by degrees. The 
kidneys are the organs by which the urine is excreted from the body ; besides 
water there are various salts and organic matter which are constantly being 
removed from the blood, the retention of which may act injuriously. The 
abdomen varies much in size ; in fat people it may attain large dimensions 
from the accumulation of fat in the abdominal walls and around the viscera. 
The presence of flatus or gas may cause an increase in size. Tumors, such 
as ovarian, hepatic, and pregnancy, alter both its shape and size. Cysts, or 
cavities containing fluid, have a similar effect. The abdominal cavity is some- 
times Oiled with fluid, and then the patient is said to be suffering from ascites. 
In the ordinary process of breathing the diaphragm descends and increases 
the capacity of the chest ; when from any cause this is interfered with, short- 
in iss of breath is the result; so any tumors or accumulations of fluid, fat, or 
gas, tend to produce embarrassed breathing by preventing free action of the 
diaphragm. The abdominal muscles are used in the acts of micturition or de- 
fecation, and help to expel the contents of the bladder and rectum. Jn some 
women who have borne many children, the abdominal walls become flabby 
and weak, and numerous transverse lines over the lower part of the abdomen 
show the previous distension. 

Ablution, a washing away, internal or external. See Bathing. 

Abnormal, a term used by medical men to denote anything irregular, out 
of order, or not in accordance with health. 

Abortion means, speaking broadly, the premature expulsion of the foetus 
from the womb. The causes which lead to abortion may be grouped into 
causes affecting the life of the fcetus either directly or indirectly. The condi- 
tion of the mother has a powerful influence, certain states of constitution hav- 
ing a great tendency to cause expulsion of the immature fcetus. When this 
constitutional susceptibility exists, and especially when there has been a habit 
of aborting, very slight causes will bring it on, — such as drawing a tooth, 
running up and down stairs, severe coughing, or any violent emotion. Hence 
it is of the utmost importance to avoid any of these exciting causes. Some 
of these causes operate by separating the attachments of the foetus from 
the mother; but others, as scarlet fever, small-pox, typhus, etc.. which com- 
monly cause abortion, first of all kill the fcetus, and then lead to its expulsion. 
The death of the foetus is followed by the expulsion, but by no means always 
at the same period. Bleeding, too, into the womb, commonly leads to abor- 
tion. One of the most certain causes of abortion is syphilis, whether affecting 
the mother or child, but especially if both are under its influence. The signs 
which announce the onset of abortion are generally languor, uneasiness, and 
some pain in the back. After the pains begin they resemble those of ordinary 
labor, recurring at intervals until the fcetus is expelled. Sometimes there is 
much bleeding with abortion. This is technically known as flooding. The 
great thing to know in dealing with abortion is up to what period it can be 
stopped, and alter what period it is to be fostered. Roughly, it may be said 
that bleeding is the sign that expulsion has become inevitable ; if there are 
slight pains we may hope to arrest it ; but if the pains recur at regular inter- 
vals, and there be bleeding, we can hardly hope to avert the mischief. To 
stop or prevent an abortion, the first thing is absolute rest. The body should 
be lightly covered, and all excitement avoided. The patient should have cool- 
ing drinks, and cold should be applied to the abdomen. Thirty drops of lau- 
danum in cold water every two or three hours may be given to arrest the con- 



ABO 25 ABS 

tractions of the womb. Should these measures fail, the foetus must be allowed 
to come away, due precaution being taken against loss of blood. Plugging, as 
it is called, is the best precaution, but here the case passes into a stage where 
skilled attendance is requisite if obtainable. 

Abortion, Criminal. By this is meant unlawful attempts, successful or 
unsuccessful, to procure the premature expulsion of the foetus. Such attempts 
are by no means unfrequent, with a view to avoid shame and disgrace, or even 
to avoid inconvenience. In America the practice has risen to the position of 
an open trade. In England, however, this is not so. It should be distinctly 
understood that both in America and in England not only is the act a crime, 
but should death occur to the unfortunate woman the crime rises to murder 
in the eye of the law. Moreover, it is to be understood that abortion is at 
all times attended with risk to life, and that abortion unlawfully induced is 
more dangerous than that arising from natural causes. The plans commonly 
had recourse to for procuring the expulsion of the foetus are of two kinds. 
One is by giving medicines which act on the womb, either directly or indi- 
rectly ; these often give rise to inflammation of the interior of the abdomen, 
and so death. Another plan is to obtain the death of the foetus by means of 
instruments, and subsequently wait for its expulsion. This not unfrequently 
leads to the death of the mother before it does to that of the child. 

Abracadabra, the name of an Assyrian deity, supposed to have an influ- 
ence as a charm in disease. The word abracadabra was written on a piece of 
parchment in the form of a triangle, and then sewn up in a bag and tied round 
the neck or arm. 

Abrasion, a rubbing off of the epidermis of the skin, leading to the ex- 
posure of the true skin below. Treatment : -Remove all dirt or poisonous 
matter with lint and tepid water; then dress the wound witli lint dipped in 
tepid water, and cover with oiled-silk, or with a dressing of lint and cerate. 

Abscess. This term is commonly applied to a painful and inflamed swell- 
ing, which after a certain course, in most instances very rapid and acute, in 
others slow and indolent, terminates in the discharge of a yellowish creamy 
fluid called pus or matter. A gumboil, a whitlow, and the large and painful 
collection of pus frequently formed in the female breast during suckling, are 
all instances of abscess. There is no structure or organ in the economy which 
enjoys any immunity from the possible deposit of pus and formation of ab- 
scess. The symptoms by which we may know an acute inflammatory abscess 
are these: A very hot and painfui swelling covered by stretched skin of a 
bright red hue, most intense at the centre. As the swelling increases in size 
the pain becomes very severe, and has a characteristic throbbing or pulsating 
character. In the further course of the affection the skin and subjacent soft 
parts around the inflamed swelling become puffy, and retain for a short time 
the impression of the finger. As the centre of the abscess becomes more pain- 
ful and inflamed it loses its hardness, and gradually ripens or breaks down 
into pus. The skin at this part becomes thinner, more prominent, and loses 
its bright red color, presenting the well-known sign of pointing, a light yellow 
or bluish spot. The whole swelling is now soft, and by making gentle press- 
ure alternately with the fingers of each hand, a sensation may be generally 
felt of a small wave of fluid moved from side to side. The abscess finally 
bursts, and discharges the contained pus through one or more small apertures 
formed in the thinnest and most distended portion of skin. The discharge at 
first is profuse, and consists of a thick yellowish fluid ; as the cavity of the 
abscess contracts and closes, it becomes clear and thin. The progress of an 



ABS 26 ABS 

abscess towards ripening and the discharge of pus is usually accompanied by 
constitutional symptoms, proportional in severity to the size of the swelling 
and the amount of inflammation. These symptoms are : shivering, general 
uneasiness, feverishness, headache, and wandering pains in the back and joints. 
Acute abscess is generally the result of debility or a depraved state of the 
blood, and is often met with after fever and during suckling. In persons who 
have subsisted for some time on bad or insufficient food, any slight injury, as 
a bruise or cut. may result in inflammation and the formation of pus. Inflam- 
matory diseases of bones and glands in scrofulous subjects are frequent causes 
of abscess. In the second variety of abscess the symptoms are much less se- 
vere. The swelling increases in size very slowly, and with little pain or ten- 
derness. The skin remains for a long time free from inflammation or puffi- 
ness, until the pus has collected in such quantity as to cause its distension and 
attenuation. There is then a slight blush of redness, and the matter or pus is 
discharged through a small opening, as in the acute abscess. This variety is 
known by the name of chronic or cold abscess. In the early stage an attempt 
may he made to prevent the formation of pus by applying cold lotions and 
leeches, and keeping the affected part at perfect rest. If the patient, however, 
has had much shivering, and complains of throbbing pain about the swelling. 
one should at once carry out such measures as may further the ripening and 
pointing of the abscess. Nothing favors the rapid formation of healthy pus 
so much as nourishing and easily digestible food, as soups, beef-tea, eggs, etc. 
Stout and small quantities of wine, or some spirit, may be given without hesi- 
tation. The severe and throbbing pain of the abscess will be relieved by the 
frequently repeated application of hot poultices made of linseed meal, bread, 
or bran. Fresh pure air is essential for speedy recovery. When the abscess 
points, an incision may be made with a lancet for the purpose of letting out 
pus. The fluid should be allowed to flow away spontaneously, as forcing it 
out by pressure not onlv causes much pain, but increases the inflammation. 
After tlie abscess has been opened, or has burst spontaneously, the application 
of the poultices should still be continued for some days. When the discharge 
has become thin and scanty, the poultice may he replaced by water-dressing ; 
that is, by pieces of lint dipped in cold water and covered by some impermea- 
ble material, as oil-skin or gutta-percha tissue. 

Absinthe. A strong liqueur flavored with wormwood and much used in 
some parts, especially France. Used inordinately it gives rise to symptoms 
somewhat resembling those of chronic alcoholism (see Alcoholism), but dif- 
fering in certain minor respects. See Wormwood. 

Absorbents are medicines which soak up, or in any manner neutralize, 
acid or noxious matter in the stomach and bowels. See Antacids and 
Chalk. 

Absorbents are a set of minute vessels which are distributed over the 
whole body, and have the power of soaking up the food from the stomach and 
intestines, and also the effete materials in all parts of the body, and carrying 
them into the blood. 

Absorption is a physiological term applied to that process by which the 
chyle is taken np from the food in the intestines as well as the removal of the 
effete materials of the tissues of the body by the vessels called absorbents, or 
lymphatics. See LYMPHATICS, Chyle. 

Abstinence. This term is commonly applied to complete or partial dep- 
rivation of food by one's own voluntary act. It may be productive of good, 
or it may be productive of harm. A deficient supply of duly nutritious food 



ACA 27 ACC 

inevitably leads to disease ; no matter what is the reason for the deficiency. 
Voluntary abstinence from food enjoined by certain churches during certain 
periods often does great harm if injudiciously carried out. 

Acacia. The gum Acacia is procured from various species of the Acacia 
tribe growing in the desert parts of Africa, where it is sometimes used as food. 
In this country the gums commonly employed for domestic, commercial, and 
other purposes are called gum Acacia, but in reality are the product of many 
other trees ; cherry gum being largely used. In medicine, it is chiefly used to 
suspend heavy powders when given in liquid, and to allay cough. The gum, 
in solution, is sometimes given after a corrosive or irritant poison has been 
swallowed, to protect the coats of the stomach. 

Acarus, the insect met with in the common skin-disease called itch. See 
Itch. 

Accidents. If we consider for a moment the wonderful and delicate 
mechanism of the human frame, it seems almost incredible that it does not get 
out of order at our every movement, and that the ordinary efforts of locomo- 
tion are not attended with some derangement of the elaborate machinery which 
controls them. Of all the evils which flesh is heir to, there is nothing in which 
the benefit of present help in time of need is so welcome as in " an accident." 
We intend in this article to point out, in the various forms which an accident 
may take, "What to do." In the first place, if possible, Dispatch some one 
for the nearest professional man. The accidents which most commonly happen 
are bruises, sprains, burns, scalds, cuts, punctures; foreign bodies, such as 
splinters, fish-bones, needles, shot, etc., in the various structures of the body 
or in its several passages, such as the nose, ears, throat, eyes, etc. ; broken 
bones, bones put out of place, or dislocated, serious injuries to large blood-ves- 
sels, suffocation from drowning or hanging, suspended animation, poisoned 
wounds, bites from rabid animals or snakes. We shall, therefore, proceed to 
offer some ready methods of dealing with each of these. The following arti- 
cles should be in every home : Old linen, which may be formed into lint 
(charpie) by being scraped with a blunt knife on one side ; laths of various 
lengths; roller bandages, which may be made from old sheeting and torn about 
2 1 or 3 inches wide ; cotton wool ; a few broad tapes ; some old wide hand- 
kerchiefs or neck-ties ;' a pair of good scissors, and a pair of forceps or pliers ; 
adhesive or diachylon plaster. Old newspapers, rolled up, make excellent 
splints ; bandboxes, with the bottom knocked out, are capital makeshifts, if the 
bed clothing is required to be kept off a broken or wounded limb. The nap 
of an old hat plucked off and plugged into a cut is often of great service. A 
pocket-knife saw may be used for the manufacture of extempore splints, which 
should be well padded with cotton wool, old linen, handkerchiefs, tow, or any 
handy material, and applied comfortably, but firmly, on both sides of a broken 
bone, after it has been reduced, that is, its ends put in apposition. (See 
Splints.) Bandages and slings can be made out of old sheeting, towels, or 
handkerchiefs, and to facilitate application should be rolled up. (See Band- 
ages.) Hemorrhage, or bleeding (see Haemorrhage), is of two kinds, 
namely, arterial and venous ; in the former the blood is scarlet, and spirts out 
of the wound in jets ; in the latter it is dark purple, and oozes rather than 
gushes out. In the more trivial cuts, the edges of the wound merely require 
to be brought together with strips of adhesive plaster, not too close together ; 
if the bleeding be obstinate, a pad of lint should be firmly bound over the seat 
of the wound by a roller bandage. (N. B. Adhesive plaster should always 
be taken off when it gets black.) A piece of lint steeped in some styptic, as 



ACC 28 ACC 

perchlorkle of iron, is of great service in arresting bleeding. If a main artery 
be wounded, pressure should be made immediately with the thumb or fingers, 
between the wound and the heart. A tourniquet, as it is termed, may be ex- 
temporized by tying a knot in a handkerchief, and tying the handkerchief 
round the limb so that the knot presses immediately above the wound ; a piece 
of stick thrust between the handkerchief and the limb, and a twist or two given 
it, will arrest the haemorrhage effectually. If a large vein be wounded, a stout 
pad of lint, or linen, graduated, that is, somewhat conical in form, should be 
thrust into the wound, with the apex of the pad downwards, and retained 
by means of a well-applied roller-bandage. The great vessels most commonly 
wounded, because most exposed, are: the great artery of the thigh (femoral), 
the two small arteries at the wrist (radial and ulnar), and the great artery of 
the arm (brachial). The great vessels of the neck (carotid artery and jugu- 
lar vein) are sometimes cut in attempts at suicide or stabbing; such wounds 
are very difficult for any one but a surgeon to treat, and very rapid in the 
result, although great service may be done by immediate pressure with the 
thumb in the wound. (See Cut Throat.) Bruises. If ati injury be in- 
flicted on the skin by some instrument which does not break it, a bruise or 
contusion is the result. Bruises vary in degrees of severity, the most simple 
being a discoloration of the skin, accompanied by some amount of swelling 
and pain, the black or blue color being due to some of the small superficial 
blood-vessels, which are distributed to the skin, bursting by the blow, and the 
contained blood becoming effused. The discoloration, however, does not 
usually come on until some little time after the receipt of the injury. In the 
more severe forms, large vessels may be ruptured, and the blood escape into 
the surrounding textures, or the various structures of a limb may be entirely 
crushed, giving rise to conditions which will be more conveniently treated 
under other headings. (See Aneurism, Amputation.) Treatment: Ordi- 
nary bruises may be treated by the application of lint steeped in cold water and 
laid upon the part ; if more severe, by the use of some stimulating liniment, 
such as the common ammonia, or camphor liniment ; brandy, spirits of wine, 
vinegar, or a solution of alum or tannin, frequently do good. These remedies, 
with perfect rent of the injured part, due attention to the state of the bowels, 
and a moderate diet, will be found sufficient. Sprains. When through any 
sudden or violent wrench, a joint, or tendons, or the structures connecting the 
several [tarts of the body, become strained, pain, swelling, and ecchymosis 
(bruise) occur ; and if this happen to any of the larger joints, such as the 
knee or elbow, the result may be most serious ; especially if the individual to 
whom it occurs lias been intemperate in drink, and is of weak health. Treat- 
ment: Perfect rest, and the parts maintained at rest by splints and bandages 
(see Bandages), if necessary; warm fomentations, the bowels to be kept 
open, and the living moderate. Should the sprain be very severe, and if there 
be great heat, swelling, and throbbing, leeches should be applied to the affected 
part (Leeches), cold water douching, and some stimulating liniment, such as 
camphor or opodeldoc. Burns and Scalds. The great thing to be at- 
tended to iii these cases is, not to tear away the clothing from tin- burned or 
scalded surface, as by so doing the cuticle or scarf skin is stripped oil', and a 
large, raw, ulcerating surface is the result, and the process of healing greatly 
complicated. (See Burns and Scalds.) Bites or Stings. In the case 
of stings of bees or wasps, stimulants should be at once administered, such as 
brandy and water, or sal-volatile; and the seat of injury should be carefully 
searched for the sting, which is generally left in, whdst the wound should be 



ACE 29 ACO 

treated with sal-volatile, vinegar, or eau de Cologne. Supposing the throat be 
stung in drinking, there is of course great danger of suffocation, and leeches 
may be applied outside the throat, and a gargle of hot salt and water used im- 
mediately, and medical attendance sougbt at once. In snake bites, powerful 
stimulants, such as hot brandy and water, and ammonia, should be given 
freely : in the case of poisoned wounds of the fingers, etc., the cut or puncture 
should be immediately sucked, and bathed in warm water, and no hesitation 
whatever should be shown in this proceeding, as tbe danger of the poison lies 
in the fact of its being absorbed by the skin, and not in its being introduced 
into the system by the stomach. Encourage bleeding. Cauterizing the wound 
may be employed, by some such agent as nitric acid, caustic potash, carbolic 
acid, or even a red-hot iron. 

Acetic Acid may be prepared in various ways, but that commonly used is 
obtained from the distillation of wood in appropriate retorts, whence it is also 
called pyroligneous acid. It is used in medicine in two forms, the strong or 
glacial, and the dilute. The glacial acetic acid, so called from being normally 
solid or in the condition of ice, is chiefly used for external applications, the 
most frequent being the destruction of warts. The skin round the wart must 
be protected by a layer of grease or oil, and the acid applied to the body to 
be removed by a bit of stick or camel's hair pencil. 

Acholia signifies absence of bile, and this occurs in acute atrophy of the 
liver, and in some other diseases of that organ. See Jaundice. 

Acidity of the Stomach is a frequent symptom of indigestion, and 
arises from the food taken being converted by decomposition into an organic 
acid. The treatment consists in avoiding those articles of diet which produce 
acidity, as sugar, butter, and starch, and the taking medicines which will 
correct it. One of the best of these is bicarbonate of potash, which may 
be taken with some tonic, as tincture of orange peel, in doses of ten or fifteen 
grains three or four times a day. See Antacid, GtAsthodynia, Indigestion. 

Acne is a term given to the small raised spots so often met with in youth, 
on the face, neck, and shoulders. It is most common about the age of puberty, 
and is met with in both sexes. On the surface of the skin numerous little 
pits or pores open, which end in small pouches called sebaceous follicles ; 
when the channels get blocked up, the contents of these follicles increase, and 
a little pimple is produced, with a small black depressed centre, marking the 
seat of obstruction ; sometimes the spots are red from the vessels around 
becoming congested, and if there is much irritation, they may suppurate. The 
contents may be squeezed out by piessing the pimple between the fingers, or 
by using a watch key in a similar way. Treatment: Cold bathing every 
morning, active exercise, and a diet not containing too much animal food, or 
stimulants. Acne rosacea is the name applied to the prominent, ruddy, un- 
even nose of those who are accustomed to the excessive use of alcoholic 
liquors. A mixture of sulphur and alcohol rubbed together, so as to form a 
smooth paste, is an excellent application for acne ; it may be rubbed over the 
skin every night, and washed off in the morning. A popular remedy is to 
take every morning a teaspoonful of fresh yeast or barm in a glass of beer, 
and it certainly does seem to do good in some cases. When the spots occur on 
the chin or upper lip, and are very numerous, it is best not to shave, as much 
irritation may be caused by that process. It is a disease which may last a 
long time, as fresh spots often appear as the old ones are healing. 

Aconite. The common plant, Aconitum Napellus, or Monkshood, found 
in almost every garden, is one of the most deadly poisons known. Every 



ACO 30 ADD 

portion of the plant is poisonous, but the root especially so. Various accidents 
have occurred from its use, especially by confounding its roots, which last 
over winter, with horse-radish. It has once or twice been used for suicidal 
purposes; and once at least, by the notorious Prichard, for that of murder. In 
medicine, preparations both of the green part and of the root are employed ; 
the former furnishing an extract, the latter a weaker and a stronger tincture, 
the stronger intended for outward application only, and called a liniment. 
The tincture is the only preparation which should be used, and then with the 
greatest caution. When taken into the mouth, it causes a tingling sensation, 
followed by numbness. "When swallowed, a similar sensation is produced in 
the hands and feet, but its most important action is on the heart, the number of 
whose beats is reduced by it, and the force of the pulse considerably lessened. 
The number of respirations per minute is also diminished. Should the use of 
the drug be carried too far. great muscular weakness is the result ; extreme 
faintness is produced, and in fatal cases the poisoned individuals seem to die by 
stoppage of the heart's action. It is chiefly used for two purposes : as a 
means of relieving pain, that is, as an anodyne, and as a means of keeping 
down inflammation, that is, as an antiphlogistic. For relieving pain, the rem- 
edy may be applied locally, or given internally. It is chiefly used in neuralgia 
ami that special form of the same malady known as sciatica. When given in- 
ternally, the dose should not exceed five minims or measured drops of the 
tincture, repeated after an interval of four or five hours, and with great cau- 
tion. When used externally, the best plan is to rub the tincture, mixed with 
a little soap liniment to facilitate the process, into the painful spot by means 
of a piece of warm flannel or soft glove. Care must be taken to see that there 
is no crack or injur;/ of the surface, which would render its application in this 
manner most dangerous. It has also been used internally in acute rheuma- 
tism, in gout, and in certain forms of heart disease. 

Aconitin is the alkaloid, or active principle, of aconite. It is ordinarily 
obtained from the root of the Aconitum ferox, a native of India, and was for- 
merly much used as a poison there. Aconitin is one of the most powerful poi- 
sons known, and should not be handled save by competent persons. Its prop- 
erties are those of aconite in an exaggerated degree. 

Acrid, a term applied to any substance which produces irritation, more 
especially of the stomach. Thus, poisons that produce inflammation, pain, and 
heat in the stomach are called acrid. 

Actea is the root of Actcea race?nosa, or black snakeroot, a native of North 
America. It has been recommended in acute and chronic rheumatism, and 
bronchitic affections. 

Acupressure signifies a method of arresting haemorrhage from an artery, 
by passing a needle under it, and thus pressing it against adjacent structures, 
just, in fact, as the stalk of a flower is compressed against the coat when fast- 
ened in with a pin. It is preferred in many instances by surgeons to the lig- 
ature. See Arteries. Woinds of. 

Acupuncture is a method of lessening pain, such as neuralgia, by thrust- 
ing needles, some two or three inches long, into the painful part. It is a very 
favorite proceeding with the Chinese. 

Acute Hydrocephalus, a form of inflammation of the membranes of 
the brain, or meningitis, common between two and five years of age, but oc- 
curring occasionally in the adult, and nearly always proving fatal. See AIen- 
INGITIS. 

Adder's Bite. See Accidents. 



ADD 31 AFF 

Adder's Tongue is the name given to a common British fern, known to 
botanists as Ophioglossxm vulgatum. It was formerly used as an ointment for 
snake bites and other wounds. 

Addison's Disease is the name given to a somewhat obscure malady first 
described by Dr. Thomas Addison, of Guy's Hospital. It is almost invariably 
associated with disease of the suprarenal capsules. Moreover, the disease is 
almost invariably of the kind called tubercular, and is frequently associated 
with similar disease elsewhere. The most marked feature of the disease is a 
gradual bronzing of the skin, which goes on until the patient is of the deepest 
mulatto tint, or even quite black in some parts of the body. The patient com- 
plains first of all of great debility and feebleness, his appetite becomes im- 
paired, his stomach becomes irritable, and he vomits his food from time to 
time. Such patients commonly adopt standing postures showing debility, the 
head and shoulders hanging forward, and they have a peculiar listless expres- 
sion. The disease is almost always fatal, lasting on an average eighteen 
months. As things now go, and until we get a more perfect knowledge of the 
malady, we can only try, by giving good food and strengthening remedies, to 
improve the general health. This tendency to a fatal termination, however, 
renders it of the greatest importance that we should bear in mind that there 
are other circumstances which produce skin-bronzing, especially in females. 
During pregnancy the skin of females becomes very much darker than usual, 
especially on the breast and abdomen, and even in some an increased darkness 
of complexion is noticeable during menstruation. This form of bronzing 
passes away with its cause. 

Adhesion. This term is used to express the union or ready healing of 
the divided portions of soft structures after wounds and ruptures. It gener- 
ally results from the pouring out into the wound of a clear tenacious fluid 
called coagulable lymph, which becomes organized and subsequently converted 
into scar structure. The process of union between divided soft parts by 
means of the early formation of a scar from this coagulable lymph is called 
healing by primary adhesion. When the edges of an old and gaping wound, 
the surface of which is raw and discharges pus, can be brought together so as 
to unite, the process of adhesion in this instance is called healing by secondary 
adhesion. This variety of healing is sometimes observed in neglected wounds, 
extending through the thickness of the lips, and in the union, of two or more 
fingers after bad burns. 

Adipose, a medical term for the fatty tissue which is more or less prevalent 
throughout the body ; when it occurs in isolated nodules under the skin, fatty 
tumors are said to have formed. When there is a large accumulation of adi- 
pose tissue beneath the skin all over the body, the individual becomes stout and 
unwieldy. This condition seems natural to some people, but in others it is 
induced by excessive drinking and sedentary work. See Bantingism, and 
Height and Weight. 

Aeration is the term applied to the process by which the air taken in dur- 
ing breathing is absorbed by the blood in the lungs. See Respiration. 

.^Ethiop's Mineral. The popular name of the sulphide of mercury. See 
Mercury. 

Affusion, to which the term cold is commonly prefixed, is a mode of treat- 
ment sometimes had recourse to in narcotic poisoning. It is also employed 
in reducing bodily heat, if that be too high. The patient is seated or placed 
in an empty bath, and four or five buckets of cold water are poured over his 
head and chest from a height of two feet or more. The colder the water and 



AFT 82 AIR 

the greater the height, the greater the effect of the remedy. After this the 

patient is carefully dried and placed in bed. 

, After-birth. ' See Labor. - 

After-pains is the term applied to those pains which follow on the expul- 
sion of the child and its appendages in a labor otherwise quite natural. They 
are more common in women who have previously borne children. They begin 
shortly after delivery, and may continue, if unchecked, for four-and-twenty 
hours. They are commonly due to efforts on the part of the uterus to get rid 
of clotted blood which may have collected in its interior. They may also be 
due to distension of the bladder or bowel. Treatment : Remove all causes 
and give a sedative, such as a small dose of opium, or apply warmth to the 
abdomen. . 

Agrimony is a wild British plant belonging to the rose tribe, and having 
bitter astringent properties. It has no poisonous properties. 

Ague, a disease characterized by paroxysms of fever occurring at intervals, 
brought on by a malarious poison. Each attack has a cold, a hot, and a sweat- 
ing stage, and is followed by a period of complete cessation of fever. Rarely 
occurring in cold countries, it is common in temperate climates, and still more 
so in the tropics. See Intermittent Fever. 

Air. The air is a gaseous envelope which surrounds the earth, and which 
is commonlv called the atmosphere. It is composed of nearly four parts of 
nitrogen and one part of oxygen ; the oxygen is the most important constit- 
uent, as it is essential to the support of animal and vegetable life, and hence 
was called by the older chemists vital air ; the nitrogen serves chiefly to dilute 
the oxygen. The presence of oxygen may be known by burning a caudle in 
the air, when the carbon and hjclrogen of which the candle is composed will 
combine with the oxygen of the air and form carbonic acid and water respect- 
ively. It is owing to this property of supporting combustion that this gas is 
so needful for those chemical actions which are constantly going on in all those 
substances which are living bodies. The nitrogen may be obtained by ab- 
stracting the oxygen from common air. Let a glass bell jar be inverted over 
a dish containing water in which are floating a few pieces of phosphorus. If 
the phosphorus be ignited by a hot wire, it will combine with the oxygen of 
the air and form phosphoric' acid, which readily dissolves in the water, and ni- 
trogen will be left in a nearly pure state. It may be known by not supporting 
combustion, for when a lighted taper is held in the gas it becomes instantly 
extinguished. A small animal placed under the jar would soon die, because 
deprived of oxygen. The atmosphere is a mere mechanical mixture of these 
two gases. The air is kept of an uniform density in consequence of a princi- 
ple known to chemists as the diffusion of gases, by virtue of which there is a 
thorough intermixture of the two elements. This is due to the absence of 
cohesion among the particles of which gases and vapors consist. However 
much gases may differ from each other in density, they will soon mix thor- 
oughly if free communication is allowed between them. Oxygen has a specific 
gravity of 1.1056, and nitrogen of .'J72, air being taken as the unit ; but by 
means of diffusion the heavier gas is uniformly distributed through the air. 
Chemical actions too on the face of the earth are constantly taking place, and 
oxygen is being removed from, while carbonic acid and other gases are added 
to, the atmosphere ; these do not sink to the lower level of the air, although 
heavier than either oxygen or nitrogen, but rapidly mix and become equally 
diffused. And this is* a very important process, as without it life could not 
well be maintained in the vicinity of manufactories or in large towns owing to 



AIR 33 AIR 

the rapid accumulation of impurities. Carbonic acid and water are the most 
common impurities in common air. Carbonic acid may be recognized by plac- 
ing some lime-water in a saucer in a room where several people have been 
sitting ; a pellicle will soon form over the surface, owing to the carbonic acid 
having combined with the lime and formed chalk. It is very prejudicial to 
life, and therefore close rooms should be avoided and a proper supply of pure 
air should be constantly passing through the room. The amount of water 
varies with the state of the atmosphere. If a glass of cold water be brought 
into a warm room the outside soon becomes bedewed with moisture, owing to 
the cold glass condensing the aqueous vapor of the air into visible drops. The 
dew on the grass in the early morning is a common example of the presence 
of moisture ; when the sun rises the earth becomes warmer and the dew es- 
capes into the air as invisible vapor. Evaporation from rivers, lakes, and seas 
is the source of the moisture. Ammonia exists in small quantities, about one 
part in a million of air ; it is mainly from this source that vegetables obtain 
the nitrogen which they require to form their seeds and fruit, for they do not 
seem able to assimilate the free nitrogen of the atmosphere. Ozone is present 
in fresh air, but not in the close air of towns, as it is decomposed by the or- 
ganic matter. It is supposed to be formed by the discharge of electricity, and 
to be an active kind of oxygen. In large towns carburetted hydrogen, sul- 
phuretted hydrogen, and sulphurous acid may exist in minute traces. Many 
substances which occur in small quantities, such as dust or the minutely divided 
particles of inorganic bodies, may be looked upon as accidental impurities. 
More important than these are volatile organic impurities, which probably in a 
great measure influence the healthiness of a locality. The low fevers and agues 
met with in marshy districts are caused by the presence of some organic im- 
purity. Any one who passes from the fresh air into a crowded room becomes 
aware of the, existence of organic impurities. Many fevers are conveyed by 
means of the air from one locality to another ; in this way scarlet fever or 
measles may spread ; this, too, will account for the rapid extension of cholera 
from one country to another. Air may be inodorous and yet not healthy, as 
particles emanating from a fever patient may be floating in it; it may be odor- 
ous and yet healthy, as in the vicinity of gas-works, tan-yards, and tallow- 
melting ; these smells, though disagreeable, are not injurious to most people. 
In some localities, as in the vicinity of copper or iron works, the air becomes 
loaded with the impure gases emanating from the furnaces ; in some parts 
this is so injurious, as to prevent trees or plants growing for some miles 
round. The average composition of air may be thus represented in 100 
parts : — 

Oxygen 20.60 

Nitrogen 77.95 

Carbonic acid 04 

Water 1.40 

Ammonia ) 

Inorganic impurities > . . ; traces. 

Organic imparities ) 

Since air is essential for the continuance of life, it is most important to breathe 
it as pure as possible. In badly ventilated rooms, carbonic acid is apt to 
accumulate and produce a feeling of drowsiness and languor with headache. 
When this gas accumulates to more than four parts in ten thousand of air, it is 
injurious to health. Organic bodies in a state of putrescence should be de- 
stroyed or buried, so as to prevent any noxious particles spreading into the 
atmosphere. Excreta should be removed, and the cause of any bad smells 
3 



AIR 34 ALB 

arising from water-closets or cesspools should at once be seen to. See Fe- 
vers. Ventilation. 

Air-passages. The air-passages form the channel by which the air can 
enter the lungs ; different names have been given to each part of the tube. At 
the back part of the mouth, and just in front of the oesophagus, or gullet, is 
a chamber called the larynx, which communicates above with the mouth and 
nose, and can be closed by a valvular lid called the epiglottis; below, it is 
continuous with the windpipe, a capacious, circular tube, lying in front of the 
neck ; at the level of the top of the sternum, or breast-bone, this tube divides 
into two branches, called bronchi, one of which goes to either lung; these, on 
arriving at the lungs, break up into a number of branches, and at last end in 
dilated extremities with very Hue walls, which are called the air-cells. In the 
ordinary state, the epiglottis is open, and air can go in and out the larynx with 
ease; but when the act of swallowing takes place, the epiglottis falls over the 
upper opening of the larynx, and prevents any food going that way. Any- 
thing which prevents the entrance of the air into the lungs by obstructing the 
air-passages will cau>e great distress in proportion to the amount of the ob- 
struction, and, if very great, will cause death by apncca. 

Albino is a name given to an individual whose hair, skin, eyes, etc., are 
deprived of all coloring matter. They are generally short-sighted, and the 
pupils of the eye have a pink color; the hair is thin and of a silvery-white 
color. See Maculje. 

Album Graecum is the white and solid excrement of dogs which have, 
fed on bones. It consists principally of phosphate of lime, and was formerly 
used in medicine. See Phosphorus. 

Albumen is a chemical compound found in the tissues of both plants and 
animals. The best example of it in the animal kingdom is the white of the 
egg. It is also found in all animal blood and nerves and brain. It is found 
in the juices of many kinds of vegetable food, as in cabbages, asparagus, and 
potatoes. It is in all these instances in solution in water. It is easily discov- 
ered by the facility with which it coagulates by heat. It belongs to that class 
of alimentary substances which are called proteinaceous, nitrogenous, or flesh- 
forming. As a part of our food it supplies' the waste of the nerves and mus- 
cles of the body. It sometimes appears in the urine and constitutes the disease 
called albuminuria. (See Albuminuria, Bright's Diseask.) It is easily 
detected in the urine by heating a small quantity of the urine in a test-tube 
over a spirit lamp, when it speedily coagulates. It is also speedily coagulated 
from its solution, by the agency of nitric and other mineral acids. It contains 
a certain quantity of sulphur, and when decomposing yields the disagreeable 
gas known as sulphuretted hydrogen. 

Albuminuria, or the presence of albumen in the urine, is a symptom met 
with in many cases of disease of the urinary organs. It is known by boiling 
the urine in a glass tube over a spirit lamp, when a white, flocculent precipitate 
is thrown down, which is not dissolved on adding nitric acid. In all cases of 
Bright's Disease this substance is present in greater or less quantity in the 
urine; in many eases of heart disease, when associated with dropsy of other 
parts; in many febrile disorders, as typhus and typhoid fevers, diphtheria, 
etc.; in all cases where blood is also present in the urine (see Hematuria), 
and whenever there is pus in the urine, as when a stone is present in the blad- 
der, or when there is inflammation of the lining membrane of that organ. The 
treatment adopted must have; reference to the particular disease which is the 
cause of the albuminuria. See Bright's Disease. 



ALC 



35 



ALC 



Alcohol. The active principle of wines, spirits, beers, and other fer- 
mented beverages. It is formed during the process of fermentation from fruit 
sugar, which loses carbonic acid gas, and is converted into alcohol. This sub- 
stance has a special power of acting upon the nervous system, producing first 
a pleasant stimulation, then great excitement, and finally a state in which the 
person who takes it is more or less unconscious. 

QUANTITY OF WATER, ALCOHOL, SUGAR, AND ACID CONTAINED IN ONE PINT OF VARIOUS 
FERMENTED BEVERAGES. 



Name of Beverage. 



London Stout 
London Porter 
Pale Ale . . 
Mild Ale . . 
Strong Ale . 
Cider . . . 
Port . . . 
Brown Sherry 
Pale Sherry . 
Claret . . . 
Burgundy 
Hock . . . 
Moselle . . 
Champagne . 
Madeira . . 
Brandy . . 
Rum . . . 
Gin (best) . 
Gin (retail) . 
Whisky . . 



Oz. 

18* 

19 i 

17£ 

18| 

18 

19 

16 

15* 

16 

18 

17* 

17| 

17 
16 

9* 

5 
12 
16 
10* 



2* 

l| 
3 

4 
10* 
15 

8 

4 

9* 



Sugar. 



Oz. Grs. 


Grains. 


281 


54 


267 


45 


240 


40 


280 


38 


2 136 


54 


.. 100 


150 


1 2 


80 


360 


90 


80 


170 





161 





160 





127 





140 


1 133 


90 


400 


100 


80 


100 





100 





100 


* o 


100 





100 



This state is called drunkenness. Habitually taken in small quantities it 
produces great disturbance of the nervous system (Alcoholism). If taken 
in large quantities it causes complete derangement of the brain and nervous 
system, which often terminates fatally, and always leaves it more or less per- 
manently deranged. (See Delirium Tremens.) By the constant abuse of 
alcoholic drinks, the mucous membrane of the stomach becomes inflamed, and 
indigestion is produced. The liver is subject to a peculiar disease from its 
action. (See Cirrhosis.) The blood is deranged, and the nourishment of the 
various organs is interfered with. A series of changes takes place in the heart, 
the liver, and the kidneys, which are known by the name of Fatty Degeneration 
(Degeneration, Fatty). Children and young healthy adults have perfect 
health without taking it at all. Where small quantities are required it may 
be stated that from one to two ounces of" pure alcohol is all that can be safely 
taken from clay to day. The table given above shows the quantities of alcohol 
contained in various common forms of beverages. In some forms of disease 
alcohol is the only substance acting as a nutrient that can be absorbed into the 
blood, and in these cases it acts as a stimulant to the heart and brain, and also 
supplies aliment to the body. In the low forms of fevers and other exhaustive 
diseases of the body it is the sheet-anchor of the physician. Alcohol is used in 
medicine chiefly for dissolving out the active ingredients of various remedies. 
Its properties are, as is well known, stimulant; as such it is used in the form 
of wine and spirits. 

\ 



ALC 86 ALO 

Alcoholism. Long-continued abuse of intoxicating liquors leads to a 
serious change in the blood, and then of the various tissues of the body. The 
liver may become fatty or cirrhosed, the heart weak and flabby ; the kidneys 
are liable to waste, the lungs to become emphysematous, and the patient short 
of breath. The brain also shares in the general mischief, and many of the 
nerve-cells waste through being badly nourished ; the mind in consequence be- 
comes affected ; there is loss of memory, giddiness at times, disagreeable dreams, 
and restlessness at night, and the patient wakes up in the morning with no 
appetite for breakfast, and a feeling of sickness. His nervous system, too, is 
weakened ; any excitement or trouble affects him ; in advanced cases the tongue 
and hand tremble, and he weeps easily. If the heart be affected, he may be 
troubled with fainting, which at length may prove fatal. Sooner or later 
the health is impaired, and any acute illness will quickly carry the victim off; 
such a course of life induces premature old age. Very little can be done for 
the habitual drunkard; a sedative may be given at bed-time to enable him to 
sleep better, and for the dyspepsia or indigestion which accompanies this dis- 
ease some bitter tonic, as gentian or quassia, may be given with nitric or hydro- 
chloric acid two or three times a day. 

Ale. See Leer. 

Aliment. See Food, Diet. 

Alkalies are the oxides of certain metals and their salts. The oxide of 
potassium (potash), the oxide of sodium (soda), and lithia are the alkalies ; 
the oxide of calcium (lime) ; the oxide of magnesium (magnesia), are alkaline 
earths. Ammonia, which is not the base of a metal, acts as the alkalies, and 
is called the volatile alkali. . See Potash, Soda, Ammoxia, Lime, Magnesia, 
Lithia. 

Alkaloid, a term applied to those vegetable principles which act chemically 
like alkalies, such as quinine, morphine, strychnine, etc. 

Allopathy is a term applied to the practice of medicine as carried on by 
the great mass of medical practitioners. It is opposed to the term Homoeopa- 
thy, in which diseases are supposed to be cured by remedies which produce the 
same effect on the system as the disease ; hence the axiom, Similia simillbus 
curantur. On the other hand, allopathy is supposed to cure by remedies which 
produce effects different from those the}' are given to cure ; and a contrary 
axiom is assumed, Oontraria contrariis curantur. 

Allspice is the fruit of a tree belonging to the same family as the clove. 
It contains an agreeable volatile oil, which is used for giving flavor to bread- 
sauce and other articles of food. See Pimento. 

Almonds are the seeds of a species of Amygdalus, and are of two kinds, 
sweet and bitter. The sweet almonds are brought to table, and in countries 
where they grow form an important article of diet. They contain starch, oil, 
and albumen. The oil is often expressed and used as salad oil. The bitter almond 
contains, in addition to the fixed oil, a peculiar oil known by the name of oil of 
bitter almonds. The almond itself and this volatile oil are used in cookery for 
the purpose of giving flavor to custards, cakes, puddings, etc. It is also used 
in perfumery. The smell of the oil is imitated by an artificial compound, nitro- 
benzol, obtained from coal tar, and it is often sold in the shops for oil of bitter 
almonds. In the -hops two kinds of oil of hitter almonds are sold, the pure and 
impure. The impure contains hydrocyanic acid, and is very poisonous, whilst 
the pure contains no poisonous principle. The taking impure oil of bitter 
almonds by mistake or design is a frequent cause of death. 

Aloes is the thickened juice of various species of plants, called aloes, growing 



ALO 37 AMA 

in many parts of the world. That used in medicine is chiefly brought from 
Africa and the West Indies. Its most prominent properties are purgative. 
Dose, two or three grains. It seems to act as a tonic as well as a purgative. 
In larger doses it is said to produce piles, and should not be employed where 
these exist, neither should large doses be given during pregnancy. 

Alopaecia, a synonym for baldness. See Baldness. 

Alteratives is a term applied to medicines which are supposed to alter the 
condition of the blood and tissues without exciting any sensible action of the 
excretory organs. Thus, small doses of the mercurial preparations are regarded 
as alteratives. 

Alum is a compound crystalline body having as its essentials alumina and 
sulphuric acid with potass or ammonia. It is an astringent substance, and is 
used to lessen discharges of many kinds, and as a gargle in sore throat. When 
heated, it melts and becomes powdery ; this, which is called burnt alum, is often 
used for ulcers when they become flabby. Two or three grains along with an 
ounce of decoction of oak bark constitute a safe local application for ordinary 
discharges. 

Amalgam. A compound of the metal mercury (quicksilver) with any other 
metal. 

Amaurosis. This word is used to express imperfect vision or total blind- 
ness due to some unhealthy changes in the back of the eye, in the optic nerve 
or nerve of sight, or in the brain. It also includes various nervous affections 
of the eye in which there is no apparent change of structure to account for the 
failure of vision. The chief causes of amaurosis are the following : Diseases 
of the brain, as apoplexy, inflammation, tumors, abscess ; affections of the nerve 
of sight ; tumors growing within the eye-socket, and disease of the soft parts 
surrounding the eye-ball ; inflammation of the retina and choroid, two mem- 
branes of the eye ; certain changes in these membranes associated with Bright's 
disease of the kidneys, with syphilis and with diabetes. Amaurosis occasionally 
results from debility, and during convalescence from fever, diarrhoea, and profuse 
haemorrhage, and may occur in pregnant and hysterical women, and in children 
affected with intestinal worms. The most common and important cause of 
impaired vision, however, is debility and congestion of the interior of the eyes, 
due to the prolonged use of these organs under certain conditions. When minute 
objects are closely watched for a long time under a bright light, and especially 
when one eye only is used, as in microscopical examinations, injury of the retina 
or visual membrane is likely to result. Long-continued exercise of the eyes in 
very hot and badly- ventilated rooms with glaring lights is another frequent 
cause of amaurosis. Stokers, watchmakers, draughtsmen, compositors, and 
needlewomen are peculiarly exposed by their occupations to amaurosis. The 
sudden exposure to bright light of a person who has previously remained for a 
long time in dusk or total darkness may give rise to impairment of vision. 
There are many different forms of amaurosis. It may affect one or both eyes. 
In some cases it consists in total blindness, in others in slight weakness of vision. 
It may be permanent, temporary, or intermittent. Sometimes it comes on 
suddenly, but in most instances slowly, and at first almost imperceptibly. It 
may be attended with severe local and general symptoms, as intense pain in 
the eyeball, headache, vomiting, giddiness, convulsions, and palsy ; or, on the 
other hand, cause no uneasiness to the patient except what arises from the 
failure of a most important sense. The following are the chief symptoms of 
the affection, especially of the slow form, that results from long-continued abuse 
of vision : Difficulty in reading print or writing, the letters being doubled, or 



AMB 38 AMB 

halved, or distorted, obscured, or discolored ; the appearance of small black 
specks, like particles of soot, floating before the eye ; the appearance of larger 
fixed specks ; a dense mist before the eye, varying in color at different times ; 
flashes of bright yellow or blue light appearing when the eyelids are closed ; 
distortion of objects, especially of flame ; an iridescent and rainbow like halo 
around flame and strongly illuminated objects; pain and a sense of fullness in the 
eye-ball : with these symptoms is associated a gradual failure of vision, until 
the power of appreciating the shape and color of external objects is quite lost. 
In the treatment of amaurosis one must seek for the probable cause of the disease. 
In debilitated subjects much good may be done by strengthening the system. 
Quinine and steel drops may be taken with advantage, but more beneficial than 
any medicinal agent will be found good living, fresh air. and a change of scene 
and occupation. The bowels should be freely relieved and kept open by blue 
pills, Epsom salts, or a frequently-repeated black draught. "Wine and beer 
ought to be taken. A bright light must be avoided, and the patient, when 
taking exercise in the open air, should wear spectacles with glasses of a light 
blue tint. This treatment is applicable only to amaurosis brought about by 
such avoidable circumstances as want of fresh air and good diet, and an incau- 
tious use of the eyes. In other forms of the affection, a proper use of remedial 
means is to be based upon a recognition of its true cause. 

Amber is a hard, semi-transparent substance of a yellow color. It has the 
character of a resin, and is supposed to be of vegetable origin. An oil is ob- 
tained from it called Oleum svccini, which is extensively used as an embroca- 
tion in rheumatism and whooping-cough. 

Amblyopia. See Double Vision. 

Ambulance. The term ambulance has a different signification amongst 
American and foreign writers. In Europe it means a field hospital attached 
to an army and moving with it, for the primary reception and care of its sick 
and wounded. In America the term is often applied to the conveyance by 
which the sick and wounded are carried to or from the field of battle. Ambu- 
lance conveyances are constructed for carrying patients, either lying at full 
length or sitting. The recumbent position is undoubtedly the best in the case 
of severe wounds, and in cases of shock or faintness from luemorrhage, as it is 
the position in which the several parts of the body are subjected to the least 
amount of concussion. The sitting posture is, as a general rule, only adapted 
for those whose injuries are of a comparatively slight nature. The semi- 
recumbent position is very desirable in wounds of the chest, owing to the feel- 
ing of oppression in breathing, preventing the recumbent position and the 
jolting of the sitting. If no conveyance be at hand, the assistance of bearers 
must be resorted to, and it will be convenient to mention some method of 
affording help when only one attendant or bearer is at hand. If the wound 
be in the head, neck, or upper part of the trunk, the patient should partly sup- 
port himself, with a stick in one hand (or musket), while his other hand and 
arm lean upon the upper part of the back and distant shoulder of the attendant 
who walks by his side. At the same time the attendant should place his near 
arm across the neck of the wounded man, reaching round and partly encircling 
his body with the forearm and hand, so as to support the trunk. If more than 
one attendant is available, a regular litter is at hand. The first method they 
may adopt is that of carrying the patient by the two bearers joining hands 
beneath the thighs, while their arms which are not thus occupied are passed 
round bis loins. A second and better method of joining two hands for the 
semi-recumbent support of a patient is as follows : The advanced right and 



AME 39 AMM 

left hands of the two bearers are closely locked together, and the wrists brought 
into contact; at the same time, their other hands are made to rest upon, and, 
in a Certain degree, grasp each other's shoulders on the same sides respect- 
ively. One of the best methods is that of a four-handed seat with crossed 
arms, known commonly as the " sedan chair." The sick transport convey- 
ances are: (1) conveyances borne by men, such as hammocks, stretchers, 
dhoolies, swinging litters ; (2) conveyances wheeled by men ; (3) conveyances 
borne by animals ; (4) wheeled conveyances borne by animals, such as carts 
and wagons ; (5) conveyances moved by steam on railways. 

Amenorrhcea means an absence of the usual flow which generally occurs 
at regular periods in women from the time of puberty until middle life. Men- 
struation usually begins between the age of fourteen and sixteen ; in some 
cases it is very much later, in a few it never appears at all, and in many the 
"periods " are very irregular. Amenorrhcea may result either from retention 
or suppression of the flow of blood ; in the first case, it depends upon some 
malformation of the organs of generation, and a simple surgical operation is 
necessary for its cure. Suppression of the flow is far more common; it occurs 
naturally during pregnancy ; it is often brought about by exposure to cold, by 
sitting on the damp grass, or by getting wet feet ; it ensues in the course 
of many exhausting diseases, as consumption, kidney disease, cancer, etc. ; it 
is met with for a time after the patient has passed through a severe illness, 
as typhus or typhoid fever ; and finally, it may result from disease of the 
uterus and ovaries. In many cases of anaemia, amenorrhcea is generally 
found to exist. Patients suffering from this complaint are usually extremely 
pale ; the lips and inside of the eyelids lose their usual color ; the patient 
is very liable to headache, palpitation of the heart, faintness, and lassitude. 
Treatment: When due to pregnancy, of course nothing need be done; in 
other cases, tonics, especially those which contain iron, moderate exercise in 
the open air, a generous and wholesome diet, avoidance of late hours and 
close rooms, early rising and fresh, bracing air, with cold bathing, will do 
much good ; but some of these remedies cannot be adopted when the patient is 
suffering from other diseases which really are the cause of the amenorrhcea. 
The bowels should be kept open by aperients, and a warm bath should be 
given at bed-time, just before the time when the " period " should recur. 
These remedies are most valuable when the amenorrhcea is dependent upon 
anasmia, on overwork, exposure to cold, etc. ; but in cases of consumption, 
cancer, uterine, ovarian, and kidney diseases, etc., there is no occasion to treat 
the amenorrhcea, but attention must be directed to the more important malady. 

Ammonia is used, both by itself and combined with other chemical agents, 
for a variety of purposes. It is nowadays got from gas-house refuse, but 
used to be obtained by burning hartshorn, whence it got the same name, 
l'ure ammonia, or, as it is called by chemists, caustic ammonia, is rarely .used. 
When ammonia is given internally for its stimulant virtues, its carbonate is 
used — sal-volatile, or smelling salts. It is used as aromatic spirit of ammo- 
nia in doses of from a few drops on sugar to a teaspoonful or more (m. v. to 3j.) 
to relieve flatulence, to remove the feeling of sinking, and to get rid of acidity 
and heart-burn. It is also useful in some forms of headache, and in the 
chronic bronchitis of old people, when their winter cough is complicated with 
copious tenacious expectoration. Liquid ammonia has been of late used with 
much success as a remedy for snake bite. It has been given internally in 
considerable quantity along with brandy or whisky. In Australia it has been 
repeatedly injected into veins for snake bite, and the treatment has proved 



AMM 40 AN^E 

there quite successful, but has failed in India. The old remedy, hartshorn and 
oil {freshly prepared), will be found very useful for the stings of bees and 
wasps, the bites of mosquitoes, gnats, and such like. 

Ammonia (Acetate of). This substance has been a good deal used in 
practice as liquor of acetate of ammonia, commonly called Mindererus' Spirit. 
Its dose is from two to six teaspoonfuls (3ij. to 3yj.), and it has commonly 
been given to relieve feverishness, as in ordinary fevers, colds, etc. It is sup- 
posed to cool the skin by promoting perspiration, whence it is called a diapho- 
retic. It may be given along with sweet spirits of nitre, and a few drops, 
(two or three) of antimonial wine, when the skin is hot and dry, and the pulse 
quick. 

Ammonia (Hyduochlorate of), also known as Chloride of Ammonium, 
more commoidy as Sal Ammoniac, is used in certain forms of headache. It 
often succeeds when everything else has failed. Five to twenty grains should 
be taken for a dose. It is also useful in certain female complaints, especially 
when the periods have been irregular or have prematurely ceased. 

Ammoniacum is what is called a gum resin ; that is to say, it is both 
gummy and resinous in character. It comes from the northeast of India. It 
is of most use in the chronic bronchitis of old age, and is given in doses of 
from five to twenty grains. 

Amnesia, or loss of memory, is met with in some cases of apoplexy. It 
varies in amount. At times, the patient will lose all memory of recent events, 
while there is a clear recollection of the past ; at other times, the converse 
may exist, while generally there is more or less forgetfulness of everything. 

Amyloid Degeneration. See Degeneration. 

Anaemia is a condition in which there is an impoverished state of the 
blood, and where the patient is very pale and in a state of general debility. 
Anaemia may exist alone or in conjunction with other exhausting diseases, as 
consumption or cancer. In the first variety the patients are generally young 
women employed in close workshops and confined places from morning to 
night; or women who have lived badly, and having had several children, are 
suffering from over-lactation. In such people the whole surface of the skin is 
paler than usual, and the lips and lining membrane of the eyelids, instead of 
being rosy, are of a pale pink color. There is also a feeling of general debil- 
ity and an inability for much exertion. Palpitation of the heart, headache, 
pain in the back and in the left side are commonly met with. This disease arises 
chiefly from want of pure air and light, and from living badly. The treat- 
ment consists of moderate exercise every day in the fresh air, and working or 
living in well-lighted and well-ventilated rooms. The diet should be light and 
nourishing; a moderate amount of animal food should be taken, but anything 
which causes indigestion should be avoided. Stimulants should not be resorted 
to, but a glass of beer with a meal may be beneficial. A cold bath in the 
morning is often of great service, and for those who can afford it a change to 
the seaside, or some place where the air is bracing and refreshing, may be very 
useful. Tonic medicines are of great value, especially those which contain 
iron. When women are at the same time suffering from over-lactation, it may 
be advisable to wean the child. Hot and crowded rooms should be avoided, 
and late hours are injurious. When anosmia arises as a symptom of other dis- 
eases, as consumption or cancer, or is associated with any complaint of long 
standing, remedies are not of so much use. Anaemia is often associated with 
a temporary cessation of the menstrual function, but this is usually restored 
with the improvement of the general health. The habits of town life predis- 



ANiE 41 ANC 

pose to this disease in a great measure, and in all cases country air is most 
beneficial. In young girls tight lacing is often most injurious, as it prevents 
due expansion of the chest and the free entrance of air into the lungs, a 
process which is most important for the various changes which are constantly 
going on in the blood. Persons who are anaemic are very often nervous and 
hysterical, and all sources of mental worry or anxiety should be avoided as far 
as possible. 

Anaesthetics are remedial agents which take away the sensibility from a 
part or the whole of the system. Those substances which, when externally 
applied to any particular organ, take away its power of sensation are called 
local anaesthetics, whilst those which are taken internally and act through the 
blood are called general anaesthetics. The same substances are generally ca- 
pable of acting in both ways. Thus chloroform and ether, both of which are 
general anaesthetics when applied locally, especially by means of a spray, are 
capable of producing on a particular part an entire want of sensation. See 
Opium, Ether, Chloroform, Aconite, Belladonna. 

Anasarca is a state in which there is a general swelling of the body and 
extremities, caused by an effusion of the serum of the blood into the loose 
cellular tissue under the skin. The skin in such cases is generally very pale, 
and when the finger is pressed upon it a little pit or depression is formed as 
the effused fluid is by the pressure squeezed away. It is generally associated 
with kidney disease, and often occurs after scarlet fever, when that organ is 
also affected. It is generally noticed first in the face and genitals, where the 
skin is looser than elsewhere. In more chronic cases, when the kidneys are 
much diseased, the whole surface of the body may become puffy and swollen ; 
the lips especially are liable to suffer, and they are worse after they have been 
in a dependent position, as the fluid gravitates to the lowest parts, and thus 
•it often happens that the face is most swollen in a morning. Swelling of the 
legs and other parts of the body may thus arise from various states in which 
the blo'od is altered in quality, but these cases are in a great measure amenable 
to treatment. Other cases, however, arise, where the blood is altered in quan- 
tity, such as those where there is some mechanical obstruction to its flow. 
When the return of blood to the heart is prevented by obstruction of the veins, 
the parts behind the obstruction become so full of blood that the serum ex- 
udes from the distended vessels, and soaks the tissues around. A more serious 
class of cases are those in which the obstruction is seated in the heart or lungs, 
and arises from disease of those organs. It is not uncommon in persons who 
have bad winter cough and shortness of breath for some time to find a swelling 
of the legs ; this arises from the obstruction to the flow of blood through the 
lungs. The treatment of such cases will depend upon the nature of the cause. 
Relief may usually be obtained by preventing the affected part from remain- 
ing in too dependent a position ; thus the legs may be considerably reduced in 
size by placing them in a horizontal position. Pricking the extremities with 
a needle so as to allow the effused fluid to escape is often of great advantage ; 
but here great care must be taken, and the parts should be wrapped in flan- 
nels wrung out in hot water, and gradual oozing may be permitted for some 
days. This plan is more successful in cases resulting from kidney diseases 
than in those in which the heart is affected. 

Anchylosis. This is a term used in surgery, signifying a fusion or weld- 
ing together of the ends of bones at the joints, as a result of injury or disease. 
It is of two kinds, partial or fihro,us, and complete or osseous. The former re- 
sults from shortening and thickening of the ligamentous textures,- and adhe- 



ANB 42 ANG 

sions between the fibrous texture, while the hitter consists in osseous union of 
the articular ends of the bones forming the joint. 

Aneurism. An aneurism is a pulsating tumor, communicating either di- 
rectly or indirectly with the calibre of an artery. (See Auteuy.) If its sac is 
composed of the arterial coats, it is called a true aneurism ; if formed by sur- 
rounding tissues, owing to a wound being made in the vessel, it is termed false. 
True aueurism is the result of disease of the arterial coats. It is formed by 
the diseased portion of the vessel losing its elasticity and giving way before 
the pressure of its contents. The contents of the sac are blood, fluid or coagu- 
lated, and layers of fibrin. There are several kinds of true aneurisms : thus, 
surgeons speak of the tubular, that is, when the sac is uniformly dilated ; the 
sacculated^ when the sac is unequally dilated ; the dissecting, when the blood 
gets between the coats of the artery. Tumors situated over an artery may have 
a pulsation communicated to them by the underlying vessels, and simulate 
aneurism; but such a tumor can be generally told from an aneurism, from the 
fact that by pressure the latter can be emptied, and refills immediately the 
pressure is removed ; and on listening to it closely with a stethoscope (see 
Stethoscope), a peculiar thrill, or rush, can be heard, caused by the blood 
passing through it. The chief means adopted for the cure of aneurism are the 
ligature, pressure, and flexion. That by ligature consists in passing a stout 
hempen thread round the artery, between the aneurism and the heart, so cut- 
ting ofF the current of blood through the main trunk, the circulation being 
gradually reestablished by what is termed collateral means ; that is to say, the 
work of the main vessel is thrown upon its smaller branches, and by their dila- 
tation the blood finds its way into the limb beyond the point of ligature. This 
method of dealing with the disease is due to John Hunter. Pressure may be 
exerted upon an aneurism either by mechanical means, such as tourniquets, or 
by the fingers — digital compression. The treatment by flexion consists in 
flexing or bending the limb, such as the leg upon the thigh, or the forearm 
upon the arm, where the aneurism is situated. In the case of false aneurism, 
resulting from rupture or puncture of an artery, pressure should be immedi- 
ately applied between the heart and the supposed point of escape of blood, 
until surgical aid arrives. There are several other methods of treatment, 
which, however, need not be discussed here. 

Aneurism, Internal. The forms of aneurism which most frequently 
occur internally are aneurisms of the great vessel of the body, the aorta, or of 
its branches, or aneurisms occurring within the head. Aortic aneurisms may 
be situate either in the cavity of the chest or in the abdomen. A certain num- 
ber of fcbem admit of operative interference, which is sometimes successful ; 
whilst some of them yield to remedial treatment, especially if accompanied by 
absolute rest in bed.' The earliest signs of chest (thoracic) aneurism are ex- 
cessively obscure, and may be simulated by other swellings. 

Angelica root is produced by the plant known as Gaudea angelica, the 
Angelica, archangelica of the botanist. It contains a pleasant volatile oil, and 
is used as a, stimulant and carminative in medicine. The stem of the same 
plant is preserved in sugar, and used as a sweetmeat. 

Angina Pectoris or Breast Pang is fortunately not a disease of fre- 
quent occurrence. It comes on in paroxysms, in which there is a struggling 
for breath, intense pains about the region of the heart, and a terrible sense of 
impending death. The anguish is extreme whilst it lasts, but it passes off and 
leaves the patient apparently tolerably well till the next attack. The face is 
pale, the body covered with sweat, and the sufferer perfectly sensible. The 



ANG 43 ANT 

attack does not last long, ordinarily only a minute or two, though sometimes 
longer. It always recurs, but at no fixed interval, and may come on at any 
time — night or day — whether the patient be walking about or lying down. 
The cause of these attacks is obscure ; generally there is some malady of the 
heart itself. It may be fatty, or its own particular vessels may be diseased 
and the circulation through them obstructed, or both may exist. As after one 
seizure another is to be dreaded as likely, during the interval everything ought 
to be done that will conduce to the patient's health. During the paroxysm, 
stimulants such as brandy, aromatic spirit of ammonia, ether, and spirit of 
chloroform ought to be given. 

Angostura Bark is obtained from South America. It is not much used 
in medicine, but its name has been given to a kind of " bitters " a good deal 
employed. It is tonic in its properties, and is also said to be of some use in 
ague and similar tropical fevers. 

Angular Curvature is a disease of the spine often met with in scrofulous 
or rickety children, and resulting from the erect posture being assumed when 
the spinal column is. too weak to bear the weight of the head and upper part 
of the body. The spine is curved so that the convexity looks backward ; the 
ribs often bulge out more on one side than on the other ; and the chest is 
much encroached upon, so that there is less room than usual for the lungs to 
expand. See Rickets. 

Animal Heat. See Circulation ; Respiration ; Heat, Animal. 

Aniseed furnishes a volatile oil with stimulant properties. A drop or two 
may be given on sugar to allay windy spasms. 

Ankles, Weak. An affection depending upon weakness of the flexing 
and extending muscles of the ankle-joint, or on a rickety condition of the 
bones of the leg. To remedy this condition, high-heeled boots should be worn, 
with the inner edge of the heel thicker than the outer ; or a stout webbing 
bandage should be applied, carried round the ankle from the inner side of the 
foot. (See BandaCxES.) Cold-water douching and some astringent lotions, 
such as arnica lotion, are sometimes cf value. 

Anorexia signifies loss of appetite. See Indigestion. 

Antacids are medicines which counteract the formation of acids in the 
system. The alkalies and alkaline earths are the best antacids. The best 
forms of antacid medicines are the bicarbonates of soda and potash, and the 
carbonates of lime and magnesia. See Chalk. 

Anthelmintics are medicines which are given generally in conjunction 
with a purgative to expel worms from the intestinal canal. Those in most 
common use are three or four in number. (1.) The extract of male-fern, which 
is given in cases of tape-worm, and which should be taken on an empty stom- 
ach after fasting. (2.) Santonin, a crystalline white neutral principle, turning 
yellow on exposure to the light ; it should be given when a round worm or 
lumbricus is present in the intestines ; five grains of this substance with an 
equal quantity of compound jalap powder will prove effectual in a child from 
six to ten years of age. (3.) Kousso is a part of a plant growing in Abys- 
sinia ; it is occasionally given for tape-worm. (4.) Kamela is an orange-red 
powder which purges freely, and is used in India for tape-worms. There are 
also many purgatives, as rhubarb or jalap, which will bring away worms, but 
they have no special character beyond their purgative action. Injections or 
enemata of salt and water, or solution of the perchloride of iron and infusion 
of quassia, are very useful in the treatment of thread-worms in children. See 
Entozoa and Parasites. 



ANT 44 ANU 

Anthrax is the technical name for carbuncle. See Carbuncle. 

Antidote is the name given to any remedy which is capable of counteract- 
ing the effect of a poisonous agent. See Poisons. 

Antimony is most commonly employed in combination with cream of tar- 
tar, when it is called tartarated antimony, or more commonly tartar emetic. 
In small doses not exceeding half a grain, it promotes perspiration, in larger 
dose.s producing nausea, and in still larger doses vomiting; for the latter pur- 
pose two or three grains suffice. It is best given as antimonial wine, from ten 
to thirty drops, to produce perspiration ; a teasp'oonful or more to produce 
sickness. It is useful in promoting expectoration in the earlier stages of bron- 
chitis, when the chest is sore and the cough dry. Antimony constitutes the 
active ingredient in the well-known patent medicine called James's Powder. 
A preparation intended to take its place has been introduced under the name 
of Antimonial Powder. It is very useful in feverish colds, promoting per- 
spiration and relieving the aching pains then often experienced. The dose is 
from three to five grains. Antimony has occasionally been used as a slow or 
secret poison. The symptoms it produces are sickness, tendency to vomit, 
complete loss of appetite, and extreme debilit}-. Its detection is easy. 

Antiphlogistics are remedies which are supposed to oppose inflammation 
in any part of the body, and act as antagonists to any excitement or stimula- 
tion going on in the body from disease. Bleeding is one of the most power- 
ful antiphlogistic remedies. The salts of antimony and mercury are also anti- 
phlogistic remedies. 

Antiscorbutics are medicines and articles of diet that counteract the 
effects of sea-scurvy, or any tendency to that disease. The most efficient an- 
tiscorbutics are uncooked vegetables, and lemon, lime, and orange juice. See 
Scurvv. 

Antiseptics are agents that counteract the effect of putrescency in the 
living or dead organisms, as carbolic acid, charcoal, common salt, vinegar. 
See Deodorants, Disinffctants, Sprat. 

Antispasmodics are those medicines which overcome pain, cramp, or 
spa>m. in the human body, as ether, opium, assafectida. 

Anus, Artificial. Artificial anus is an unnatural opening in some part 
of the walls of the abdomen, communicating with an orifice in the intestinal 
canal. The most frequent causes of the affection are penetrating wounds of 
the abdomen, neglected strangulation, and mortification of a rupture, and the 
ulceration set up by the presence of a foreign body in the intestine ; but an 
artificial anus is sometimes formed intentionally by the surgeon in cases of ob- 
struction of the bowels, or to relieve the severe pains caused by the flow of 
excrement over a cancerous growth in the rectum. In seme instances, instead 
of a large opening into the intestine, there exists one, two, or more minute 
orifices through which but a small quantity of excrement, and that in a liquid 
state, is passed. To this latter condition the name of faced fistula is given by 
surgeons. An artificial anus presents a circular depressed orifice, surrounded 
by a zone of skin with radiating creases, and much irritated and reddened by 
the contact of excrementitious fluids. The portions of intestine immediately 
above and below the artificial anus form with each other a very acute angle, 
the apex of which is directed towards the unnatural orifice, and the base to- 
wards the interior of the abdominal cavity. In consequence of this disposi- 
tion, the round portion of the wall of the intestine immediately opposite to 
the orifice in the wall of the abdomen is thrust forward into the canal, so as 
to form a jutting valve, which prevents the flow of excrement further down- 



45 




Fig. ti. 



Fi&. nr. 



AOR 47 APE 

ward along the intestine, and directs it outward through the artificial anus. 
Artificial anus when placed near the stomach terminates sooner or later in 
death, owing to the debility caused by the discharge of partially digested food. 
In consequence of the frequent and involuntary flow of excrement from the 
orifice, the patient complains of uncleanliness, and suffers from pain and irri- 
tation in the skin about the opening. Severe colic is also a frequent affection 
in cases of this kind. Occasionally there is a prolapse or protrusion of a con- 
siderable portion of bowel through the artificial opening, a very painful condi- 
tion, and necessitating immediate relief and return of the displaced tube. 
The palliative treatment of artificial anus consists in frequently repeated 
cleansing of the skin around the opening and the application of lead lotion, 
zinc ointment, or a lotion of zinc and tannin. For the purpose of hindering 
the constant discharge of excrement, a plug of metal or wood must be worn. 

Aorta is the name given to the large vessel which arises from the left 
ventricle of the heart, and thence conveys the arterial blood by numerous 
branches to the various parts of the body. It is an elastic tube, about three 
inches in circumference at first, but afterwards becomes considerably nar- 
rower. In the first part of its course it is nearly vertical ; it then forms 
an arch and, curving from right to left, and from before backwards, descends 
through the diaphragm into the abdominal cavity, and there divides into two 
terminal branches called the iliac arteries. From the upper portion of the 
arch arise three great trunks, the innominate, left carotid, and left subclavian, 
which supply the head and neck and upper extremities with blood. From 
each side Of the descending aorta are sent off numerous branches which sup- 
ply the lungs, and the thoracic and abdominal walls, while from the anterior 
aspect, in the lower part of its course, vessels are given off which convey the 
blood to the stomach, liver, kidneys, pancreas, spleen, and intestines. As peo- 
ple advance in age, or when their blood becomes impoverished by disease, 
the walls of this artery are liable to decay through receiving insufficient nour- 
ishment, and degeneration of the coats takes place in consequence. As a 
result of this the vessel becomes more rigid, and there is difficulty in the con- 
veyance of the blood to the various organs ; sometimes an uniform dilatation 
of the aorta occurs, at others a bulging of the wall takes place at one spot, and 
gives rise to an aneurism, a state attended with great danger. Aneurisms 
more frequently occur in the ascending part of the aorta than in the rest of 
its course, as here the strain upon its walls from the impetus of the blood cur- 
rent is the greatest. People who are subject to gout, or who indulge in drink, 
or those who have kidney disease, are liable to have degeneration of the coats 
of the vessel. Great exertion tends to cause dilatation of this vessel. Mal- 
formation of this vessel sometimes occurs in foetal life : it is in rare cases 
given off from the right ventricle instead of the left ; for such cases no treat- 
ment can be of any avail, and death generally takes place in early life. 

Aperients are medicines which act on the bowels and enable them to ex- 
pel their contents. They act for the most part in making the muscular coat 
of the bowel contract more vigorously than usual, and some set up an irritation 
of the lining membrane. Aperients are divided into different classes according 
to their nature and action. (1.) There are the simple aperients, as senna, castor 
oil, and rhubarb ; pi'unes, figs, tamarinds, and sulphur also belong to this class ; 
they simply empty the bowel, do not cause much griping pain, and are useful 
in many cases of disordered stomach. (2.) The sdine aperients, as Fpsom salts 
or sulphate of magnesia, Rochelle salt, citrate of magnesia, sulphate of potash, 
etc. These may be taken in an effervescing form, and are useful when there 



APH 48 APH 

is any fever present with the constipation. (3.) Drastic aperients, like colo- 
cynth and jalap, cause much purging and drain the blood of fluid also; they 
act as direct irritants to the intestinal canal. (4.) Hydragogue aperients, as 
elaterium, scammony, and gamboge, cause very watery evacuations, and are 
used in cases of dropsy to diminish the quantity of fluid which is effused into 
the different tissues. (5.) Cholagogue aperients, or those which are supposed 
to act more especially on the liver, as mercury, taraxacum, and podophyllum. 
(6.) Emmenagogiie aperients, or those which act more especially on the womb, 
as aloes, etc. The reader must refer to each drug for any further description 
of its action. 

Aphasia, or loss of the faculty of speaking, occurs in certain cases of hem- 
iplegia of the right arm and leg ; this must be distinguished from aphonia 
or loss of voice ; in the former, the faculty is lost, in the latter, the mechanism 
is interfered with. The person so affected will probably understand what is 
going on around, but is unable to ask for anything, and if he speak at all, will 
limit himself to the use of monosyllables. Even if asked to spell his own 
name he will fail to do so, and in reply to any question he generally reit- 
erates the same expression. The handwriting is affected, too, in most cases, 
and although he knows what particular letter to write, he is unable to put it 
in writing. Often in the course of a few weeks or months, recovery slowly 
takes place, and every day he will learn a few fresh words, until he acquires 
a tolerably large vocabulary. Nothing can be done specially for this singular 
symptom, except daily educating the patient, beginning with simple words and 
short phrases. 

Aphonia implies loss of voice. It is very frequent in cases of common 
cold, or catarrh, and then the patient can hardly speak above a whisper, and 
there is frequently more or less pain or feeling of soreness in the throat and 
chest. The best thing to do is to wrap some warm, dry flannel round the 
throat, and inhale steam by the mouth. It is necessary, as far as possible, to 
avoid going out at night, or even during the day when the air is cold and raw, 
or when there is much fog. This variety is very curable. It is more common 
in women than in men. Another kind is met with in some cases of hysteria, 
and chiefly in highly nervous young women. It occurs quite suddenly, and 
often without any marked cause. Generally, however, there is some emotional 
cause which has brought on the complaint, as fright, mental worry, loss of a 
relation, or trouble in pecuniary affairs. When it happens for the first time 
it is apt to alarm the patient, but there is really no danger in it. Frequently 
the voice returns as quickly as it went, but the complaint is very liable to come 
back again. There is no actual disease, but the muscles which are brought 
into action in the mechanism of speech are not affected by the will, and hence 
will not act. Galvanizing the throat, change of air and horse exercise, easy 
circumstances, and the .removal, if possible, of the exciting cause, will often 
effect a cure. Sudden shocks have been known to bring back the voice at 
once. Persons engaged in the open air and exposed to all kinds of weather, 
as costermongers, cabmen, and watermen, are liable to this disease, but here 
there is some altered condition of the lining membrane of the air-passages. In 
the last stage of consumption, aphonia is often met with, and here, too, there is 
a roughening or ulceration of the vocal cords which are mainly concerned in 
the production of speech. In other cases there may be warty growths on the 
vocal cords which interfere with speech. The treatment for these growths 
consists in their removal. Foreign bodies in the larynx or upper part of the 
air-passages, as coins or marbles, etc., are obvious causes of loss of voice ; they 
should be removed without delay. 



APH 49 APO 

Aphthae (or Thrush) are white curd-like specks which occur in the mouths 
of children, and not unfrequently extend downwards into the stomach. They 
constitute the disease called thrush in infants. In adults they rarely occur ex- 
cept in the worst stages of certain fevers or allied conditions, where the bodily 
powers are at the lowest possible ebb. In children they begin as small white 
specks on the tongue and insides of the cheeks. Sometimes a number of these 
grow together, and form a single mass covered with a whitish or yellowish 
leathery-looking substance. Beneath the membrane the surface is red and angry 
looking. They occasion great discomfort to the poor infant, and frequently 
interfere with its powers of taking food. In dealing with such a condition the 
first thing is to keep up the child's strength by careful feeding. As the bowels 
are generally disordered, they should be attended to ; a little gray powder be- 
ing perhaps the best opening medicine. Limewater should be given, always 
with milk. For the lips and mouth, borax and honey, or glycerine, well 
smeared on, is perhaps the best application. Or a wash consisting of sixty 
grains of sulphate of soda to the ounce of water may be freely applied by a 
feather or brush. 

Apncea is the name given to the mode v of death which results from not al- 
lowing the entrance of air into the lungs. Death does not take place directly, 
but may occupy three or four minutes. After death the lungs will be found 
to contain moi'e blood than usual, and the right side of the heart and the large 
veins will be very full of blood, while the left ventricle is firmly contracted. 
Ecchymoses, or small spots of blood, will also be found on the pleura and the 
pericardium. In cases of suffocation, where the hand or a pillow is placed 
over the nostrils, death is produced in a similar way ; and also in those cases 
where a cord is drawn round the neck, as in the process of strangulation. 
When hanging takes place, death may be produced by fracture of the spine, or 
by apoplexy, yet sometimes it is produced by apncea when the drop is not very 
great. It is by no maans uncommon for children to die of apncea, owing to 
the carelessness of the parents, and many cases of infanticide occur yearly 
where death is caused by suffocation, accidental or otherwise. In drowning, 
also, death is produced by apncea. It will be seen, therefore, that death can 
hardly take place in less than four minutes, even when the strangulation is 
very complete, and of course it takes much longer in the majority of cases. 
Every means should therefore be taken to restore the respiration as soon as 
possible, so long as the body is warm, and by continuing to do so for a long 
time many persons have been successfully restored to life, although quite in- 
sensible and apparently dead. Any person found hanging should be at once 
cut down and all pressure removed from the neck ; the patient should be 
placed in the open air, and artificial respiration should be performed at once. 
Similar treatment ought to be adopted in cases of strangulation, suffocation, or 
drowning. In the latter case the body should be at once stripped, rubbed dry, 
placed in a blanket, and every means be taken to restore circulation and res- 
piration. It is probably impossible to recover a person who has been a quar- 
ter of an hour under water. See Drowning. 

Apoplexy. A state in which a person falls down suddenly and lies with- 
out sense or motion, while the breathing is often labored and noisy, and the 
pulse beats often with unnatural force. To this condition the name of coma 
has been applied. A person thus attacked is unable to think or to feel, or to 
make any voluntary movement, but the functions of the respiratory and circu- 
latory organs still continue, although their action is more or less interfered 
with. The attack does not always come on in the same way. In some cases 



APO ' 50 APO 

the person falls rtpwn in a deep sleep, with a flushed face and labored breath- 
ing, and convulsions may ensue, or rigidity and contraction of the muscles of 
the arm or leg. In others there may at first be sharp and sudden pain in the 
head, then faintness and pallid skin and vomiting ; after a lapse of time, vary- 
ing from a few minutes to several hours, the patient becomes heavy and stupid, 
and sinks into a state of coma. There is yet a third sort of cases, in which 
the patient becomes paralyzed without actually losing consciousness. There 
is sudden loss of power on one side of the body, and to this kind of paralysis 
the name of hemiplegia is applied; the patient may be sensible and able to 
answer questions and give an account of the attack, but very frequently speech 
is affected, and there has been some transient giddiness. These cases are less 
formidable than the others above mentioned. Sometimes the patient soon 
gets well, and the paralysis passes away completely ; or he may recover to a 
certain point and be able to walk about, but only partially regain the power of 
moving his leg, and drag it after him in walking; or the leg may improve and 
his arm remain weak. Occasionally no improvement takes place, and the per- 
son becomes bedridden and perhaps unable to talk, while he is still more or 
less sensible, and after a lapse of some weeks or months he finally dies of ex- 
haustion. When a person falls down in a fit of apoplexy he is quite uncon- 
scious of anybody or anything around him. The breathing may be heavy and 
noisy, or irregular, and when he takes a breath it is attended by a snoring 
noise, and his cheeks puff out when he empties his chest on expiration. The 
face is sometimes flushed or of a dusky appearance ; the eyes are generally 
closed, and the pupils smaller than natural. Often, too, one side of the face 
is palsied and the mouth is awry, because it is drawn over to the healthy side ; 
when this occurs, the patient cannot masticate his food well, because it lodges 
between the gum and cheek of the affected side ; when he tries to whistle, the 
paralyzed cheek puffs out in a helpless manner ; occasionally, also, he is unable 
to close the eye on the palsied side, and care should be taken to keep it 
covered, as otherwise the wind or dust, or some foreign matter, may get into 
it 'and cause considerable irritation. Sometimes convulsions occur, or one limb 
may be rigid. The bowels are often sluggish, and a motion is passed in the 
bed unconsciously; the urine, too, will flow or dribble away without the pa- 
tient being aware of it. This state does not, as a rule, last long, and death 
may take place in a few hours ; in other cases the coma may still continue, 
ami the patient may linger on for several days; but generally, if death does 
not take place in twenty-four hours, there is considerable hope of recovery. 
The deep sleep by degrees passes off, the patient becomes partially sensible of 
persons or objects around him, and is able to swallow some nourishing liquid ; 
but although consciousness may thus return, the memory is often much af- 
fected, and the patient is low-spirited and ready to weep on any occasion, or 
he may remain more or less imbecile for the rest of his life. "When the coma 
has passed away, the hemiplegia, or palsy of one side of the body, may yet 
remain for some weeks or months ; in some cases complete recovery may take 
place ; others are bedridden for life, while many obtain a partial use of the 
palsied arm or leg. Apoplexy attacks people of all ages, but it is far more 
common after fifty years of age ; it is met with in both sexes ; it is found not 
o;dy in full-blooded people with a red face, short thick neck, and stout frame, 
but also in thin and spare people. Some persons are more or less liable than 
others in consequence of some hereditary taint of constitution. A patient 
generally has some warnings before a fit comes on : headache, sickness, and 
giddiness coming on in advanced life are threatening symptoms ; or there may 



APP 51 ARC 

be double vision or squint, or numbness of a limb, and the familiar sensation of 
pins and needles ; in other cases loss of memory and mistaken use of words 
are signs of the coming attack. Anything which makes the heart beat faster 
or fills the head with blood may excite an attack ; much bodily exercise, as 
galloping on horseback, or hastening to catch a train, or running up-stairs ; any 
violent mental shock or fright, or any kind of excitement, may bring on a fit 
in those who are liable to the disease, and therefore should be avoided. Strain- 
ing at stool and any stooping position should be guarded against. When a 
person is in a fit, his neckcloth or any tight part of the dress should be loos- 
ened ; he should be kept in a horizontal position and placed on a bed or couch, 
with his head slightly raised. A piece of linen, dipped in vinegar and water, 
may be laid across the forehead, and hot bottles should be applied to the feet 
if they are cold. Perfect quiet should be kept, and the shades may be drawn 
down so as not to let too much light into the room, and only one or two peo- 
ple should be allowed by the bedside. 

Appendix Vermiformis is a small portion of the cascum (see Intes- 
tines) which hangs down in a worm-like shape in the centre of the abdomen. 
It is often a source of disease and death. In the passage of the food through 
the intestines it often happens that a cherry stone, lemon or orange seed, or 
other such hard substance drops into the cavity of the appendix, and produces 
inflammation, ulceration, and often death. This catastrophe may be suspected 
when intense pain occurs in the abdomen over the seat of the caecum. 

Appetite, as used in medical language, means a healthy desire for food. 
Loss of appetite, technically called anorexia, is one of the most invariable 
symptoms of some disease, as is the return of appetite one of the most certain 
signs of returning health. This returning appetite is one of those things 
which require somewhat careful management. At first, as the powers of the 
stomach have been greatly weakened, only small quantities of food, carefully 
prepared, ought to be given, and repeated frequently if necessary. Depraved 
appetite, pica, is frequently a symptom, in females, of hysteria : it may also 
occur in early pregnancy. 

Apple is the fruit of a species of Pyrus, and one of the most common 
fruits brought to the table in America. Apples contain malic acid, which 
gives them their acid flavor, and a varying quantity of sugar, pectin, cellulose, 
and salts. Only the sweeter and softer should be eaten raw. When eaten, it 
is advisable to take off the peel and remove the core, as those parts are less 
digestible. In cooking, the peel should be removed and sugar added. If 
roasted, the peel should be allowed to remain on. Apples, like other vegetable 
products, contain saline matters which act beneficially on the system. 

Aqua Fortis. An old Latin name, meaning strong water, for nitric acid. 
See Nitric Acid. 

Aqua Toffania. A name given to a solution of arsenic, which was sold by 
a woman named Tophania, who lived in Palermo. It is said that upwards of 
six hundred persons perished by this poison. 

Arachnitis. A name sometimes given to inflammation of the membranes 
of the brain. See Meningitis. 

Arcus Senilis. This term is applied to the narrow opaque zone which 
may be observed near the margin of the cornea of many aged persons. It 
usually affects both eyes, and varies in tint,- according to its period of duration, 
from a pale gray to a dense chalky white. It commences as an indistinct 
semi-opaque crescent seated near the upper or lower margin of the cornea, 
which crescent gradually extends around the whole circumference of this 



ARD 52 ARS 

portion of the eye, and increases in width and opacity. This appearance is 
due to fatty changes in the circumferential parts of the cornea, and is some- 
times an indication of fatty degeneration of the heart and other internal 
organs of the body. Though must frequently met with in old subjects, it 
often makes its appearance on persons of thirty or forty, who have become 
prematurely aged. 

Ardent Spirits. See Alcohol. 

Aristolochia, a genus of plants, so called from its being thought a remedy 
promoting recovery after child-birth. There is a species of this genus called 
the Virginian snake root, having the doubtful reputation of being a remedy 
against the bites of serpents. It is used in medicine, and is a stimulant and 
tonic, and given in cases of debility and ague. 

Arnica, the root of the Arnica montana, as a remedy, is mostly used in 
homoeopathic practice. Its tincture is most commonly used as an outward 
application in sprains and bruises. 

Aromatics are drugs which have a pleasant smell, agreeable flavor, and 
slightly stimulating properties. Most of the essential oils belong to this group 
of substances. 

Arrack is a kind of distilled spirit, much used in the East, and is obtained 
from fermented rice, betel nuts, and the sap and fruit of palms. It contains 
pure oil and other substances, which produce headache ar.d other disturbances 
of the nervous system. 

Arrowroot is the name given to an alimentary substance obtained from 
the tubers and roots of various plants. Genuine arrowroot is. however, 
obtained from the root stock of various species of Maranta. Arrowroot is a 
white powder, consisting entirely of the granules of starch. It is sold in shops 
under the names of West Indian, East Indian, and B< nnuda arrowroots. Like 
all amylaceous food, arrowroot becomes thickened by boiling in water, and 
can be made the recipient of other substances, as wine, brandy, sugar, spices, 
etc. In dietetical value it is no higher than other forms of starch. See Sago, 
Tapioca. Corn Flour. 

Arsenic is the common term for what is more strictly called arsenious 
acid, or white arsenic. It is both a dangerous poison and a powerful remedy. 
It is best given in the form of Liquor Arsenicalis or Fowler's Solution, of which 
three, four, or five drops may be given in water immediately after a meal. 
Notwithstanding the disastrous consequences of large doses, given in the small 
one- described it is very valuable in certain complaints. A preparation of 
arsenic was long used in England as a remedy for ague, under the name of 
the Tasteless Ague Drops. Even in tropical fevers of the same class in 
which quinine lias been given and tailed, arsenic will sometimes succeed. 
There are some kinds of headache, especially one called brow-ague, in which 
arsenic does good, as it also does in others more distinctly neuralgic in char- 
acter. It has also been given for some forms of nervous disorder. Of all 
remedies arsenic seems to be that which is of most use in skin diseases, 
especially those of a scaly or scurfy kind; where much purulent matter is 
produced it seldom does much good. Small doses should be given very 
regularly in the way indicated above, and if any smarting of the eyes comes 
on it, should be discontinued for a time, and again resumed in smaller quantity. 
In cancerous affections arsenic has sometimes been used locally for its destruc- 
tive effects, but this is dangerous, and lives have been lost by the practice. 
Arsenic eating is said to be common in Styria, and it is also said to be given to 
horses to give them a smooth and glossy coat. In poisoning by arsenic the 



ART 53 ASC 

contents of the stomach should be promptly evacuated, and as an antidote the 
hydrate peroxide of iron given. The antidote is made by taking a chemist's 
stock-bottle of tincture of muriate of iron, adding to it the contents of the liquor 
ammoniae bottle, and pouring off the fluid at the top. The precipitate at the 
bottom is the antidote- 
Artery. An artery is an elastic tube, conveying blood from the heart, to 
which, after having nourished the various structures to which it is distributed 
by means of the capillaries, or ultimate branches, it is carried back by the 
veins. For the general reader it is sufficient to state that an artery consists 
of three coats or coverings : (1) an outer one, composed of elastic fibrous 
tissue ; (2) a middle, composed of muscular fibre in a great measure ; and 
(3) an internal, composed of epithelium, of which there are several sub- 
divisions, which we need not specify here. The elasticity of the coats of an 
artery serve to assist in the propulsion of the blood throughout the system. 
The arterial system is divided into two main parts, one springing from the left 
ventricle of the heart, and carrying the blood by means of the aorta, the great 
artery of the body, and its branches to the head, trunk, and limbs, and a sec- 
ondary system {pulmonary), upon which the former depends, namely, that 
arising from the right ventricle of the heart, which throws the spent blood, 
already sent back to the heart, by the veins, to the lungs to be converted (ar- 
terialized) into fit and proper blood for distribution by the first-named system. 
In the unborn child (foetus) considerable difference in the arterial and venous 
circulation exists. See Heart. 

Arthritis. Arthritis properly signifies any inflammation of a joint, but in 
surgery the term is most frequently associated with rheumatism : thus we hear 
of chronic rheumatic arthritis, a disease characterized by an alteration of all 
the structures composing a joint. It afflicts rheumatic and gouty patients, 
and its symptoms are a racking, gnawing, wearing pain in any joint, gener- 
ally dependent on weather, accompanied by a grating feeling when the joint is 
used, and an audible evidence of friction of the opposed surfaces of the articu- 
lation. Opiate embrocations, warm douches, and Turkish baths seem to be 
good local means of alleviation. 

Artichoke is the name of two plants which are used as articles of diet. 
The common artichoke is Gynara scolymus of botanists, and the bracts on the 
outside parts of the unopened flower of this plant are boiled and eaten with 
melted butter. They contain starch, sugar, albumen, but no medicinal proper- 
ties. The Jerusalem artichoke is produced by a species of sunflower, and the 
word Jerusalem is a corruption of Girasole or Turnsol. The part of the 
plant eaten are the tubers, which are cooked like potatoes. They contain 
more sugar and less starch than potatoes, and are even less nutritious. 

Artificial Respiration is used in cases of drowning, or. after an overdose 
of chloroform has been given, or whenever insensibility by apncea has ensued, 
and there is a chance of saving the patient. For the various methods to be 
adopted, see Respiration. 

Arum Maculatum is a poisonous plant with spotted leaves. It flowers 
early in the spring, within a sheath or large bract. Its receptacle, which pro- 
jects beyond the flower, is colored orange, yellow, and purple. Although the 
leaves are poisonous, starch is procured from the roots, and eaten under the 
name of Portland sago. 

Ascarides are commonly called thread-worms. They look to the naked 
eye like short bits of white thread, and they are of two kinds, male and female, 
the latter being longer and larger than the former. They live chiefly in the 



ASC 54 AST 

lower part of the bowel, and may accumulate there in vast numbers. They 
occasion great itching. This worm is chiefly found in infancy and childhood, 
and only rarely attacks the adult. The symptoms by which it may be known 
to be present are, picking of the nostrils, fetid breath, distension of the stom- 
ach, and irritation about the anus and genitals, as well as the actual passage of 
the worms. In female children a discharge from the genitals is not uncom- 
mon in consequence of the irritation caused by the worms. It is found 
amongst the children of the poor and those of dirty habits, and is said to be 
caused by eating blackberries, apples, etc. It is certain that the ova producing 
the worms are taken in with the food. An occasional purge, with an injection 
every morning up the bowel of a solution of common salt, and careful atten- 
tion to the diet, will usually suffice to get rid of this parasite. 

Ascites signifies an accumulation of fluid in the cavity of the abdomen. 
Its most common causes are diseases of the liver, heart, or kidneys ; in the 
two latter, dropsy of other parts, and especially of the legs, is liable to ensue, 
but not so when the liver is affected. Cirrhosis of the liver arising from drink 
causes an obstruction to the passage of the blood, and so the abdominal cavity 
becomes full of fluid; the patient is then of a sallow or yellow color, loses 
flesh, and also his appetite. The abdomen is round and swollen, and the veins 
distinctly seen. It is a disease which is gradual in its course, and may last 
some months or years. Hot fomentations may be applied over the surface of 
the abdomen to relieve any pain which may exist, and sometimes tapping the 
swelling and letting out the fluid is very beneficial. Chronic inflammation of 
the peritoneum or scrofulous disease of the mesenteric glands in children is a 
frequent cause of ascites, and here the general health must be attended to, 
for the local disease depends in those cases on the constitutional taint. Cancer 
of the liver or other abdominal organ may cause ascites in the course of its 
progress, but in such cases no remedies are of much avail except in so far as 
they relieve the patient from suffering. 

Asiatic Cholera. See Cholera. 

Asparagus is a cultivated plant, the undeveloped stem and head of which 
are boiled and eaten with melted butter. It does not appear to possess any 
medicinal properties. 

Asphyxia is the name given to the mode of death which occurs in drown- 
ing, suffocation, strangulation, and in some cases of hanging. The term apncea 
is, however, a more correct designation. See Apncea. 

Assafcetida is a foul smelling gum resin, coining to us from the East. It 
is much used in the treatment of hysteria. Combined with aloes, it is useful 
in certain forms of flatulent colic, especially in hysterical women. 

Asses' Milk. See Milk. 

Asthenia, a medical expression used to indicate a want of power or strength 
in the system. 

Asthma is a nervous disease affecting the lungs, and characterized by a 
painful gasping for breath, coining on suddenly, and passing away without 
necessarily leaving injury to the lung behind it. We may speak of at least 
three varieties of the disease : (1) The first spoken of, which is also called 
Spasmodic Asthma ; (2) asthma occurring as a sign of other disease, that is, 
Symptomatic Asthma : and (.'!) certain peculiar varieties of the disease, of 
which hay fever or asthma is the most important. Spasmodic asthma is so 
called because it is supposed to he due to spasm or violent contraction of the 
air tubes, whereby air is prevented from reaching the interior of the lung. Most 
frequently the disease come-, on without any warning, and commonly occurs 



AST 55 AST 

an hour or two after midnight, the patient being suddenly roused from his 
sleep by an attack. There is a feeling first of all of constriction, which grows 
till there is a fearful struggle for breath. The patient most frequently has 
recourse to the open window, and there holding firm with his hands, so as to 
enable him to use the powerful muscles of the upper arm for breathing, he 
may remain for hours gasping for breath. Over the chest various kinds of 
unusual sounds are heard, the skin becomes cold, and the temperature falls 
sometimes many degrees. Subsequently this gives way to sweating from 
fatigue. By and by relief comes ; the patient begins to cough, expels some 
pellets of mucus, and before long falls asleep. During the intervals of attack, 
the patient may be tolerably well, but may be said to be a valetudinarian. 
The disease may attack the individual in apparently the most healthy situa- 
tions, and leave him alone in smoky, apparently unhealthy quarters. Not 
unfrequently asthma is hereditary, and commonly sets in about middle life. 
Suppers, especially of an indigestible kind, are prominent causes of an attack. 
Asthma seldom directly destroys life, however bad the patient may seem in 
the fit. Many who are subjects of asthma live a good long life, the reason 
probably being that they are forced to take care of themselves. Generally, 
however, the disease induces other conditions, especially of heart and lung, 
which indirectly prove fatal. Symptomatic asthma, as far as the paroxysm is 
concerned, resembles the other form, only, being connected with disease of the 
lung or heart, its conditions are not the same, and the fits are not subject to 
the same laws. The conditions of lung most commonly associated with asth- 
matic attacks are chronic bronchitis and emphysema. Sometimes the order 
is reversed, and the asthma gives rise to these. The third variety of asthma 
is that which is induced by certain peculiar causes, hay fever (which see) be 
ing among them. The grand rule to be observed is to avoid everything likely 
to setup the attack, particularly prejudicial articles of food. If the attack has 
been brought on by an injudicious meal, let the stomach be emptied. During 
the paroxysm a few whiffs from a pipe of tobacco or stramonium will fre- 
quently act like a charm. Datura inhaled is also a powerful remedy. For 
many, chloroform or ether is best, but requires careful management; whilst in 
others a draught of hot brandy and water, or strong coffee is best. In the 
interval, the health of the patient should be carefully attended to, iodide of 
potassium and arsenic being among the most approved remedies to be then 
given. 

Astigmatism is a term signifying irregular refraction ; that is to say, 
that light, as it passes through the transparent portions of the eye to the 
retina, is acted upon differently by sections of these portions, thus producing 
a blurring of the object ; or, while one portion of the viewed object appears 
distinct, the one next to it seems smudgy. It is dependent upon several 
causes, such as some original defect in the eye, the results of wounds of the 
eyeball, or displacement of the lens. Spectacles recommended by some com- 
petent oculist are the means of relief. 

Astringents are drugs which act by causing a shrinking or puckering of 
the tissue to which they are applied, if strong enough ; they coagulate albu- 
men, and check the flow of blood from a part. Some act locally, and may be 
applied to a wounded surface ; others are absorbed into the blood, and check 
haemorrhage from a distant part. Tannic and gallic acids, iron, zinc, some 
salts of lead, especially the acetate or sugar of lead, catechu, logwood, chalk, 
and kino are astringents. Matico may be applied locally to a wound to check 
bleeding. Turpentine is a very useful astringent when there is haemorrhage 



ATA 56 BAL 

from the lungs, and can be inhaled with steam. In cases of diarrhoea, chalk, 
opium, and catechu or sugar of lead can be given, while, if there is haemor- 
rhage from the womb or kidney, iron and mixtures containing tannin or gallic 
acid are necessary. Iron and tannin or gallic acid must not be given together, 
as they form a disagreeable and nauseous inky compound. 

Ataxy is a peculiar affection of the spinal cord, in which the patient loses 
control over the movements of his limbs. See Progressive Locomotor 
Ataxy. 

Atheroma is a degeneration very liable to occur in old age, as a natural 
result of senile decay ; it occurs earlier in life in those who have led fast and 
intemperate lives. See Degeneration. 

Atmosphere. See Am. 

Atrophy or Wasting is a term used generally and specifically. Thus, if 
the arms and legs waste in any disease, they are said to be atrophied. The 
same often happens in a paralyzed part. There are, however, certain specific 
forms of disease to which the term atrophy applies. Such are acute yellow 
atrophy of the liver (see Liver), progressive muscular atrophy (see Pro- 
gressive). 

Atropine is the active principle of belladonna. See Belladonna. 

Aura is the name given to certain peculiar sensations which sometimes 
usher in an attack of epilepsy. These feelings are of various kinds. Per- 
haps the most common are a feeling of a stream of water or air — cold or hot 
— gradually creeping up from an extremity towards the head. This feeling 
reaches a certain point, and then the patient becomes unconscious. Occasion- 
ally, if it can be stopped, the fits do not occur. For this purpose machines 
are sometimes worn, which, being touched, suddenly and powerfully grasp the 
arm or leg, certainly in some cases working the desired result. 

Auricle is the name given to two of the cavities of the heart, from their 
resemblance to an ear. See Heart. 

Auscultation is the art of ascertaining the condition of the internal organs 
of the body, especially the lungs, by the aid of the ear. See Percussion, 
Stethoscopk. 

Axilla is the anatomical name for the arm-pit. 

Azote is a name for nitrogen gas. Substances, such as certain foods, are 
called azotized, on account of their containing nitrogen. See Food. 

B. 

Baby-farming. See Infant Mortality. 

Bakers' Itch, a form of skin disease produced on the hands of bakers by 
the irritation of the yeast used in making bread. See Psoriasis. 

Baldness, or Alopecia, as it is technically called, means loss of hair. It 
may be partial or general, temporary or permanent. It is best known in the 
form of calvities or senile baldness, which is one of the changes indicating 
general structural decay and advancing age. In some individuals the head 
bocomes bald during middle life, and in others it is well covered by hairs 
even at a very old age. These differences depend upon two influences : that of 
general health and strength of constitution, and that of hereditary peculiari- 
ties. In this form of baldness, whether due to senile or premature decay, the 
hairs first become gray and then white; they no longer present their usual 
appearance, but are short, split, and very dry and crisp. The scalp at the 



BAL 57 BAL. 

same time becomes thin and tense. At last the white hairs are shed, and no 
others are formed; complete baldness is then produced, and the thin scalp 
becomes smooth and shining. These changes always begin on and are very 
often limited to the vertex of the head ; they are due to senile shrinking of 
the tissues of the scalp and obliteration of the hair-follicles — those small 
depressions in the skin in which hair originates. Baldness has been observed 
in newly-born infants, although this form is very rare. The growth of the 
hair may be retarded for one or two years, or it may never take place. Of 
accidental baldness there are several varieties. The most common form, per- 
haps, is that general thinning which is caused by exhausting diseases, as, for 
instance, fevers, by bodily decay, and by great mental emotion. Sometimes 
extensive thinning, or even total loss of hair, may be seen in children and 
young adults, apparently strong and in good health, and without any affection 
of the scalp to account for this. serious condition. It has been suggested that 
this early loss of hair may be due to failure of nervous power, or to cessation 
of the natural reproducing function of the hair-bulbs and hair-forming ap- 
paratus. Accidental baldness is also very frequently produced by parasitic 
diseases of the scalp, such as favus and the different forms of tinea. Accord- 
ing to the nature of the disease it is general or partial : in favus the whole 
scalp is affected, and in tinea decalvans there is complete baldness only over 
small circumscribed patches. Thinning of the hair is a symptom of venereal 
disease ; in some instances the patient becomes (mite bald. This affection, 
however, is usually temporary, and the hair grows again after the course of 
the general disease has been averted by suitable remedies. The congenital 
and senile varieties of baldness are not amenable either to local or general 
treatment. In the former class of cases, one must wait patiently until the 
formative organs of the hair are well developed, and in the latter class the loss 
of hair is to be regarded, like many other concurrent phenomena, as an inevi- 
table result of advancing age. The application of stimulating washes only 
irritates the skin, and may do much mischief. In baldness occurring during 
convalescence from fever or other exhausting maladies, the hair usually grows 
again as the patient recovers. In cases where the hair becomes thin and loose 
in consequence of debility or want of tone, local stimulant is the best treat- 
ment ; in slight forms of the affection, cold water should be poured over the 
head every morning, and the scalp then well rubbed with a rough towel ; at 
night, a wash made up of equal parts of glycerine and sal-volatile should be 
rubbed into the scalp at the roots of the hairs. In more advanced forms of 
baldness from debility, tincture of iodine may be painted over the most 
denuded portions of the scalp two or three times in the course of the week. 
Shaving the scalp also does good in bad cases. The hair when it begins to 
grow again is soft and downy, but in course of time resumes its natural ap- 
pearance. Whilst it is in this state care should be taken not to apply any oil 
or pomatum to the scalp. In baldness from constitutional debility or disorder, 
attention should be paid to the important organs of the body, such as the 
stomach, which is often at fault. Sometimes also the nervous system is 
affected. 

Balm of Gilead is the name given to a juice which exudes from the 
branches and leaves of various species of Balsamodendron. 

Balsam, Friar's. See Bknzoin. 

Balsam of Peru is a thick treacly-looking substance with a peculiar odor 
called " balsamic." It was at one time much used in the treatment of wounds. 
Occasionally it is given in chronic bronchitis of the aged. It is rarely used. 



BAL 58 BAR 

Balsam of Tolu differs from Balsam of Peru by being lighter in color 
and rather more solid. 

Bandages. Bandages consist of strips of linen, calico, or flannel, of vari- 
ous breadth, from one to six inches, and of any length, from one to ten or 
twelve yards. The best material is stout unbleached calico ; but a strip of 
sheeting, or strips of an old petticoat or dress, are very serviceable. They 
should be rolled up firmly for use, as they are applied by unrolling them over 
the part to be bandaged. There are some few plain rules which ought to be 
attended to in the application even of the simplest bandage which can be used ; 
as the manner in which it is bound round the limb makes all the difference to 
the comfort of the patient. It will be found most convenient to hold the roller 
on the inner side of the limb (if it be a limb) to be bandaged, so that in the 
case of the right side being operated on, the bandage is held in the operator's 
right hand, and vice versa, and for expedition in application the portion which 
is still unwound should he underneath that wdiich is being wound round the 
limb ; in fact, that the bandage should form a sort of continuous figure of eight. 
On first starting off, rather more than the circumference of the limb should be 
unwound and cast around the part, and the hand not employed in holding the 
bandage made to tuck the free end under the first complete turn. If this 
slight manoeuvre be dexterously done, the bandage will never slip, unless pur- 
posely unwound. It is then lightly but firmly wound round the limb by a 
series of turns as far as required. IS'ow it is evident that, in the case of a 
well-shaped, muscular limb, this winding cannot be made evenly, as it will not 
lie flatly ; the simple devise of " reversing " is then employed ; it consists of 
taking a " turn " in its application, and bending it upon itself by changing the 
surface of the roller which -is applied to the skin by making an acute angle or 
reverse at each turn, and giving it a sharp " twitch " at each. In bandaging 
ihe arm or leg, it is best to commence with a few turns round the hand or foot 
first, whether it be for the retention of splints or dressings. Bandages should 
always be applied with an equable pressure throughout, and not too tightly. 
Bandages such as the above may be rendered hard and strong by smearing 
their successive turns with gum, plaster of Paris, glue, paste, or white of egg, 
which speedily sets, serving the double purpose of bandage and splints. See 
Slings, Splints. 

Bantingism is a term applied to a system of diet by which it is proposed 
to make fat people thin, and which succeeded in the case of a Mr. Banting, 
who wrote a pamphlet on the subject. The great principle recognized in the 
system is the withdrawal from the diet of those articles of food, such as bread, 
potatoes, sugar, fat, and butter, which are known, when taken in excess, to 
produce obesity. If stout persons wish to reduce themselves they should 
diminish the quantity of bread, sugar, fat, and butter in their diet, but not 
suddenly leave off anything to which they have been habituated through a 
long lite. See Height and Weight. 

Barbadoes Leg. See Elephantiasis. 

Barbadoes Tar. This substance is a species of naphtha, found naturally 
in the island of Barbadoes in great abundance. It is only used in this coun- 
try as a horse medicine ; but in the West Indies has a reputation in bronchial 
and pulmonary diseases. 

Barberry, the common name of the Berberis vulgaris. The fruits are of 
a red color, and contain a sweetish acid juice which is reckoned a febrifuge. 
An active principle is also obtained from this plant, called Berberiue. 

Bark. See Cinchona. 



BAR 59 BAT 

Barley is a well-known grain, valuable as an article of diet, both as an ad- 
dition to soups and broths, and, when ground in the form of meal, as a nutri- 
tious food. The medicinal drink known as barley-water is made from the 
pearl or Scotch barley, and if carefully made is a pleasant and soothing drink 
in diseases of the throat and chest. 

Barometer is an instrument for measuring the pressure of the atmosphere. 
It consists of a stout glass tube about thirty-two inches in length, closed at 
one end, uniform in calibre, and divided into inches from below upwards, or, 
as is more usual, a scale of inches is attached to the frame which supports the 
tube. This tube having been filled with mercury is inverted, so that the open 
end dips into a vessel containing mercury, and then the fluid in the tube will 
sink to about thirty inches, leaving a vacuum above. This height is main- 
tained by the atmosphere, which presses on the mercury in the vessel below 
with such force as to maintain the fluid in the tube at that height ; increase 
the pressure of the atmosphere and the mercury will rise still higher; diminish 
the pressure and the mercury will sink proportionately. On the top of a 
mountain, where the air is much rarer, and therefore the pressure less, the 
mercury will not rise so high, and by this means the height of elevation may 
be calculated. The atmospheric pressure on the earth at the level of the sea 
is found hy experiment to be fifteen pounds to the square inch, and a column 
of mercury a square inch in area and thirty inches high will be found to weigh 
fifteen pounds. 

Barrenness. See Sterility. 

Baryta is a mineral product, a preparation of which is used in medicine 
under the name of solution of the muriate of baryta, or chloride of barium. 
It is prescribed in scrofulous affections, glandular enlargements, and cutaneous 
diseases, and care must be taken in its administration, as it is very powerful. ■ 

Basilicon. This is known as royal ointment, and it is an old-fashioned 
remedy for ulcers, wounds, and abrasions. It is of three kinds : the black, 
made with pitch; the green, in which the flowers of melilot form a part; and 
the yellow, made of wax, rosin, and simple ointment, the only one now in use. 

Bathing (Sea) is a remedy potent for good or evil. There are few con- 
stitutions so delicate that they will not bear sea-bathing if the process of prep- 
aration is carefully gone through, but that is all important. To a delicate 
female sea-bathing is often like the renewal of life, but it must be carefully 
gone about. If the patient has been accustomed to a cold bath in the morn- 
ing, the only change required first of all is the substitution of salt water for 
fresh ; if she has not, she must use the sea-water tepid first of all, gradually 
accustoming herself to water of the temperature of the sea. Next, a sunny 
day having been selected, she may try, when the sun has been well out, a 
bath from the beach, but should remain in the water only long enough to be 
completely wetted from head to foot, and then rubbed dry ; a gentle walk 
should afterwards be taken along the shore. This should not be attempted 
within less than three hours after breakfast, but by degrees the time may be 
lessened, breakfast being made less and less of a meal till it consists merely of 
a cup of milk, which it is better to take in all cases before proceeding to bathe. 
By and by the morning hours may be used for bathing ; these are the best ; the 
bath should not last more than ten minutes, and a smartish walk should follow. 
Never bathe with a full stomach, or when feeling cold before entering the water. 

Baths. Baths, whether regarded as a means of preserving or recovering 
health, are of very great importance. The baths employed by a very consider- 
able number of our countrymen daily for the purpose of cleanliness and the 



BAY 60 BAY 

preservation of health are cold baths ; that is to say, their average temperature 
is under 60°. If intended more for cleanliness, water of a higher temperature, 
from 60° to 100°, is employed. They differ too in respect of mode of use, for 
whereas the cold bath is administered variously, as shower, plunge, shallow, or 
sponge baths, the warm bath is almost entirely restricted to what is called the 
shallow bath. The douche is perhaps the most powerful mode of administer- 
ing the cold bath, but is commonly used as an appendage to the so-called 
Turkish or Roman bath. As remedial measures, hot-air baths are sometimes 
very useful, especially perhaps in cases of sub-acute rheumatism, colds, and the 
like. They are, however, to be used with caution, as to many individuals 
they are dangerous, producing unpleasant sensations in the head. This is 
especially the case if high temperatures are employed. As a rule, it may be 
said that 14U° Fahr. is quite high enough for all useful purposes, and the time 
of remaining in the bath should be regulated rather by the effect produced in 
bringing out perspiration than by other considerations. Generally such baths 
terminate either with a cold plunge or a douche, which to many is the pleas- 
an test part of the whole. Medicated baths are in use in this country ; some 
prepared so as to resemble mineral waters abroad, others constituted on a dif- 
ferent principle, and used mainly in the treatment of skin disease. One 
variety, namely, alkaline baths, have been found of great use in chronic or 
sub-acute rheumatism. Iodine baths have been used lor the same complaint, 
and for advanced syphilis. Sulphur baths have been used in lead poisoning, 
as well as in itch. Nitro-muriatic acid baths have had a great reputation 
among old residents of the Indies for diseases of the liver. The most important 
of these baths, if indeed it deserves the name of bath at all, is the so-called 
mercurial vapor bath, which is of undoubted value as a remedy in syphilis. 
The mustard foot-bath is a favorite remedy among females, who ascribe to it 
considerable powers of bringing on the menstrual flow. Abroad, mineral 
waters are generally used both externally and internally. The Hot Springs 
waters are excellent for rheumatism, and allied affections, also in certain forms 
of skin disease. The Harrogate (English) waters differ in quality at different 
springs. The sulphurous waters are those used for bathing ; they are very 
good in certain forms of skin disease. The foreign baths are .^o numerous, we 
can only allude to the chief. Vichy is one of these. Its waters are strongly 
alkaline, and are very useful in gout. Aix-la-Chapelle has hot bath waters, 
which are very useful for stiff joints, scrofulous diseases, etc. The waters of 
Kreuznach in Rhenish Prussia are very valuable in certain derangements of 
the womb. Wiesbaden, Homburg, and Baden-Baden are rather pleasure 
grounds than bathing-places ; their fate remains to be seen. Carlsbad waters 
are now seldom used for bathing, except, as at Marienbad, in the form of mud- 
poultices. These are, however, of undoubted service. For effects of simple 
baths, see HYDROPATHY. 

Bay, technically called Laurus nobih's/is the true laurel of the ancients, the 
sweet bay of the English. The berries are aromatic, and are used as spices in 
food. They are also employed in medicine, and act as carminatives and stim- 
ulants. The leaves are used in the same way as the berries. 

Bay Cherry, or Bay Laurel, is the name given to the common Frunui 
Laurocerusus. This shrub goes by the name of the Laurel in our gardens. 
Its leaves and fruit contain oil of bitter almonds and hydrocyanic acid. They 
are used in the same manner as oil of bitter almonds. See Almonds. 

Bay Salt is a name given to a form of common salt, chloride of sodium, 
which is prepared from sea-water by evaporation in the sun. 



BEB 61 BEE 

Beberia is a substance obtained from the Greenheart tree of Demerara. It 
has tonic properties, and is said to be useful in ague, but is hardly ever used. 

Bed-sores are large unhealthy ulcers formed over the hips, buttocks, and 
the lower part of the hack of bedridden persons. They are due to long-con- 
tinued pressure on these parts, to a vitiated state of the blood, and to general 
debility, and are met with in the subjects of fever, paralysis, broken back, and 
in very old people who have been in bed for a long time. In cases of palsy 
of the lower half of the body, bed-sores are very large and deep, and spread 
with rapidity. A bed-sore commences as a dusky-red patch on the skin, which 
becomes excoriated. After the separation of the cuticle the surrounding soft 
parts become swollen, and the inflamed integument is converted into a gray or 
black slough, from the under surface of which there is a discharge of thin 
matter. This sloughing process extends both superficially and deeply until a 
large cavity is formed, which, in some instances, exposes bone. In old or very 
debilitated subjects, death is frequently the result of this affection. Except in 
cases of palsy and broken back the existence of a bed-sore bears witness to the 
incompetence or carelessness of the nurse. In cases of long-continued illness 
and confinement to bed injurious pressure on the back and hips may be pre- 
vented by the use of soft pillows and air and water cushions, and by a con- 
stant attention to cleanliness. Draw sheets should be placed over the lower 
half of the bed and be frequently renewed, and the buttocks and back ought 
to be washed twice in the day with a weak lead lotion or spirits of wine, and 
afterwards carefully dried. When a red patch makes its appearance on the 
skin, collodion should be applied and the inflamed part protected from further 
pressure by means of a circular air cushion perforated in the centre. When 
the skin is broken, resin ointment will be found a good dressing. The treat- 
ment of large sloughing sores consists in the use of poultices sprinkled with 
charcoal or chloride of lime, and in supporting the strength of the patient by 
good diet and alcoholic stimulants. In the first stage of bed-sore, when the 
skin is simply reddened, the contact for ten minutes of a bladder containing 
ice, followed by the application of a linseed-meal poultice, will often prevent 
further mischief. 

Beef-tea. The great object in making beef-tea should be to extract every 
particle of nutriment from the beef; and in order to make it good and nutri- 
tions there must be no stint in the quantity of material used. A pound of 
gravy beef will not make above a pint of really strong beef-tea. Where it is 
necessary to feed a patient with spoonfuls of beef-tea, and to get as much 
nourishment taken as possible to assist recovery, an excellent and delicious 
extract or essence of meat can be made by cutting up about a pound of gravy 
beef and placing it in ajar, with alternate slices of a nice large turnip and a 
little salt. Add no water, but cover the jar tightly and let it stew in an oven 
for six or eight hours. When taken out a most fragrant and nutritious cupful of 
extract of beef will be there, which will contain all the life-giving constituents 
of the meat. 

Beer. A form of alcoholic beverage made from the fermentation of roasted 
germinating grain. When a seed begins to germinate its starch is converted 
into sugar. By roasting, the process of germination is arrested, and the dried 
grain, under the name of malt, is used for making beer. The flower of the 
hop is added before the fermentation is commenced, and a bitter taste and tonic 
quality is given to beer which is not possessed by wines or spirits. Hence 
medicinally beers act as stimulants and tonics. Beer is sold, according to the 
way it is made, under various names. Thus we have ales, porter, and stout. 



BEE H2 BEN 

Ales are mild, strong, and bitter. Mild ales contain from half an ounce to an 
ounce of alcohol in the pint, and are most recommended as ordinary articles 
of diet. Strong ales contain from one ounce to an ounce and a half of alcohol 
in the pint, and ought only to be used when the stimulant eifects of alcohol 
are required. Bitter, pale, or Indian ales contain from one to two ounces of 
alcohol, and have a larger quantity of hops than either mild or strong ales. 
Porter and stout are brewed with over-roasted or blackened malts, and thus 
get a dark color. London porter contains from three-quarters of an ounce to 
an ounce of alcohol in the pint, whilst stout contains an ounce and a half. All 
these beers are bottled for sale. The only difference bottling makes is that 
the carbonic acid gas liberated during fermentation is kept in the bottle and 
passes out mixed with the beer. In some cases this carbonic acid has appar- 
ently the power of assisting digestion, and as a matter of experience is pre- 
ferred to draught beer. In some states of the system beer is a most objec- 
tionable article of diet. The uuf'ermented saccharine matter undergoes changes 
in the stomach which communicate certain properties to the blood favorable to 
the generation of such diseases as rheumatism aud gout. When the-e diseases 
are not produced, there is a general condition of the system brought about in 
which attacks of serious disease are rendered much more liable to a fatal ter- 
mination than they otherwise would be. 

Beeswax. See Wax. 

Belladonna, technically known as Atropa belladonna, is a native of Great 
Britain, flowering in June and July. All parts of the plant are active, but 
those chiefly used are the leaves and the root. From the leaves are prepared 
a tincture and an extract ; from the root, the alkaloid atropia and a liniment. 
The effects of belladonna are very striking, especially in allaying pain and 
arresting muscular spasm. In over-doses it is poisonous, and its attractive 
berries not unfrequently prove fatal to children. When taken internally the 
drug produces a dryness of the throat, and sometimes an eruption on the skin. 
This occurs w T hether the medicine is given internally or applied externally, and 
is taken advantage of by oculists in dealing with eye diseases. In many spas- 
modic or convulsive diseases belladonna is of use. Thus it has been used in 
asthma, in whooping-cough, in epilepsy, and in neuralgia. In inflammation of 
the eye, when there is danger of the pupil becoming closed permanently, bella- 
donna is of the greatest possible use by removing the edges of the iris as far as 
possible from each other. It is also of use in the incontinence of urine in 
children. Briefly, it maybe said that wherever there is much local pain, bella- 
donna does good. Here, it may be applied locally, either as a plaster made 
from the extract, or as a liniment containing a good deal of a strong tincture. 
In palpitation of the heart a plaster worn constantly over the part gives very 
great relief. In chronic rheumatism the liniment w^ell rubbed iu is of great 
value. Dose : of the tincture of belladonna, ten drops ; of the extract, half a 
grain. 

ATROPIA is the alkaloid or active principle of belladonna; combined with 
sulphuric acid it is used by oculists to dilate the pupil of the eye. Atropia 
should not be given internally, but may be applied under the skin. 

Bellain. A name given in Derbyshire, England, to painter's colic. See 
Lead Poisoxixg. 

Belly. See Audomex. 

Belly-ache. See Colic. 

Ben Oil is the expressed oil of the Ben nut, which is the fruit of a species 
•of Moringa. The oil is remarkable for not becoming rancid. 



BEN 63 BIS 

Benzoin or Gum Benjamin is a resinous exudation from a plant growing 
in the Eastern Archipelago. Combined with aloes, storax, and balsam of Tolu 
dissolved in spirit, it used to have a great reputation as a vulnerary or appli- 
cation to cut surfaces. This compound was known as Friar's Balsam. Jt is 
rarely given internally. 

Berberry. See Barberry. 

Beriberi, or the Bad Sickness of Ceylon, is a malady, as its name implies, 
almost confined to that island. The essential feature of the disease is a dropsy 
affecting almost every part and cavity of the body, though it commonly begins 
in the lower extremities. The heart, kidneys, and lungs are also affected. 
Death sometimes occurs suddenly. Little is known regarding the real nature 
of the malady. 

Berries, Poisonous. Children often eat poisonous berries, and show 
symptoms of illness before it can be found out exactly what they have eaten. 
When a suspicion of poisoning exists, an emetic of mustard and water or salt 
and water should be given, and the throat tickled with a feather till vomiting 
comes on ; then give vinegar and water, or milk, to neutralize the effect of the 
poison in the stomach. 

Betel is used in the East Indies as a masticatory. It is the fruit of a species 
of palm called Areca catechu. This fruit contains tannic acid, and it is on 
account of the astringent properties of this substance that it is used. When 
chewed, the nut is cut up and placed in a leaf of the Biper betel, and mixed 
with a small quantity of lime. 

Bile or Gall, the name of the secretion formed by the liver, and which is 
emptied into the gall bladder, from whence it flows into the intestines, where it 
mingles with the food. It is of a green color and intensely bitter taste, hence 
the term ''bitter as gall." (See Liver.) The gall of animals, more especially 
that of the ox, is used in medicine as a tonic, and in cases of deficient biliary 
secretion. 

Bilious Headache. See Headache. 

Birds as Food. Next to the flesh of mammalia, that of birds is most con- 
sumed as food by man. Sevei'al species are domesticated in this country, and 
used as food, whilst a large number of wild birds are congumed. About 40 
species are thus commonly used in America. Upwards of 170 species have been 
recorded as eaten by man in various parts of the world. The flesh of birds has 
not been so carefully analyzed as that of the mammalia. It contains, generally, 
more of the principle creatine, and this is especially the case with wild birds- 
Young birds contain albumen and gelatine, whilst older birds contain fibrine. 
The flesh of birds contains but little fat ; this is more especially the case in wild 
birds. Domestic fowls are fattened, more especially in the form of the capon. 
The goose and duck become fat by abundant feeding in domestication. The 
flesh of birds presents a greater variety of flavor than that of any other class 
of animals. As a rule, the flesh of carnivorous birds has a stronger flavor than 
those which are herbivorous or graminivorous. 

Birth-rate. See Population. 

Bismuth is used in medicine in two forms, the sub-nitrate and carbonate. 
The former is the more commonly employed. It is exceedingly useful in 
certain kinds of irritation of the stomach ; dose, five to twenty grains. As it 
is quite insoluble, it must be given in something which will suspend it ; gruel 
will do. Gum Arabic is commonly used for the purpose. A useful liquid form 
of the remedy is known as Schacht's Solution of Bismuth. Some people prefer 
the carbonate to the nitrate ; its effects are similar. 



BIS 64 BLI 

Bistoury. A long, narrow-bladed surgical knife. 
Bites. See Accidents. 
Bitter Almonds. See Almonds. 
Black Eye. See Accidents and Bruises. 

Black Draught is a popular name given to an infusion of senna with Epsom 
salts or sulphate of magnesia. 

Black Drop is a solution of opium in verjuice, the juice of the crab apple. 
It is sold in the shops as a patent medicine. One drop equals three of laudanum. 
See Opium. 

Black Vomit is a term applied to the dark-colored fluid that is thrown 
up in many fevers. It consists mainly of decomposed blood. It is often seen 
in yellow fever, and is considered one of the most disastrous symptoms of that 
disease. See Fever. 

Black Wash is made by adding calomel to lime-water, and is used as an 
external application for venereal and other sores. 

Bladder. This organ is situated in the pelvis, in front of the rectum in the 
male, and of the womb in the female. It is a hollow cavity, made up chiefly 
of muscular fibres, which enable it to contract, and lined within by a smooth 
coat of epithelium. It has three openings : two small ones on its posterior 
aspect, where are the ureters, these being the small tubes which convey the 
urine from the kidney on each side into the bladder ; in front there is also the 
opening into the urethra, or canal which allows the passage of the urine out 
of the lody. The bladder, like other organs, is liable to disease; it may be 
inflamed, and cause intense pain. (See Cystitis.) It may become dilated 
from being too full of urine, or its walls may become paralyzed, as in some 
cases of disease of the spine. (See Paraplegia.) A calculus, or stone, may 
become deposited or form in this cavity, requiring for its removal the operation 
of lithotomy or lithotrity ; or the prostate, a gland which is situated at the 
neck of the bladder, may become enlarged, as in old people ; or a tumor, either 
cancerous or simple in its nature, may be developed. 

Blebs, or Bullae, are large vesicles, like little blisters, which form on the 
surface of the skin in some diseases, and very frequently in the later stages of 
erysipelas of the face. 

Bleeding is a procedure not often adopted now, except in cases of heart or 
lung disease, where there is great obstruction to the circulation. Formerly 
nearly every one was bled as a matter of course every spring and autumn. 
The Operation is performed thus: The patient, sitting in a chair, bares his 
arm. and the surgeon fastens a piece of tape or bandage tight round it about 
two inches above the elbow ; in this way the return of venous blood to the heart 
is prevented, so that the veins in the bend of the elbow swell up and become 
prominent. The surgeon then slits up the vein with a sharp lancet, and draws 
as much blood as may be required. Gentle friction along the arm will encour- 
age the flow of blood. Bleeding is a mischievous practice, except in cases 
where the venous system is too full, and where the abstraction of live or six 
ounces of blood may prove beneficial. 
Blindness. See Eye. 

Blister. Any substance which, applied to the skin, raises the outer cuticle 
or scarf-skin, and fills the space between that and the true skin with water or 
serum, is called a blister. The most commonly applied blister is made from 
Spanish fly or cantharides ; besides which, mustard, crotou oil, nitric acid, etc., 
are sometimes used. Blisters are considered by many physicians to be most 
valuable, as they are most powerful remedies. They frequently produce a 



BLO 65 BLO 

desirable depletion of the system, and do away with the necessity for bleeding. 
The ordinary blistering plaster is composed of lard, suet, rosin, wax, and 
Spanish flies, a piece of which mixture is spread on adhesive plaster, cut to the 
proper shape and size. All blisters should have a margin of at least half an 
inch. The plaster must be spread with the thumb, smoothly and evenly, and 
not less than the thickness of a twenty-five cent piece. The time a blister takes 
to rise varies, but is usually between eight and eighteen hours. It is best to ap- 
ply a blister before going to bed. As soon as the blister has been formed, the 
plaster should be gently taken off, and the bag of fluid carefully nicked with a 
sharp pair of scissors at the lower part, so as to insure the escape of all the 
serum, which should be carefully prevented from running on to the skin. Care 
must be taken not to remove any of the outer skin. A warm bread poultice, 
inclosed in a piece of muslin, should now be applied, and kept on for an hour. 
When this is removed, the blistered surface should be dusted with violet powder, 
and covered from the air, a little fresh powder being added from time to time. 
This method of dressing a blister generally causes it to heal in a few hours, 
and prevents the cracking, smarting, and stiffness that often follows the appli- 
cation of ointment, or washing the part. Blisters are always liable to affect 
the kidneys, and, in some constitutions, produce very painful results. To 
prevent this, the patient should drink freely of barley-water, with about a 
scruple of powdered nitre in each quart, whilst the blister is on, and for awhile 
after its removal. A mustard blister is seldom used, unless severe counter- 
irritation is required : it is a painful remedy. 

Blood is that fluid which is formed from the food of animals, out of which 
all the organs of the body are developed. The blood of men, when drawn and 
looked at with the naked eye, is a red liquid. When allowed to stand a few 
minutes it coagulates, and is separated into two parts : a solid part, called clot., 
and a liquid part in which the clot floats, called serum. If a drop of blood is 
placed under a microscope before it coagulates, it is found to consist of two 
parts — a liquid called liquor sanguinis, and a number of small flattened 
globules or cells, which are called blood-globules. The latter are of two kinds, 
red and white ; the white globules are rounder, rougher, and larger than the 
red ones. The size and shape of the blood-globules varies in different animals: 
in sheep, oxen, and deer they are smaller than in man, and are much larger 
in reptiles ; they are oval in birds and fishes. A knowledge of the forms of the 
blood-globules has sometimes led to the detection of crime, by revealing the 
exact nature of blood-stains found upon clothes after the commission of crime. 
The liquor sanguinis consists of water, albumen, and saline matters. When 
blood coagulates, an albuminous body, which has been called blood-fibrine, is 
formed and separates, entangling the blood-globules, and constitutes the clot. 
The serum which is left holds in solution most of the albumen and saline matters. 
The serum also contains various other matters, such as coloring and odoriferous 
principles, with dissolved fatty matters. The proportion of these substances 
in 100 parts of dead blood is as follows: Water 79 parts, albumen 4, glob- 
ules 14, fibrin e £, and the salts and other principles 2|. It also contains 
oxygen and nitrogen gases, cai'bonic acid, and a little ammonia. Thus consti- 
tuted, it is carried by means of the heart and arteries to all parts of the body. 
On coming in contact with the delicate structures of the body it supplies them 
with new materials, by which they perform their various functions, and carries 
away those particles which have done their duty in the work of life. In its 
course through the body it is carried to various glands, which separate from it 
those compounds which are to be thrown off from the body. In the liver it 
5 



BLU 66 BLU 

gets rid of certain products which form the bile, and which appear to be again 
taken up into the blood in the bowels. In the kidneys it gets rid of a substance 
called urea. (See Heart.) Blood is the means whereby every structure 
which is worn out for the time being is renewed, and the means whereby its 
debris is washed away. Now blood consists of two parts, a solid and a fluid; 
the former consisting of what are called blood-corpuscles, red and white, which 
float in the fluid part of the blood. Either of these may exist in a morbid state, 
and so we shall try to consider the diseased conditions of each separately. 
When the blood is poor in quality, that is to say, when its red corpuscles are 
deficient, whatever other change may have taken place, the patient is said to 
suffer from Anaemia (which see). These corpuscles may also be imperfectly 
colored ; at all events the patient is pale, the gums white, and sometimes there 
is a greenish-white tinge all over the body. This last condition exists in what 
is called Chlorosis. There is, however, another condition, perhaps allied to 
these, in which not only are the red corpuscles imperfectly constituted, but the 
white ones greatly exceed their usual proportion. This condition is described 
as that of white-celled blood, Leucaemia or Leucocythrcrnia (which see). In it 
the spleen is generally greatly enlarged, and other organs may be so also. 
There is a condition where the blood is infected from a suppurating wound, in 
which pus is supposed to be found. This condition is characterized by the 
formation of abscesses in all parts of the body, especially the internal organs. 
It is common in war, after injuries to bone. It goes by the name of Pyaemia, 
that is, pus in blood. In all of these conditions, the solids of the blood are 
concerned ; in those which follow it is the fluid part which is at fault. First 
among these is a very rare form of disease called Piarrhaemia, where the fluid 
seems to contain an excess of fat. More common is that condition which gives 
rise to diabetes, where there is an excess of sugar in the blood. Wherever 
sugar is found in the body, it is thence removed by the blood, and if in excess 
is removed by the urine. Now this is the constant rule with another substance, 
the removal of which is essential to life. This substance is urea, and the con- 
dition characterized by excess of urea in the blood is called Uraemia. This 
condition supervenes in diseases of the kidneys, which interfere with their 
function, and is the common mode in which these prove fatal. (See Uraemia.) 
There are yet other morbid states of the blood, in which the fluid portion is 
altered ; one of these is characterized by a general yellow tint of the body. Bile 
is circulating with the blood, and the body turns yellow in consequence. This 
is jaundice, or, if the bile has not been formed, and its unformed materials are 
circulating, there will be no jaundice ; this is acholia or suppression of bile. 
There are three other conditions in which the blood is altered, but in a way as 
yet unknown to us. There is in some individuals an uncontrollable tendency 
to bleeding from their birth upwards ; this is spoken of as a hemorrhagic 
diathesis or haemophilia. Again, there are two conditions acquired by insuffi- 
cient food and exposure, the cause of which we know, though the changes in 
the blood are unknown. These are sea scurvy and land scurvy, or purpura. 
See Scurvy. 

Blue Disease. See Cyanosis. 

Blue Ointment, the popular name of the mercurial ointment of the 
Pharmacopoeia. It is made with fresh lard, suet, and pure quicksilver. See 
Mercury. 

Blue Pill, I he popular name of the mercurial pill of the Pharmacopoeia. 
(See Mercury.) It is made with conserve of roses, licorice root in powder, 
and pure quicksilver. 



BOI 



67 



BON 



Boil. As boils frequently depend upon the state' of health, constitutional 
treatment is necessary. If soft, red, and painful, a hot linseed-meal or bread 
poultice should be applied (see Poultick), and a clean cut made well into it 
with a sharp penknife or lancet. If indolent, a mixture of equal parts of glyc- 
erine, extract of opium, and belladonna, with about twenty times its bulk of 
resin ointment, is a most excellent application, or iodine paint in obstinately 
indolent cases. The constitutional treatment consists in the administration of 
tonics, such as iron, quinine bark, and ammonia ; the bowels should be kept 
open, but not purged. 

Boiling. Liquids boil and freeze at various temperatures. Water freezes 
at 32° and boils at 212° of Fahrenheit's thermometer. Alcohol boils at a tem- 
perature of 192° and ether at 96°. Boiling water is sometimes used for sud- 
denly producing a blister. 

Bone. The hard parts of the vertebrate animals which form their skeleton 
are called bones. Bones are divided into two sorts, cartilaginous and osseous. 
The former are characterized by the absence of phosphate of lime, whilst the 
latter consist of from forty to sixty per cent, of that material. In the living 
human body the bones contain a considerable quantity of water; when dried, 
they are found to consist of about one-third of organic matter, and two-thirds 
earthy matter. The organic matter consists of fat and gelatine. The teeth 
are composed of the same materials as the bones, but they contain less organic 
and more mineral matter. The enamel of teeth contains only two per cent, 
of animal matter. The following table gives the composition of bones in one 



Constituents. 


Ox. 


Sheep. 


Man. 


Tooth. 


Enamel. 




30.58 

57.67 

2.69 

6.99 

2.07 


26.54 

61.99 

2 79 

6.92 

1 58 


31.11 

59.14 

2.23 

6.32 

1.20 


28.6 

j- 64 3 

5 3 
1.0 
1.4 


9 


Phosphate of lime 

Fluoride of calcium 

Carbonate of lime 

Phosphate of magnesia 

Other salts 


88.5 

8.0 
1.5 



hundred parts. Although the bones are very hard, like all other tissues of the 
body, they are developed from cells. Originally, the bony skeleton in the 
young of the higher animals is composed almost entirely of cartilage. Grad- 
ually bony matter is deposited in the cartilage, and the osseous takes the place 
of cartilaginous tissue. It is some years after birth that the cartilaginous skel- 
eton of the fetus becomes fully converted into bone. Bony matter is, how- 
ever, formed after birth independent of cartilages, as is seen in the union of 
bones after a fracture, or in the formation of new bones in cases of necrosis. 
(See Necrosis.) When a very thin slice of bone is examined under the mi- 
croscope, it is found to consist of fibrous, hard material, in which are a series 
of radiating bodies — black spots with lines running in all directions — look- 
ing like minute insects. These are really little cavities, and are called bone- 
lacunce ; they are the active agents in the growth of the bone. These cav- 
ities radiate around certain centres or tubes, which are called the Haversian 
canals, and which serve as passages for the minute blood-vessels and capillaries 
which nourish and cause the bone to live. The cartilages present much sim- 
pler cells than those of bone, and between them are deposited much larger 
quantities of intercellular matter. The cartilages also possess fewer blood- 



BOO 68 BRA 

vessels than the bones. The teeth resemble boue in their ultimate structure. 
On the outside of all teeth is the enamel, which contains very little animal 
matter, and a great deal of mineral matter. The outside of the fangs of the 
teeth is covered with bony matter, whilst the mass of the tooth is made of a 
substance called dentine, which stands between the bony matter and enamel in 
the quality of hardness, aud is full of very little tubes, which meet in the 
middle of [he pulp. Bone dust is used for making jellies. Ivory dust con- 
tains more phosphate of lime than bone dust. In rickets and softening of the 
bones and scrofula these things may be used as articles of diet with advantage. 
The marrow of bones is principally fat; it may be taken by invalids where a 
fatty diet is indicated. Bones when damp are liable to decompose, and when 
used for cooking purposes should be employed fresh and be well crushed be- 
fore they are cooked. 

Boots, as proved in the Franco-German war, are often things of the very 
utmost importance to troops. To private individuals, if of less importance one 
way. they doubtless exercise a very considerable influence in the comfort of 
the individual. The shape of the boot should be suited to that of the foot as 
set down on the ground, when the individual partially rests on it ; the sole 
should he broad, and the heel on a level with the sole. 

Borax, known to chemists as biborate of soda, is chiefly used as a domestic 
remedy for children whose mouths are sore with thrush. It is mixed with 
honey, and smeared all over the inside of the mouth. 

Bougie is a long and smooth cylindrical instrument used in the treatment 
of stricture of the urethra, rectum, or any other canal leading to the interior 
of the body. There is great variety in their size and composition. The treat- 
ment by bougies consists in passing the instrument through a stricture, and al- 
lowing it to remain for a time, in order to produce by pressure gradual relaxa- 
tion of the contracted portion of the canal. The parts of the body into which 
a bougie is introduced in disease are the urethra, the gullet, the rectum, the 
entrance to the womb, and the Eustachian tube or canal leading from the back 
of the throat to the internal ear. When a rapid dilatation of the contracted 
passage is required, recourse is had to bougies formed of some material which 
will readily expand when moistened. Instruments of this kind are usually 
composed of catgut, of pieces of compressed sponge, or of the stem of the sea- 
tangle (LaminaHa, digitata). 

Bowels. See Abdomen. 

Brain. The brain is a complicated structure formed of nerve-tissue, and 
constituting a most important part of the nervous system of man. It is in- 
closed in a bony cavity called the skull, and is thereby protected in a great 
measure from external injury ; it has also three special membranes covering 
it : the dura mater, a fibrous texture lining the skull ; the arachnoid, a fine 
delicate membrane lining the dura mater, and covering also the brain ; and 
finally, the pia mater, a tissue rich in vessels, which here become of very mi- 
nute size, and. running into the brain, supply that organ with blood. The brain 
is formed in two nearly, if not quite, symmetrical halves, which are partially 
joined together, so that a close communication exists between each division. 
Each part is composed of a vast number of white fibres, which form a great 
proportion of the bulk, while externally there is a shell of gray matter, where 
the nerve cells are met with, and where the active functions of the brain in 
great measure are developed. This shell, or superficial layer of gray matter, 
is in man aud the higher animals very much convoluted, so as to increase the 
superficial area ; the convex surface of the braiu is marked with a number of 



BRA 69 BRA 

sulci, or grooves, into which the vessels of the pia mater dip and supply the 
nerve cells with nutriment. The white fibres merely convey impressions, 
while in the gray matter reside the functions of the mind. Those functions of 
the brain which are called the intellect, emotion, and will, and which together 
make up the mind, have their seat in the outer gray shell, which is made up 
of layers of delicate nerve-cells, freely supplied with blood ; but each nerve- 
cell communicates with other nerve-cells, and with distant parts by means of 
fibres, and these fibres pass down through the spinal cord and ramify all over 
the body under the name of nerves. For instance, we desire to move a 
hand ; through the influence of the will, or volition, an impression is sent by 
means of these fibres from the surface of the brain down to the right muscle 
or muscles of the arm which have to perform the movement ; the direction of 
the current here is from the centre to the periphery or circumference. Again, 
when a finger is pricke 1 the sensation is really felt in the brain, and conveyed 
there by another set of fibres ; it is not until the brain receives the message, 
not until it knows what has taken place, that we feel the sensation called pain. 
The direction of the current is here from the periphery to the centre ; the 
first set of fibres are called motor or excito-motor, and the second set sensory 
or exeito-sensory. Besides this large circuit there are smaller ones, whose 
movements are made unconsciously ; such movements are termed reflex move- 
ments, and the will has no power over them. Besides this active gray matter 
and the white fibres in the brain, there are numerous local centres in each 
half, termed nuclei ; they also are formed of nerve-cells', and from them proceed 
various nerves which have special duties to perform. These nuclei are seated 
in the lower part of the brain, and near its middle line, and the fibres from 
them form nerves which, emerging from the base of the brain, pass through va- 
rious holes in the skull, called foramina, and then they supply the parts for 
which they are destined. These nerves are twelve in number on each side, and 
are divided from before backwards as follows : (1.) The olfactory nerve, which 
supplies the mucous membrane of the nose, and to which we owe the special 
sense of smell. (2.) The optic nerve passes forward and supplies the retina, a 
delicate membrane spread out within the eye, and by means of which we have 
the special sense of sight. (3.) The motor oculi, which is distributed to nearly 
all the muscles that move the eye. (4.) The fourth pair supply the superior 
oblique muscle of each eye. (5.) The fifth pair are very much larger ; each 
nerve has a motor and sensory root ; the former supplies the muscles used in 
deglutition, the latter supplies the skin of the face, and from having three 
chief branches has received the name of trigeminal ; it is the nerve of common 
sensation for the face, and is affected in cases of neuralgia. (6.) The sixth pair, 
supply the external rectus of each eye, and turn the eye outwards. (7.) The 
seventh pair furnish motor nerves to the muscles of the face , this is called the 
facial nerve. (8.) The eighth pair are the auditory nerves, or special nerve of 
hearing; they supply the internal, ear. (9.) The ninth pair (glossopharyngeal) 
are mixed nerves ; they contain special fibres for taste, and motor fibres for 
the pharyngeal muscles. (10.) The tenth pair are formed by the pneumogastric 
nerves ; these go to parts a long way from the brain ; they supply the larynx, 
lungs, heart, liver, and stomach. (11.) The spinal accessories really come from 
the spinal cord, but they emerge from the skull ; they are motor nerves to 
some muscles of the neck. (12.) The hypoglossal nerves, which supply the 
muscles of the tongue. Some authors describe only nine pairs ; they bracket 
together the seventh and eighth as one pair (the seventh), and the ninth, tenth, 
and eleventh as one pair (the eighth) ; in that way the hypoglossal nerves form 



BRA 



7» 



BRE 



the ninth pair. The brain is not a solid body, but hollowed within into various 
cavities, called ventricles, which are lined by a fine epithelial membrane, and eon- 
tain a little serous fluid. The lateral ventricles are the largest, and are found 
one in each hemisphere; the third ventricle lies below them, while the fourth is 
smaller and more posterior ; it is here that many important nerves arise, and 
any injury to this spot will cause rapidly fatal results ; the fifth ventricle is 
very small and unimportant. The internal carotid and the vertebral arteries 
on each side are the chief vessels which give the brain its blood; on entering 
the skull, they divide and form very free communication with each other at the 
base ; then, more minutely dividing, they ramify all over the surface of the 
brain and enter its substances; the blood returns by passages hollowed out in 
the dura mater, called sinuses. The various diseases of the brain will be de- 
scribed under the names by which they are commonly known. 

Bran. When wheat is ground in the mill it is separated into two portions, 
the flour and the bran. The flour is the inner portion of the grain, while the 
bran is the outside. Jt is separated on account of its coloring the flour and 
making it look coarser. It is, however, frequently retained and mixed with 
the flour made into bread. Such bread is called whole me.nl or brown bread. 
The ingredients of a pound of bran, as exhibited at the Betlmal Green Mu- 
seum, are as follows : — 



Ozs. Grs. 

Water 2 92 

Gluten and cerealin . *. . . 2 16 

Starch 8 128 

Suc:ar 70 



Fat . . 

Woody pith or cellulose 
Mineral matter . . . 



Ozs. Grs. 

2C2 

1 242 
258 



From this statement it appears that bran contains more flesh-forming matter 
and mineral matter containing phosphate of lime than the flour does. Where 
persons can digest brown bread it is undoubtedly more economical than white 
bread. Bran, however, in its coarse condition acts upon the bowels, and whilst 
it forms a very excellent diet where the bowels are confined, it is on that ac- 
count to be avoided where the bowels act too freely 

Brandy, a form of distilled spirits. It is usually distilled from some form 
of wine, and peach kernels are added to it whilst "being distilled, which gives it 
its characteristic flavor. Brandy usually contains more alcohol than other dis- 
tilled spirits, and on this account is more frequently used as a stimulant in dis- 
ease. There is nothing in brandy to make its action in any way peculiar. 
The very small quantity of oil of bitter almonds or hydrocyanic acid afforded 
by the peach kernels could not in any way affect its action. See Alcohol. 

Bread. All food is called by tins name which is made from the flour of 
grains or seeds, and then made into a dough and baked. At the present day the 
most common form of bread is that made from the flour of wheat. Other 
flours are used, as those of rye, barley, maize, and millet, but the flour of these 
grains is unsusceptible of fermentation; thus this kind of bread is heavier 
than that which is fermented. By the process of fermentation bread is made 
vesicular, because we divide bread into vesiculated and unvesiculated, or into 
unleavened and leavened bread. Flour which has the dough mixed with 
yeast, in order to start fermentation, is called leavened bread. Vesieulation 
in bread is also produced by what is called aeration, and bread thus made is 
called aerated bread. It is prepared by adding carbonate of soda to the flour 
and an acid. Another way is by injecting carbonic acid into the dough, which 
on being expelled vesiculates the bread without interfering with its composition. 
The principal constituents of bread are starch and gluten, which exist in the 



BRE 71 BRI 

proportions of about four to one. Wheaten bread is the substantive article of 
diet of four-fifths of the inhabitants of Europe and America. Unleavened 
t bread is less digestible than leavened bread. Bread leavened with yeast is 
sometimes found to disagree with weak stomachs, and in these cases the aer- 
ated bread is to be preferred. The addition of butter to bread appears to in- 
crease its digestible property, and adds to the alimentary properties represented 
by the starch. 

Breast. At the age of puberty the breasts both of girls and boys are sub- 
ject to swelling and tenderness, whicb is perfectly natural, and subsides of it- 
self after a short period of inconvenience. Soke Nipples. These painful 
cracks, or excoriations, are best treated by "painting them over with collodion, 
and the nipple should be protected from the child's mouth or from the woman's 
clothing by means of a metallic or caoutchouc shield (not vulcanized). Wash- 
ing the nipple several times daily with a solution of alum is of great service. 
The breast is peculiarly subject to tumors, the characters and diagnostic fea- 
tures of which may be found in any work on scientific surgery. There is, how- 
ever, one form of disease, "of which it seems important to say a few words, 
and that is cancer. (See Cancer.) It first commences as a swelling, attracting 
notice by its presence, is hard, with a tendency -to increase in breadth rather 
than prominence, seems adherent to the structures above it instead of rolling 
from under them, causes the nipple after a while to contract and pucker in, 
and when pain comes on it is severe and lancinating in character. After a 
while the skin ulcerates and the cancer spreads, the glands in the armpit be- 
come hardened or indurated, and the health and strength rapidly decrease. 
The most frequent disease of the female breast which the public are acquainted 
with, perhaps, is abscess. It may arise from several causes, such as lactation, 
blows, cold, neglect in suckling, sore nipples, etc., and is attended with swelling, 
great pain, tenderness, fever, and shivering. The breast should be fomented 
or poulticed, " slung " with a handkerchief or bandage, and the bowels kept 
open by a mild purgative ; as soon as the matter ''points," that is. comes to the 
surface, a vertical incision should be made into it with a sharp lancet. Poul- 
tices should be applied, and tonics of iron, quinine bark, and ammonia, port 
wine, etc., given. 

Breast-bone, a common name for the sternum, a bone wdiich runs down 
the front of the chest, and to which the cartilages of the ribs are attached. 

Breast-pang. See Angina PECTOPas. 

Bright' s Disease. This is a name applied to several affections of the 
kidney which are dependent upon an altered condition of the blood, and gen- 
erally associated with dropsy and with albumen in the urine. Nephritis is the 
scientific term applicable to this affection ; the disease may be either acute or 
chronic, so that acute nephritis is synonymous with acute Bright's disease, and 
chronic nephritis with chonic Bright's disease. (1.) Acute Bright's disease may 
occur from a cold, from a blow, from taking substances, like turpentine, or 
cantharides, which irritate the kidney ; but more usually it follows some acute 
febrile disturbance, and more especially it is associated with scarlet fever. 
About the second or third week after the commencement of scarlet fever, the 
patient may find his urine of a dark, porter color, and rather diminished in 
quantity ; at the same time he will feel lassitude, probably slight pain across 
the loins, and there may be puffiness of the eyelids and loose parts of the skin ; 
if kept in bed, the urine in a few days becomes paler, but still looks very 
cloudy and deposits a copious sediment on standing ; when boiled, a fiocculent 
precipitate is thrown down, because the albumen which is present becomes 



BRI 72 BRI 

coagulated. At times convulsions occur, which may be very numerous and 
end fatally; at the same time less water is passed. Treatment: Hot baths 
do good by causing sweating and giving free action to the excretory power of 
the skin ; they may be given at bed-time and repeated every night; the water 
should be about 9o° to 98° Fahr., and the patient may remain in it from five to 
ten minutes, and then lie quickly dried and put to bed at once. Purgatives 
should be given, such as compound jalap or compound scammony powder. 
Rest in bed in a warm room is most important, nor ought the patient to think 
of leaving his room until all the dropsy and acute symptoms have subsided. 
Light nourishing food may be taken, as bread and milk, beef-tea, fried sole, 
broth, a little mutton, rice pudding, arrowroot, and gruel. During convales- 
cence, great care must lie taken to avoid cold. Flannel should be worn next 
the skin; moderate exercise may be taken, and a nourishing diet; no stimu- 
lants are required in this disease, but after recovery a pint of beer or two 
glasses of cherry or claret may be taken every day with benefit; tonics con- 
taining iron and quinine will relieve the debility and the anaemia. (2.) Chronic 
Bright s disease occurs in three forms : (a) a large fatty kidney ; (b) a large 
waxy kidney ; (c) a small contracted kidney, (a.) The fatty kidney occurs in 
scrofulous or consumptive people, and in those who drink, sometimes. The 
course of the disease is very long, and may last for years; it comes on gradu- 
ally, and the first thing the patient may notice is that he passes less water and 
that his legs swell ; this swelling is caused by dropsy of the lower extremities, 
and is worse at night than in the morning ; the skin is pale and pits readily on 
pressure. (See CEdkma.) The urine is small in quantity, often darker than 
usual, throws down albumen on boiling, and there is more or less deposit when 
it .stands. In many cases much relief may be obtained if the case is treated in 
time, but the dropsy then may come back and spread upwards, so that the ab- 
domen becomes distended with fluid. (See Ascites.) The breathing is then 
impaired, and the more so if any hydrothorax is present, as the lungs are en- 
croached upon and there is less space for breathing. The heart has more work 
to do. and becomes hypertrophied and thicker and larger than usual; there is 
often nausea or vomiting, headache, and now and then epistaxis. The face be- 
comes pale or sallow, and the skin all over the body may become ocdematous. 
There is no fever or pain ; the appetite is often very fair, and the chief distress 
arises from the dropsy which is met with in the various tissues. The treatment 
consists dt' rest in bed. hot-air or hot-water baths to encourage the action of the 
>kiii. and purgatives which shall cause watery motions ; for this purpose jalap, 
scammony, and cream of tartar are to be recommended. If the dropsy in the 
legs be very great, they may be pricked with a needle or a lancet, in several 
places, so as to let the fluid out ; the legs should then be wrapped in hot flan- 
nel, and a mackintosh placed on the bed underneath. Although relief may 
thus be given tor a time, the patient will ultimately die, worn out by the con- 
stant drain of albumen from the blood, or suppression of urine may come on, 
and cause convulsions, coma, and death, (/a) The waxy kidney occurs in those 
who have Buffered from diseased bone, scrofulous abscesses, or from syphilis, 
or who have been exhausted by wasting diseases. Nearly always the liver and 
spleen share in the general mischief, and become much larger than usual. 
Such patients pass a large quantity of pale-colored urine, which contains plenty 
of albumen, but deposits hardly any sediment. The course of this disease is 
also very chronic, and may go on for years; it occurs in children as well as in 
adults; as in the last Case, there is no fever, nor is the appetite impaired par- 
ticularly. Death will eventually take place under similar conditions to those 



BRI 73 BRO 

mentioned under the fatty kidney. A nourishing light diet should be given, 
and tonics containing iron and quinine ; warm clothing must be worn, and 
moderate exercise may be taken when the weather is fine and mild, (c.) The 
small contracted kidney occurs chiefly in gouty people and in those who drink 
much. The disease comes on very insidiously ; dropsy is rarely present, but 
much less water is passed than in the last case, although there is often more 
than usual ; it is pale in color, deposits very little sediment, and contains only a 
little albumen. Debility, headache, a sallow expression, occasionally nausea 
and epistaxis, are symptoms met with in this form of disease. With it is often 
associated disease of other organs ; the vessels often have fat or saline matter 
deposited in their walls, and are then said to become atheromatous and cal- 
careous ; the tissues supplied by these vessels are therefore badly nourished, 
and suffer in consequence ; the brain is frequently involved, and haemorrhage 
into its substance may result, and cause apoplexy. (See Apoplexy.) The 
heart may become diseased, and inflammation of the pericardium or endocar- 
dium may ensue and add to the danger. (See Pericarditis and Heart.) 
Death may therefore take place by one of these complications carrying the 
patient off, or the urine may become suppressed and cause convulsions, followed 
by coma and death. The treatment is .-imilar to that mentioned in the last 
variety. In all cases of B right's disease the eyes are apt to become affected 
from changes taking place in the retina, which cause dimness of vision and 
even blindness. The origin of Bright's disease is always in the blood, and 
that fluid in turn becomes still further altered by becoming contaminated with 
materials which ought to pass ofF by the kidneys, but which are retained in 
the system ; the blood also becomes poor in quality by being daily drained of 
albumen — one of its most important constituents. Pallor, debility, loss of 
flesh, and defect in the general nutrition arise from this cause. 

Brimstone. See Sulphur. 

Bromine, an elementary substance found in sea water, in company with 
chlorine and iodine. It is found in combination with sodium, and is used ex- 
tensively in medicine. 

Bronchi, the name given to the air-passages which pass from the wind- 
pipe, and are distributed to the whole of the lungs. (See Lungs.) 

Bronchitis is an inflammatory disease of the lining membrane of the 
bronchial tubes. It may be acute or. chronic. (1.) Acute Bronchitis. This 
complaint is very liable to attack persons in the winter and at times when the 
east or the northeast winds are prevalent. It commences with the symptoms 
of a common cold ; there is first a feeling of chilliness and aching pains in the 
limbs ; the patient is thirsty and feverish, with languor and headache, loss of 
appetite and restlessness. There is an uneasy feeling of soreness behind the 
sternum or breast-bone, increased on taking a deep inspiration or in going out 
into the cold air. At first there is a dry, hacking cough, and very little phlegm 
is brought up ; in two or three days the cough becomes looser, and the ex- 
pectoration is more abundant ; the latter is frothy, viscid, and shortly becomes 
of a greenish-yellow color ; this is attended with relief to the patient, and the 
feeling of soreness and constriction in the chest then goes away. Wheezing 
sounds are heard in the air-passages, and may be felt when the hand is placed 
on the chest or back. The sounds are due to the air passing over the viscid 
mucus, which more or less fills the bronchial tubes. Treatment : As soon as 
the patient feels ill he should go to bed, and keep there until he is well again ; 
in this way an attack may be checked in a few hours ; the air should be warm, 
and for this purpose a fire may be lighted and the temperature kept up be- 



BRO 74 BRO 

tween 60° and 63° Fahr. There should also be a certain amount of moist- 
ure in the air, and to effect this a kettle of boiling water may be placed on 
the fire, and the steam allowed to pass into the apartment ; this may be done 
two or three times a day, and for about ten or fifteen minutes at a time. A 
warm bath before going to bed is also a most useful remedy, but the patient 
should be well dried and put to bed directly afterwards, so as to encourage 
free perspiration. Some are in the habit of taking a Turkish bath when they 
have an attack coming on; the only inconvenience in this procedure is the re- 
turn home through the cold air afterwards. A warm glass of whisky and 
water, or port-wine negus, may be taken at bed-time, and this with much com- 
fort to the patient; a little prepared barley boiled in half a pint of milk, to 
which is added a wineglassful of whisky, some grated nutmeg with sugar 
and lemon-juice, according to taste, will be found a very agreeable potion at 
night-time. The patient will not care to eat any solid food at first ; bread and 
milk, rice pudding, or one made of arrow-root, tapioca, of ground rice, may be 
given ; broth or beef-tea or chicken-broth ; jellies may also be taken ; as a 
rule, hut, bland fluids are most enjoyed. A hot linseed-meal poultice may be 
placed on the chest, and renewed when it becomes cold : to prevent the moist- 
ure from wetting the clothes a piece of oiled calico or gutta-percha tissue may 
be placed over the poultice. Good linseed-meal should not be dry, but have 
a moist appearance, and feel greasy when rubbed in the hand ; the more oily 
it is, the longer it will retain the heat. The patient should wear a flannel 
shirt next the skin. Cotton wool laid on the chest is often as good as a poul- 
tice. Hot local applications, assisted by warm and moist air and a few do- 
mestic remedies, will generally suffice to cure an attack of acute bronchitis ; if, 
however, the disease be neglected in its early stage, and the patient be ex- 
posed to draughts and cold air, serious symptoms may arise. Such symptoms 
would be indicated by the lips becoming of a purplish color, while the cheeks 
would be pale and livid ; the expression becomes more and more anxious, 
while the entrance of air into the chest is more difficult, and the patient makes 
painful efforts to breathe. Delirium may come on, and rapid sinking ; in these 
cases the patient dies from apncea. and the bronchial tubes are choked up with 
the viscid secretion which he had not strength to expectorate. Cupping-glasses 
may he applied to the chest with much benefit, while stimulant expectorants, 
as ammonia and ether, may be given internally- Although the cough may be 
very troublesome, and the patient may complain much of want of rest, yet it 
is often very dangerous to give opium or any preparation of that drug, as it 
will add to the congestion and may hasten a fatal termination. Acute Bron- 
chitis in Children is of much graver importance than in the adult, and a great 
deal of the mortality in childhood arises from this disease. In children the 
mischief is very apt to spread down the bronchial tubes even to the smallest 
branches, while in the adult the main branches are, as a rule, the seat of the 
disorder, and it is in proportion to this downward extension that the relative 
danger lies; for the more the smaller tubes are affected, the less can the blood 
become properly aerated, "and death may take place from suffocation. This 
disease begins with the symptoms of an ordinary cold, but by degrees there is 
more fever and restlessness ; the heat of the skin, as shown by the thermometer, 
is much above the average, the pulse rapid, the breathing quick and wheez- 
ing ; the cough is more frequent and painful, and then the veins of the fore- 
head and neck stand out, and the face is flushed. The child feels as if the 
chest were stuffed, and wheezing sounds may be felt on both sides when the 
hand is placed over the back or front of the chest. At bed-time the fever and 



BRO 75 BRO 

cough are generally worse, and the child is more restless ; then it will often 
sleep for several hours and awake with a fresh accumulation of mucus and 
phlegm in the chest, which causes it to make vigorous efforts to expel it by 
coughing ; vomiting may come on, and this may give relief by freeing the 
tubes of the mucus and allowing easier respiration. The tongue is moist 
throughout, the appetite bad, while there is more or less thirst. If the little 
patient become worse, the face may be pale while the lips are rather livid ; the 
nostrils dilate with each inspiration, and the breathing is more hurried and 
difficult. Convulsions often precede a fatal termination ; generally death 
takes place without much suffering, as the child passes gradually into a sleepy 
and unconscious state. The treatment should begin as soon as possible, as 
any delay is dangerous. The child should at once be placed in bed, and 
wrapped in a flannel blanket or shirt, and the temperature of the room kept 
between 60° and 65° Fahr. A warm bath may be given at the outset, so as 
to encourage the action of the skin ; the child should then be quickly dried 
before a fire and placed in bed. Cotton wool should be laid on the chest, or 
a large piece of spongiopiline wrung out of hot water ; a hot linseed-meal 
poultice may also be similarly used ; occasionally a little mustard may be 
mixed with the linseed-meal. The bowels may be opened by a dose of castor 
oil. An emetic of ipecacuanha wine may be given if there is much wheezing 
and stuffing of the chest, and this will often relieve much discomfort. Ex- 
pectorant medicines should be given so as to enable the patient to expel the 
mucus which is being poured out into the bronchial tubes. At the same time 
the strength must be carefully supported ; milk should be given freely, and, if 
necessary, a few doses of brandy may be put in also. Beef-tea or veal-broth 
may be given alternately ; solid food is not to be given. When all the severe 
symptoms have subsided, the patient may return gradually to its usual diet, 
and the exhibition of some steel wine, or other tonic, will expedite the re- 
covery. (2.) Chronic Bronchitis. This is a very common disease, and is very 
prevalent during the winter months, causing a great deal of mortality. It is 
most usually met with in middle-aged or old people, and in those who suffer 
from emphysema. Cough, shortness of breath, and expectoration are the three 
most constant symptoms of chronic bronchitis. This disease may occur as a 
consequence of old age merely ; in such cases the lungs lose in some measure 
their elasticity, and the chest cannot so well be expanded ; the blood does not 
then pass readily through the lungs, and the bronchi become congested ; then 
any slight variation of temperature, or a foggy, raw day, which might not af- 
fect a young and healthy person, will bring on a severe attack of difficulty of 
breathing, and compel the sufferer to go to bed, and keep indoors until the 
severity of the symptoms has passed off. The patient is then seldom able to 
lie down with comfort, but prefers a half-sitting, half-reclining posture, where 
he can be supported by pillows, and aid his breathing by leaning on his hands 
so as to fix his shoulders. Again, this disease may come on as a sequel to an 
attack of acute bronchitis. Cabmen, porters, constermongers, bargemen, in 
short, any whose occupation exposes them to all kinds of bad weather, are ex- 
tremely subject to this disease, and every year they become more and more 
wheezy and short of breath. Also, persons who have suffered badly from 
whooping-cough or lung affections in childhood, are liable to winter cough and 
chronic bronchitis. Those who are liable to a cough every winter generally 
become, sooner or later, emphysematous. They are unable to undergo any 
great exertion because they are so short of breath ; the chest does not expand 
so much as usual, and they often require support when the breathing is more 



BRO 76 BRU 

difficult than usual ; they cannot lie down at night, hut prefer a reclining 
posture in bed ; the lips are livid and congested, and the eyes bright and watery. 
Palpitation of the heart is common, and a feeling of fullness at the bottom of 
the sternum. The circulation of the blood through the lungs being obstructed, 
the large veins become distended, and dropsy of the legs is very common in 
those who have suffered long with this complaint. The sleep is often disturbed 
at night from attacks of dyspnoea, or difficulty of breathing, and this is much 
aggravated on a foggy night. The appetite is injured, and any indigestible 
food makes the patient worse, by causing distension of the stomach, and thereby 
encroaching on the thoracic space by pushing up the diaphragm. Treatment : 
The best treatment for chronic bronchitis, in a variable climate like ours, is 
change of country and passing the winter in the south of France, or in some 
place where the variations of temperature are slight, and where there is an 
absence of fogs and east wind. To the majority of people this is, of course, 
impossible, and the treatment must be directed to avoid as much as possible 
any exposure to cold, or to any of the exciting causes of this disease. To those 
who are engaged in out-door occupations, and exposed to all the inclemency 
of the weather, but little can be done except to alleviate any distressing 
symptoms that may arise ; thick boots should be worn, so as to prevent damp 
and cold feet. Flannel should always be worn next the skin, and warm baths 
may be occasionally taken, so as to keep the functions of the skin in good 
order. The diet should be nourishing, but easily digestible ; meat may be 
taken at least once a day, and a pint or two of beer, but starchy food, as pota- 
toes, bread, etc., should only be taken in moderate quantities. Such people 
should go out after sunset as seldom as possible, and they should not talk in 
the open air on a cold day, but breathe through the nose, as in this way the 
air is somewhat warmed before it passes down the bronchial tubes ; a respirator 
is often of great service. For those who are not obliged to work, and can 
afford to spend the winter in a mild climate, much benefit will be found by 
going out only on fine, days, and by avoidance of night air. See Asthma and 
Emphysema. 

Bronchocele. See Derbyshire Neck. 

Bronzed Skin is a peculiar discoloration occurring in Addison's disease ; 
very little is known as yet about its nature, and there does not seem to be any 
means of remedying the color. See Addison's Disease. 

Broom, the common name of the Sparlium scoparium, a shrub extensively 
distributed throughout the British Islands. The tops or ends of the branches 
are employed in medicine. They are emetic and purgative, and in small doses 
they act as diuretics. 

Brow Ague is a form of headache in which the pain recurs regularly at 
a fixed hour. It has not necessarily anything to do with malaria, such as 
induces fine ague, but headache in an individual who has been exposed to such 
influences is apt to assume an intermittent type. See Headache and 
Malaria. 

Bruise, or ecchymosis, is a painful and livid swelling at or near the sur- 
face of the body, which is caused by external violence, as a fall or blow 
inflicted by some blunt object. It is met with in most cases of contusion, and 
also with fractures and dislocations, and is caused by the rupture of blood- 
vessels and the pouring out into the subcutaneous soft tissues of blood or 
blood-stained fluid. Bruises vary very much in extent, color, size, and situation. 
Jn the slightest form there is a small and superficial patch of a light or dark 
red color, and attended with very little swelling. In the most severe cases a 



BRY 77 BUC 

soft swelling is formed as large as a child's head, or the whole of a limb is 
swollen and of a black or dark blue color. The rapidity with which a bruise is 
formed varies according to the situation of the injured part. Where the skin 
is in close proximity to subjacent bone, and is bound down by unyielding 
tissue, the blood is effused slowly, but in a blow upon the eyelids or upon the 
breast a large livid swelling is rapidly formed. In fractures of the bones of 
the leg and fore-arm there is often extensive bruising, which is associated with 
the formation of large blebs on the surface of the skin, which are distended 
by black or purple fluid. In contusions of the scalp in children a large cir- 
cumscribed collection of blood is often formed under the skin; this is usually 
soft at the centre and very hard at its margin, and feels very much like a de- 
pression in the skull. Sometimes in cases of contusion the bruise does not 
show itself at the part actually injured, but at some distance from this. A 
large bruise when fully developed is of a purple color, mottled with yellow 
and greenish-yellow patches. As the blood becomes absorbed and the bruise 
fades, the purple turns to changing shades of brownish-red, green, and light 
yellow. These changes commence at the margins of the bruise. The rapidity 
with which the disappearance takes place varies. The effused blood, even in 
very extensive bruises, is usually wholly removed by absorption, but occa- 
sionally a collection of fluid blood caused by an injury to an unhealthy 
individual, instead of becoming absorbed, sets up inflammation in the sur- 
rounding tissues and forms an abscess, which bursts and discharges unhealthy, 
ill-smelling matter or pus mixed with soft clots of blood. In the treatment of 
recent bruise, the first object is to check further effusion of blood. This may 
be done by applying cold, and by elevating, if possible, the injured part above 
the level of the body, in order to retard the circulation. If the bruised parts be 
very tense and painful, leeches may be applied near the margins of the dark 
blue patch. After the acute stage of pain and heat has passed off, the treat- 
ment should be directed so as to favor absorption of the fluids and to remove 
the swelling; for this purpose the most useful agents are the tincture of arnica 
montana, a lotion composed of two ounces of spirits of wine to twelve ounces 
of water, or a solution of sulphurous acid. The large transparent blebs which 
form over very extensively bruised surfaces should be pricked with a sharp 
needle, and then covered over with cotton wool, which will absorb the dark- 
colored fluid which is thus allowed to trickle away. 

Bryony. There are two British plants called by this name, and both of 
them are used occasionally in medicine. One is the Bryonia dioica, and be- 
longs to the order Gucurbitacece. It is called red bryony on account of the 
color of its berries. The black bryony is the Tamus com?nunis, and belongs 
to the same order as the sarsaparilla. It has no active properties. 

Bubo. A bubo is an inflammation of a lymphatic gland, usually situated 
in the groin, and having as a cause some venereal affection. Abscesses in the 
groin, however, may be caused by injury to the leg or foot, and may be the re- 
sult of ulcers of the legs, or they may come on after hard walking, riding, 
or over-exercise. -The treatment is that of acute abscess. See Abscess. 

Buchu is the leaf of a plant growing in South Africa. It is principally 
employed as a diuretic in irritation or inflammation of the bladder connected 
with disease of the kidneys. It is best used as an infusion, and should be 
employed in good large doses, almost as a drink. 

Buckbean or Bogbean. The English name of the Menyanthes trifoliata, 
a British plant belonging to the order Gentianacece. It is used in medicine as 
a tonic and anthelmintic. 



BUL 78 BUR 

Bullae, a name given to the blisters or vesicles which appear on the surface 
of the body in some forms of skin diseases. 

Bunion. This well-known affection consists in a subcutaneous swelling 
seated on the inner side of the ball of the great toe. In its earlier stage it is 
a thin-walled sac, tilled with (deal- fluid, and then causes very little uneasiness, 
lmt subsequently, in consequence of constant pressure and friction, becomes 
hard and tender. Sometimes, particularly after active exercise, the swelling 
becomes very painful and inflamed, and forms an abscess. The development 
of a bunion is caused, in most, instances, by a distortion of the great toe, and 
is much accelerated by the use of tight boots and by much walking. When 
the bunion is young, linn pressure with the fingers or a sharp tap with a 
heavy objecl may cause it to burst, and bring about a cure. In those cases 
where the swelling has existed for some time, and become hard and painful, 
very little can be done except to recommend boots made large .and roomy 
over the toes, and with the sole thicker at the outer than at the inner edge, so 
that the foot in walking may be thrown more upon the outer part. When the 
bunion becomes very tender, and the skin covering it red and inflamed, the 
treatment should be immediate, and consist in rest and the application of one 
or two leeches and warm fomentations. 

Burns. By the term burns is meant in surgery the result of the applica- 
tion of excessive heat to the surface of the body, by means of some heated 
solid body or as flame. A scald implies the contact of some hot or boiling 
fluid with the body. Burns and scalds are very serious accidents. Even m 
their slightest forms they are very painful, and when severe are attended by 
bodily prostration and congestion in the internal organs. When a consider- 
able portion of the integument of a limb has been destroyed, the patient is 
threatened with various painful maladies, as visceral inflammation, perf oration 
of the intestine, lockjaw, and pyaemia. Even after the wound has closed there 
is generally danger of distortion and hideous disfigurement from the con- 
traction of the resulting scar. In this country burns and scalds are among the 
most frequently fatal injuries occurring in civil life. The simplest and most 
convenient classification of burns and scalds with regard to their results on the 
surface of the body is that which arranges these injuries in the three follow- 
ing classes: that in which the injury causes inflammation and nothing more ; 
that in which inflammation is followed by destruction and sloughing; and, 
finally, that in which sudden charring or complete destruction is produced in 
that part to which heat is applied. It should be stated that in all extensive 
burns the two former results, and in very severe burns all these results, may 
be observed on the same patient. Simple and transient inflammation is gen- 
erally the result of a scald. In mild injuries of this kind the skin is merely 
reddened. A scald of this kind produced on the chest or abdomen of an 
infant by boiling water, or over the whole surface of the body of an adult in 
consequence of submersion in a vat of hot fluid, may, however, prove rapidly 
fatal. The next variety of local injury is vesication or blistering; this is a 
very common result, and takes place after both scalds and burns. The red- 
dened skin is covered by blisters or blebs, varying in size, and containing a 
clear yellowish fluid. This condition is well marked in severe scalds of the 
hand and fore-arm; immense bladder-like swellings suddenly appear about the 
back of the wrist, and sometimes the epidermis of the lingers and the whole 
hand are separated in the shape of a glove from the soft parts beneath. 
Healthy and well-nourished subjects soon recover from the effects of burns 
which do not pass beyond the stages of inflammation and vesication. In the 



BUR 79 BUR 

second class of burns the skin is more or less disorganized. At' the seat of the 
injury may be seen soft and elevated patches of a dark-gray color, each sur- 
rounded by reddened skin and blisters. These patches in the course of time 
separate from the surface of the body, leaving large sores, from which there is 
a free discharge of pus or matter. In some cases the whole thickness of the 
skin, in others but its upper layer, is thus disorganized and thrown off. In 
cases of sudden complete destruction of the surface of the body, the burnt skin 
is hard, dry, and tough like parchment. It is quite insensible, although press- 
ure upon it may act upon the nerves of deep-seated parts, and so cause pain. 
The color of the destroyed patch varies ; it is sometimes yellowish-brown, at 
others deep black. The thickness of the burnt part varies. The integument 
only may be involved, or skin, muscle, and all the soft parts composing a limb 
may be thoroughly charred. The chief dangers of burns and scalds lie in the 
severe general disturbance to which they frequently give rise, especially in 
young children. In the first forty-eight hours the shock may be fatal, or the 
patient may be speedily carried off in consequence of congestion of the brain, 
lungs, or abdominal organs. Immediately after a severe burn the surface of 
the body is cold, the pulse weak or almost imperceptible, the lips blue, and the 
eyes fixed and glazed. When with these symptoms are associated delirium 
and convulsions, and the patient complains of no pain, death is generally close 
at hand. The intensity of this state of shock is proportionate not so much to 
the depth of the burn as to its superficial extent and the age of the patient. 
From the third to the fifteenth or sixteenth day the chief sources of danger 
are fever, diarrhoea, inflammation of the stomach and intestines, lungs, and 
brain. From the commencement of the third week until the period when the 
wounds are completely closed, the patient is exposed to the risks of pyaemia, 
tetanus, and hectic fever. If the burn has been extensive there is generally a 
profuse and exhausting discharge of very fetid mailer from these wounds. In 
the treatment of severe burns the first and most important point is to endeavor 
to bring the patient out of the state of shock. When the extremities are cold, 
and the intense pain of the injury is expressed only by a feeble cry, the body 
should be wrapped in warmed blankets, and brandy and hot water be admin- 
istered, care being taken that no more brandy be given after the patient has 
commenced to revive. In the next two weeks in complicated cases the diet 
must be light, and saline draughts and frequent purgatives should be pre- 
scribed. When the patches of burnt and disorganized skin have been thrown 
off, and large ulcers are left, from which there is a copious discharge of matter, 
it is necessary to support the health of the patient by good diet, a free supply 
of wine or spirits, and by medicinal tonics. The local treatment of burns and 
scalds which do not proceed beyond superficial inflammation or blistering of 
the surface of the skin consists in the application of such agents as may serve 
the threefold purpose of reducing inflammation, relieving pain, and preserving 
the injured part from the air. The following are some of the very many 
methods that are used in ordinary surgical practice : to dredge the burnt part 
with flour or starch, so as to form a thick crust or paste ; to apply a thick 
layer of soft cotton wool, and fix this by a loose bandage ; to lay on strips of 
lint or cotton rags steeped in a mixture of equal parts of linseed oil and lime- 
water ; to use as a varnish a mixture of collodion and castor oil, two parts of 
the former to one of the latter ; Goulard water, sweet oil, white paint, vinegar, 
and whitening are all useful applications. Cotton wool and flour may be 
recommended as the most suitable agents in all cases in which the skin has 
not been injured to any great depth. The dressing, when once applied, must 



BUR 80 BUR 

not be disturbed for several days, so that the surface of the skin may be pro- 
tected from cold and irritation until the inflammation has ceased. Fresh 
cotton wool is to be applied over the former dressing of this material, and 
fresh Hour laid on, until the old and new layers form together a thick crust. 
After the dressing has been detached, the best application for the raw surface 
is the ordinary chalk ointment or lead lotion. When there is much blistering 
and the blebs arc very large, a small prick should be made into each before 
the dressing is applied, in order to allow the contained fluid to drain away 
slowly. Jn treating very superficial but widely extended scalds on the chest 
or abdomen of infants, the best agent is warm cotton wool. In the treatment 
of more severe burns which produce sloughing and destruction of the skin, 
stimulating applications are the rule. Of these the most approved are spirits 
of turpentine, spirits of wine, a mixture of lime-water and linseed oil, a lini- 
ment composed of one ounce of resin ointment and half an ounce of turpentine, 
an ointment of carbolic acid, a mixture of carbolic acid and boiled linseed oil 
— one part to ten. After the separation of the burnt portions of skin, the raw 
and ruddy wound may be dressed with lotions, consisting of a weak solution 
of sulphate of zinc or of copper. The deformities so frequently observed 
after bums in front of the neck, in the bend of the elbow, and in the hand are 
produced in the following way : an extensive wound left after the separation 
of destroyed skin is allowed to scar over rapidly, whilst the movable parts in 
its neighborhood are, for the sake of ease, retained by the patient too closely 
to each other. Thus in a burn in front of the neck the head is raised on a 
pillow above the level of the body, and the chin depressed towards the chest. 
In burns of the upper extremity the arm is bent and the fingers closed upon 
the palm. The dense scar foimed over the wound naturally tends to keep 
the bent parts in their acquired position, and by the contractile properties of 
its tissue subsequently increases the distortion and deformity. It is necessary, 
therefore, in treating burns to keep the edges of the wound apart and to let 
the surface heal slowly. In concluding this article, a few hints may be given 
as to the best means of immediate action in burns and severe scalds. If the 
burning clothes cannot at once be torn away, the person should be laid upon 
the floor, and covered by a rug, a piece of carpet, or a table cover, and turned 
over quickly from side to side. In order to prevent any draught, the doors and 
windows ought at once to be closed ; water, when close at hand, should of 
course be thrown over the flame. On removing the clothes from a badly 
burnt person great care must be taken not to tear away at the same time any 
portion of skin or to rupture any blisters. The body-clothing over the seat of 
injury ought to be cut in small pieces, each of which is to be raised gently ; 
if any part of this should adhere to the burnt surface, it had better be left 
until the arrival of the surgeon. The stockings when tight should be well 
soaked with oil before removal. In scalds of the upper or lower extremities 
the injured parts should be immersed in tepid water before the clothes are 
taken off. 

Bursae are closed bags of thin membrane, containing an oily fluid, which 
are placed between bone and skin, and between bone and muscle or tendon, 
so as to favor the free and ready movement of the latter structures. The 
most important of the superficial bursae, or those seated between skin and 
bone, are one in front of the knee-cap or patella, one at the back of the 
elbow, one over the bony projection at the outer part of the hip. In addition 
to these structures, which exist as constant and normal parts of the human 
body, there may be other bursa; which are accidental in character, and formed 



BUT 81 BUT 

in abnormal situations, in consequence of the application of unwonted pressure 
and friction. These accidental bursa? are developed in club feet, and over the 
prominence formed by curvature of the spine. Bursae in their healthy con- 
dition contain but just the amount of fluid necessary for lubricating purposes, 
and are scarcely to be recognized during life. In consequence of continued 
pressure, however, or of injury, they become distended from increased col- 
lection of fluid, and form prominent swellings, which, with further pressure or 
injury, become very painful and inflamed. The most common and the best 
known instances of this are the bunion, the housemaid's knee, and the 
student's elbow, in which the bursa? at the inner side of the great toe, that 
over the knee cap, and that at the back of the elbow are respectively en- 
larged. Another frequent situation of distended bursse is the back of the 
wrist, where it is met with as a smooth, painless, and very movable swelling, 
to which surgeons apply the name of ganglion. When bursa? are sub- 
jected to constant or frequently repeated pressure, they often inflame, and 
become harder from increased thickness of their walls. They are sometimes 
converted into abscesses, and then constitute a source of great danger, as the 
neighboring joint may become affected, or the bones exposed and diseased. 
Much good may be done by treatment in the early stage of an enlarged bursa ; 
rest of the affected member and a removal of irritating and compressing 
agents must be insisted upon if there be any pain or uneasiness in the swell- 
ing. When the parts are quiescent, some means may be taken for removing 
the disease ; firm pressure with the hands, or a sharp tap with a large volume 
or some heavy object, will cause rupture of the distended bag, and effusion of 
the contained fluid; this, however, is a rough and very painful proceeding. 
In cases of inflammation, and where the formation of an abscess is threatened, 
leeches, warm fomentations or poultices, and rest in the recumbent position 
are essential means of treatment. 

Butter is a common name given to a variety of fatty substances used as 
food, whether obtained from the vegetable or animal kingdoms. The term is, 
however, more generally employed to designate the fatty matter found in the 
milk of animals. The most common source of butter is the milk of the qpw. 
The quantity of butter contained in different kinds of milk varies. Thus, 
there is three per cent, in human milk, 1^ per cent, in ass's milk, and 3^ 
per cent, in cow's milk. Butter is sold in the markets as fresh butter and 
salt butter. The latter has a certain quantity of salt added to prevent its be- 
coming rancid. Butter by keeping is very liable to become rancid, a very 
disagreeable acid being formed in it called butyric acid. Butter often under- 
goes this decomposition after it has been eaten, and the bitter taste observed 
in the throat and attributed to bile is in reality butyric acid. This disagree- 
able effect of butter is easily got rid of by taking twenty or thirty grains of bi- 
carbonate of soda or potash. Butter is the chief of our fatty foods. It is 
composed of carbon, hydrogen, and a little oxygen. It is consequently more 
capable of maintaining animal heat and force than sugar or starch. When 
butter is eaten in larger quantities than is necessary for the demands of the 
system, it leads to the deposition of fat in the tissues, and persons become 
corpulent. This can be remedied only by taking less butter or by leaving 
off its use altogether. 



CJEO 82 CAM 



c. 

Caecum, a little sac formed in the course of the intestines. See Intes- 
tines. 

Caesarian Section is an operation which has been adopted in very ex- 
treme cases to save the life of the child during a confinement. It consists in 
making an incision in the lower part of the abdominal wall large enough 
to introduce the hand, and then an opening can be made in the womb and the 
child can be extracted. This procedure is in itself very fatal, and is only jus- 
tifiable as a last resource and after mature deliberation. 

Cachexia is a term applied to that condition of profound dishealth which 
accompanies certain morbid states of the system. Thus with cancer, in the 
latter stages of the malady the patient becomes thin, the color becomes sallow 
or of a dusky yellow hue, the features are sharpened, and there is a general 
expression about the patient of hopelessness and care which is very striking. 
This condition is described as a cachexia. So again among those who have 
long been exposed to malaria or the poison of ague, the skin assuming a dirty 
whitish hue. All work is done with an effort; there may be no distinct par- 
oxysm of fever, but there is a feverishness which is very striking ; this, too, is 
spoken of as a cachexia. 

Caffeine. See Coffee. 

Cajeput Oil is an oil of a beautiful bluish green tint, obtained by distilling 
the leaves of a tree growing in the Moluccas. It is powerfully stimulant in 
character, and is used both externally and internally. Externally, when 
mixed with olive oil, it may be used in certain forms of chronic rheumatism. 
Internally, a drop or two given on a lump of sugar acts as a powerful stimu- 
lant and anti-spasmodic. A drop on cotton wool applied to a carious tooth 
will often suffice to relieve toothache. 

Calabar Bean is the seed of Physostigma venenosum, and has the remark- 
able property of causing a contraction of the pupil of the eye when externally 
applied. It is used in certain diseases of the eye when the pupil is morbidly 
dilated. 

Calcareous Degeneration. See Degeneration. 

Calcification. See Degeneration. 

Calculus. By a calculus is meant a concretion in any gland or organ, 
whether it be the bladder (urinary calc), prostate gland (prostatic calc), 
breast (lacteal calc), kidney, salivary glands (salivary calc). The term, 
however, in its most common signification, is applied to the bladder, — stone 
in the bladder. See Stone. 

Calomel. See Mercury. 

Caloric. See Heat. 

Calves-foot Jelly. See Gelatine. 

Calumba. See Columba. 

Camomile. See Chamomile. 

Camphor is a concrete volatile oil, obtained from the Laurus camphora 
by the process of sublimation. It is mostly obtained from China and Japan. 
In medicine it is largely used for flavoring. To this end some lumps of the 
substance are placed in a bottle of water and allowed to remain for a time. 
The water acquires the camphor flavor, and is used as a vehicle for other rem- 
edies. It is nevertheless highly esteemed by some authorities, as a stimulant 
in exhausting diseases, such as fevers of the continued variety. It has also 



CAM 83 CAN 

been given in insanity, in asthma, and in a great variety of other affections. 
It has been of undoubted service in certain of the complaints of women, es- 
pecially in alleviating pain. Outwardly, camphor is often used in liniments 
applied to tender surfaces ; and camphorated spirits of wine is a very good 
application for chilblains. Homoeopaths have used it in cholera. The dose of 
the substance itself varies from two to ten grains. It is best given suspended 
in mucilage or made into pills. 

Camps. The points to be borne in mind with regard to the site of a camp, 
besides those of wood and water, are the characters of the soil, the capacity for 
drainage, the neighborhood of marshes or jungles, and especially the prevail- 
ing winds, whether to or from there. Health camps, such as are frequently 
had recourse to in India to get rid of cholera, are chosen purely with reference 
to health and healthy conditions. 

Canada Balsam is hardly used in medicine, although much employed by 
microscopists. Being a kind of turpentine, a mixture of oil and resin, its 
properties are allied to the better known oil of turpentine. 

Cancer is a disease of itself, and one of the class of new growths. It 
is unlike all other tumors, being an infiltration amongst the natural tissues of 
the body, and its peculiar structure is to be discerned only by the microscope. 
It is ineradicable ; if cut out, it returns, if not at the place of operation, in 
some other part or tissue. It is essentially a malignant growth. There are, 
however, cases where a cancerous tumor has been removed at its first appear- 
ance, and the patient has enjoyed an immunity from any return for ten, fif- 
ten, or even twenty years. Hitherto nothing satisfactory has been proved as 
to its causes. Domestic animals and cattle are equally subject to it. Cancer 
possesses all the characteristics of malignancy, so defined by surgeons, namely, 
constitutional origin, rapid growth, constant increase, pain, returning if cut 
out, infiltrating every tissue in its vicinity, and invading the lymphatic glands ; 
is liable to be diffused over the body from secondary deposits, is attended with 
cachexia (Cachexia), "resists all treatment, softens inwardly, ulcerates out- 
wardly, resembles no tissue naturally found in the body, and ultimately proves 
fatal." The several forms of cancer which come under the observation of the 
surgeon are called from their special features, («) Scirrhus ; (b) Medullary; 
(c) Melanotic ; (d) Epithelial ; (e) Osteoid ; (/) Colloid ; (g) Villous. The 
last two named, however, are by some scarcely held as cancer. Scirrhus : 
this form of cancer is probably the most frequent, at least in this country, 
and most commonly affects the female breast, though it is also found in the 
rectum, eye, testicle, womb, skin, bones, and salivary glands. Its chief fea- 
ture is its stony hardness, which is due to an abundance of fibrous tissue ; it is 
nodulated, becomes adherent to the overlying skin, and it has the singular 
property of drawing into it adjoining structures, is subject to severe stabbing 
or lancinating pain and to ultimate ulceration. Medullary, or brain-like can- 
cer, so called from its resemblance to the substance of the brain, differs from 
the preceding in possessing none of that peculiar characteristic of drawing 
towards itself of neighboring structures, but rather that of a disposition to dis- 
tend and thrust them aside by the rapidity of its growth, and by the great ac- 
cumulation of cancer material in its bulk. It produces greater constitutional 
cachexia, and is more speedily fatal. It is most frequent in the limbs and 
breast. It is excessively vascular, and as it nears the surface throws out huge 
fungating bleeding masses termed hsematodes, from ulceration. Melanotic 
Guncer : the main distinctive feature of this form of cancer is the presence 
of pigment or coloring cells, which give it a black or dark appearauce. The 



CAN 84 CAN 

most frequent situation for melanosis is the skin of the eye. It derives its 
color, as a general rule, from the structures in which pigment naturally exists. 
Epithelial Cancer, termed also epithelioma or cancroid, has its chief situation 
in the skin, in or near a mucous orifice, for example, lip, nose, anus, prepuce, 
scrotum, or tongue. When it exists on the scrotum it forms the so-called 
chimney-sweeper's cancer. Osteoid Cancer: a form of cancer occurring us- 
ually in hones, and more commonly in the lower end of the femur apparently 
than elsewhere. It is very rapid and painful in its growth. Colloid Cancer 
in appearance is jelly-like, ahout the consistence of thin glue or tapioca pud- 
ding, of rapid growth, and frequently attaining enormous bulk. It is most 
frequently found in the intestinal canal. Villous Cancer, not now considered 
cancerous ; the name has been associated with a vascular growth composed of 
delicate papillae, each containing a vascular loop, sometimes found in connec- 
tion with epithelioma. With regard to the treatment of cancer, all that can 
be done is to check the disease as far as possible by early removal, and thus 
endeavor to alleviate suffering and prolong life. In advanced stages of the 
disease, palliative treatment, both local and constitutional, must be had re- 
course to, hut death will sooner or later supervene, and all that can be done is 
to make the end as easy as possible. 

Cancrum Oris is an ulcerative affection of the gums and cheeks, most 
commonly met with in children between the ages of fifteen months and five 
years, and seldom observed in adults. There are two well-marked forms of 
this disease. The milder form occurs in ill-fed and squalid children during the 
cutting of one or more teeth. The anterior surface of the gums becomes red 
and swollen, and bleeds at the least touch. The roots of the teeth are laid 
bare. The swelling then extends to the inner surface of the cheek, and some- 
times to the lips, where several small but deep ulcers are formed, from which 
there is a fetid discharge. In the course of a week the swollen gum becomes 
gangrenous and separates from the surface of the jaw, exposing blackened and 
rough bone. The teeth become loose and fall out. During these changes the 
tongue is white and furred, the breath fetid, and the flow of saliva from the 
mouth almost constant. The glands in the neck are sometimes swollen and 
painful. There is much difficulty in masticating, and also in swallowing. It 
should be remembered that in this affection the swelling is generally found on 
one side only of the mouth, and that it never causes ulceration of the tongue 
or palate. In these respects it differs from the diffused soreness of the mouth, 
produced through the administration of large quantities of mercury. The 
subjects of this affection should be supported by strong beef-tea and broth, 
together with wine. Castor oil may be administered every other morning, in 
order to keep the bowels freely relieved. For the purpose of removing the 
offensive discharge, the mouth should be frequently washed with a lotion con- 
taining two teaspoonfuls of Condy's antiseptic fluid to a pint of water, or with 
one containing one teaspoonf'ul of Burnett's disinfecting solution to one pint 
of water. Undiluted claret also forms a good wash, from its astringent actiou 
on the swollen gums. Pieces of alum should be given to the patient to suck, 
and the gums painted twice in the day with a lotion made up of half an ounce 
of dilute muriatic acid, and half a pint of water. Chlorate of potash and bark 
are the usual internal remedies in this, as in most other ulcerative affections of 
the mouth. The second or more severe form of cancrum oris attacks children 
who have just recovered from measles, and in large schools, or places where 
many young patients are crowded together, sometimes spreads rapidly after an 
epidemic of this eruptive fever. The affection of the mouth first shows itself 



CAN 85 CAR 

as a large and doughy swelling on one cheek ; the skin over this swelling is 
tense and shining, and at its prominent part presents a patch of a violet or 
dark-blue color. On the inner surface of the swollen cheek will be found a 
deep, foul-looking ulcer, the edges of which are generally swollen and irregular. 
The gums become gangrenous, and there is a very fetid discharge of dark red 
or black fluid from the mouth. In the further progress of the disease, the 
cheek is perforated by the ulcer, and the orifice thus formed is subsequently 
enlarged by rapid sloughing. The little patients, as a rule, do not seem to 
suffer much pain from this affection, but about the sixth or seventh day be- 
come heavy and sleepy, and finally pass into a state of coma. This form of 
cancrum oris is usually fatal. The local treatment, to be of any service, de- 
mands energy and skill. The best agents for arresting the progress of the 
mortification are strong nitric acid, and the actual cautery or red-hot iron. 
The patient should be allowed plenty of fresh air, and wine and good nourish- 
ment. It is necessary to wabh out the mouth frequently with weak solutions 
of chloride of zinc or lime, or of carbolic acid. 

Canella is the bark of a tree growing in the West Indies. It has a hot, 
cinnamon-like taste and slightly tonic properties. It is not often used by itself, 
but is contained in rhubarb wine. 

Canker of Mouth. See Cancrum Oris. 

Cantharides, or Spanish Flies, are mostly collected in Hungary. 
More than one species are in use. They are beetles, and their wing cases, 
which are long, have a fine green color. They are collected by brushing the 
trees, killed by boiling vinegar, and dried. Before being used they are re- 
duced to powder, from which may easily be obtained a crystalline substance 
called Cantharidine. This powder constitutes the active ingredient in that 
well-known remedy, a fly blister. The other ingredients are wax, resin, aud 
fat. Blistering solutions may now be obtained, which, when painted on to any 
part of the body, and a warm poultice applied, more effectually, more speed- 
ily, aud more painlessly produce vesication. Elegant little blistering plasters 
prepared in France may also be obtained in boxes, ready for application at a 
moment's notice. Cantharides are rarely given internally ; even externally, 
when long used, they may produce troublesome symptoms referable to the 
bladder and kidneys. 

Caoutchouc. See India Rubber. 

Capsicum. The capsicum, or red pepper, is the pod or fruit of a plant 
now frequently cultivated in this country. The pod, which is bright red, is 
dried aud reduced to powder — the well-known Cayenne pepper. This sub- 
stance is a powerful stimulant, and is chiefly employed as a condiment; but 
there is an authorized tincture. Occasionally this is used mixed with water as 
a gargle. It has been given as a stimulant in delirium tremens. 

Caramel is a term applied to burnt sugar, and is principally employed for 
coloring wines and brandies. 

Caraway. The fruits of the ordinary caraway are endowed with a volatile 
oil, which administered in drop doses is used for flatulence, gripes, etc. 

Caraway Seeds, the fruit of the plant called Carum carui. See Cara- 
way. 

Carbolic Acid, or Phenic Acid, is a substance obtained from coal tar 
by careful distillation. It is met with ordinarily in two shapes, either in crys- 
tals or fluid. It is not very soluble in water, but sufficient may be taken up 
to endow the fluid with valuable properties. Applied without dilution to the 
skin, it produces something like a burn. It is. a powerful antiseptic, and as 



CAR 86 CAR 

such is very largely employed for preventing bad smells, for keeping wounds 
sweet, and for preventing the spread of infectious diseases. Carbolic acid may 
be obtained for disinfecting purposes, either as crystals, which may be dis- 
solved in water, or in the form of disinfecting powder. Its most convenient 
strength as a lotion for the prevention of smell and arresting discharge is one 
pint to fort)' of water. Internally, carbolic acid is of much value in indiges- 
tion and flatulence, pain and vomiting of fermented half-digested food. A drop 
or two of the deliquesced acid may be given in mucilage some hours after tak- 
ing food. It lias been used in the form of ointment, or dissolved in glycerine, 
for the cure of itch, with success ; and a strong solution is a capital means of 
getting rid of vermin in the hair of men or animals. It should be well rubbed 
in, and in a quarter of an hour washed out again with soap and water. 

Carbon. See Charcoal. 

Carbonic Acid Poisoning is produced whenever there is an accumula- 
tion of carbonic acid in a room or building. In France it is not uncommon 
for people to commit suicide by burning charcoal in a stove in a room in which 
all the crevices of the doors and windows are carefully blocked by pasting 
paper over them ; in this way no fresh air can enter, while carbonic acid accu- 
mulates in the room, and causes death by apncea. (See Apncea.) Carbonic 
acid is always present in the atmosphere in a small quantity, and it is partly 
an accumulation of this gas which makes a small, badly-ventilated room smell 
close and stuffy ; lauguor and headache then come on, and unless fresh air is 
admitted injurious consequences may supervene. From this cause overcrowd- 
ing is injurious, and those who work together in a room, as dressmakers, etc., 
are often liable to headache, anaemia, and general debility. Fresh air is of 
coarse the simple remedy for this condition of things, while in serious cases of 
poisoning by the gas. and when the patient is found inseusible, removal of the 
individual into the open air is the first thing to be done, and then artificial 
modes of respiration must be resorted to. Carbonic acid is a gas, and in its 
pure state is poisonous when retained in the blood. It is at all times exhaled 
in the breath, and is one of the chief agents in inducing that languid state ex- 
perienced in crowded apartments. It is the principal ingredient in the choke- 
damp so fatal to miners after an explosion. It causes death by arresting all 
change in the lungs, so that the whole blood becomes black and impure. By 
itself it is not greatly used in medicine, but in the form of soda-water it is 
often exceedingly useful. It is this agent contained in effervescing liquids 
which <;ives them their sparkling character, and which enables them to be re- 
tained on the stomach, which would otherwise reject them in fevers and such 
like disorders. It is partly due to the carbonic acid in it that champagne 
is frequently retained when nothing else is. To manufacture soda-water, the 
so-called gazogenes, now so plentiful, may be made use of, carbonate of soda 
and tartaric acid being employed in the process. On the large scale sulphuric 
arid and chalk or marble are employed, but the gas requires to be carefully 
washed, otherwise the taste of the soda-water is bad. The gas itself has 
been employed to relieve the pain of cancerous, and especially of uterine, 
affections. 

Carbuncle. A carbuncle is most frequently situated where the tissues 
underlying the skin are of a dense fibrous character, such as the nape of the 

neck. Carl sles vary in size, sometimes being as large as an orange. They 

are very hard, brawny, dreadfully painful, discharging matter from several 
apertures, and usually attended with considerable constitutional disturbance, 
such as fever, hectic, etc., the condition being indicative of blood poisoning. 






87 




• 2 




Fig. xiii. 



Flg x. 




Eig. XIV. 



Fig. xv. 



CAR 89 CAS 

With regard to treatment, it must be both constitutional and local. The 
strength must be kept up by brandy, wine, and ammonia and bark ; hot fomen- 
tations, opiate poultices, and free incision must be made through the thick- 
ened implicated tissues. 

Carcinoma, a term synonymous with cancer. See Cancer. 

Cardamoms belong in, therapeutics to the group of remedies called stimu- 
lants and carminatives. In the East they are used as a condiment. In medi- 
cine the tincture is used to give coloring and pleasant flavor to more powerful 
remedies. 

Cardialgia signifies pain in the heart, or over the region of the heart, and 
may arise from various causes. See Heart-burn. 

Caries. By caries is meant an unhealthy inflammation of bone, causing it 
to absorb or ulcerate. Any bone may be affected, and it is generally caused 
by some constitutional disorder, such as scrofula or syphilis. Its treatment is 
to rectify the constitutional condition, and locally to remove the diseased 
bone. 

Carminatives mean remedies which are slightly stimulant in their char- 
acter, which relieve flatulence by expelling gases, and alleviate colicky pains. 
They almost all contain a volatile oil, on which their properties depend. 
Favorite examples are ginger, mustard, horse radish, the different kinds of 
pepper, cinnamon, cloves, anise, coriander, peppermint, etc. See Stimu- 
lants. 

Carotid Artery. The pulsations felt on each side of the neck are due to 
arteries which pass from the heart to the brain, and are called by this name. 

Carpus, a technical name for the wrist. 

Carrageen Moss is the name given to a seaweed known to botanists as 
the Chondrus crispus. "When boiled it produces a decoction which becomes 
glutinous on cooling. It contains little or no nutritive matter. 

Carron Oil is an oleaginous mixture of lime-water and linseed oil. Its 
name was given from the fact that it was at the great Carron Ironworks, situ- 
ated in Scotland, on the banks of the Carron River, that it was first made, 
about sixty years ago, and its reputation was so great that it was sent from 
thence all over the country for the cure of burns and scalds. 

Carrot, the root of the Daucus carota. It is used frequently as an article 
of diet. It contains little nutritive matter, a small quantity of sugar, and a 
large quantity of woody fibre. Carrots are usually eaten after boiling, but 
even then they are indigestible, and care ought to be taken in administering 
them to children and invalids. 

Cartilage, vulgarly called gristle, is a firm, flexible, and highly elastic sub- 
stance, of a pearly white color. It is divided into articular and non-articular 
cartilage. The articular variety covers the joint ends of bones, favoring by 
its smooth surface easy movement of the joint, and by its great elasticity free- 
dom from shock and concussion during active exercise of the extremities. 
Non-articular cartilage is met with in the wind-pipe, the external ear, the 
nose, and the eyelids. The ribs terminate anteriorly in long pieces of carti- 
lage which pass inwards and are united to the sternum or breast-bone. Carti- 
lage varies in appearance at different periods of life. In foetal life and early 
infancy it is soft and semi-transparent ; in youth and adult life it presents the 
well-known bluish-white opacity; and in old age it becomes hard and yellow, 
and in some localities, more especially in front of the chest, is converted into 
bone. 

Cascarilla Bark is the product of a shrub growing in the Bahamas. It 



CAS 90 CAT 

has a spicy odor and a bitter, aromatic taste. It acts as a tonic and stomachic. 
The tincture or infusion may be used in teaspoouful and two-tablespoonful 
doses respectively. 

Caseine is the name given to a product found in plants and animals, and 
so called because it constitutes the basis of cheese. (See Cheese.) It is one of 
the flesh-forming constituents of plants, and is found in large quantities in 
peas, beans, and lentils. It is fouud in largest quantities in a cheese known 
as " Suffolk Bang." 

Cassia. Many medicinal articles are known by this general name. They 
are the product of plants belonging to the natural order Leguminosce. We 
may give as instances of such drugs the Cassia cinnamomum (cinnamon), 
Cassia fistula (pipe or purging cassia), and Cassia senna. 

Cassia Pulp is the pulp of a long pod or legume, which has purgative 
properties. Given by itself it gripes. It is contained in the confection of 
senna, a very useful preparation. 

Castor is an animal product obtained from the beaver. Its odor is peculiar. 
It used to be given in hysteria, but is now rarely used. 

Castor Oil is the product of the seeds of a plant called Ricin us communis. 
The oil is obtained from the seeds by pressure, which is applied with or with- 
out heat. That which is cold-drawn keeps longest, and is preferred for use. 
Castor oil is a mild laxative, producing little or no pain, and leaving, after its 
effects have gone off, no tendency to constipation. The easiest and quickest 
way of administering it is in water with a few drops of brandy, peppermint, 
or other agent to take away its taste. It may also be made into an emulsion 
with an egg, if preferred. Dose : from a teaspoonful to a tablespoonful, accord- 
ing to age. 

Catalepsy, or Trance, is a rare condition, in which an individual — very 
frequently, but not always, an excitable hysterical female — suddenly seems 
to lose all consciousness of surrounding objects, and remains fixed in one 
position ; but, if that is altered by any one standing by, the new position is 
maintained instead of the former. In this state the individual remains for a 
time, varying from minutes to hours or days, and then suddenly recovers, 
knowing nothing of what has passed in the interval. The fact that cataleptics 
have been interred alive has given rise to much uneasiness in the minds of 
many ; but the period which elapses between death and burial in our country 
is generally sufficient to prevent such an occurrence. Allied to catalepsy is 
ecstasy, where the individual seems buried in contemplation of some curious 
object. This, too, mostly occurs in women, and is mainly hysterical. 

Catamenia. See Menstruation. 

Cataplasm. See Poultice. 

Cataract may be defined as impairment or loss of vision, due to opacity of 
the crystalline lens. This affection is occasionally met with in new-born in- 
fants, but occurs most frequently in old people as a result of certain senile 
changes within the eyeball. In about 80 per cent, of the cases of cataract the 
patients are above the age of fifty. It may, however, occur at any age, as a 
consequence of a wound of the lens or of simple concussion of the eyeball by 
a severe blow. It generally affects both eyes, commencing in one before the 
other. In the cataract of old people the pupils will be found opaque, and of a 
pale amber or grayish-white color. The opacity is most marked in the centre, 
and lades away towards the circumference into gray, cloudy specks. This con- 
dition usually comes on slowly, and the sight gets gradually worse for months 
or even years, until there is almost complete blindness. During the develop- 



CAT 91 CAT 

ment of the affection the patient is much troubled by a mist or haze surround- 
ing all white or pale objects. Black spots are often observed as if floating be- 
fore the affected eye. Vision is improved by a subdued light, whilst there is 
great intolerance of bright or strong light. The flame of a lamp or light of 
any kind is surrounded by a broad misty halo. Objects are increased in num- 
ber and distorted. In daylight the patient sees objects more readily when the 
back is turned to the window and the eyes are shaded by the hand. Pain in 
the eyeball is rarely complained of. The movements of the iris remain free 
during the progress of the disease. The Catoptric Test of Cataract. 
When a lighted candle is placed at a short distance from the front of the 
healthy eye, three reflected images of the flame are distinctly seen arranged 
from before backwards. The first and third of these images are erect, and when 
the position of the candle is altered move in the same direction. The middle 
image is inverted, and when the candle is moved upwards or downwards moves 
in the opposite direction. This middle image is reflected from the posterior 
surface of the lens, and the third image from the anterior surface of this body. 
When the lens is rendered opaque by cataract, the inverted or middle image 
is much obscured, and in advanced cases of cataract altogether absent. This 
is called the catoptric test, by which cataract may be distinguished from amau- 
rosis or blindness due to disease of the retina. Cataracts may be roughly di- 
vided into hard, soft, and fluid. Hard cataract is the most frequent form, and 
is rarely met with in persons under thirty-five years of age. The opacity 
most frequently presents an amber tint. The diseased lens is harder and more 
opaque at its centre than at its circumference. When extracted it has the 
consistence and somewhat the appearance of soft beeswax. In soft cataract 
the lens is swollen and of a milky or bluish-white color. When fluid the cata- 
ract has an uniform grayish-white color, and looks like a small mass of thick 
gruel. Soft and fluid cataracts are usually found during infancy. The treat- 
ment of cataract is almost exclusively operative. During the early stages of 
the affection the failing sight may be temporarily improved by dropping in a 
solution of atropine, or by smearing the upper lid with extract of belladonna 
in order to produce enlargement of the pupil. When both eyes are affected, 
and the patient strong and healthy and free from gout, the lens may be re- 
moved with considerable chance of a successful result. There are three chief 
methods of operating on cataract : extraction, in which the lens is removed 
through an incision made in the cornea ; absorption or solution of the lens by 
breaking up its substance with a needle, and allowing it to become saturated 
in the fluid of the anterior chamber of the eyeball, which acts as a solvent ; 
thirdly, the old operation of coaching, which consists in moving the lens back- 
wards into the interior of the eyeball and, at the same time, depressing it below 
the level of the pupil. Of these operations, extraction is the one most fre- 
quently performed. 

Catarrh means simply a running, such as we have from the nose in a cold ; 
the name of the symptom has, however, been transferred to the condition which 
produces it, and so one may hear tell of catarrh of the stomach, bowels, blad- 
der, etc. See Cold. 

Catechu is of two kinds, the puce and the black. The latter is not now 
contained in the Pharmacopoeia ; it is obtained from the wood of a species of 
acacia. The puce catechu is extracted from the leaves and young shoots. of 
plants growing in Siam and other parts of the eastern hemisphere. It occurs 
in irregular pieces, generally approaching to cubes. It contains a kind of tan- 
nic acid to which it owes its properties. The substance is a powerful astrin- 



CAT 92 CAU 

gent, and is most frequently given for diarrhoea when there is no inflammation 
present, and when it does not depend on hilious derangement. For this pur- 
pose, the compound catechu powder, consisting of catechu, kino, rhatany, cinna- 
mon, and nutmeg, may be given in doses of twenty or thirty grains. For re- 
laxed sore throat, catechu, in the form of a lozenge, is very beneficial. The 
infusion may be used as a gargle, and combined with charcoal finely powdered, 
catechu forms an excellent dentifrice when the gums are spongy and expose 
"the base of the teeth. 

Cathartics. A class of medicines that act on the bowels strongly as pur- 
gatives ; such as senna, castor oil, Epsom salts, gamboge, colocynth, etc. 

Catheter. A catheter is a curved tube, made either of silver, india rub- 
ber, or gum elastic, for the purpose of drawing the urine from the bladder in 
cases of stricture of the urethra. The size, or calibre, varies from a tube the 
size of a bodkin to that of a large lead pencil. The extremity of the turned 
portion is smooth and blunt, and some short distance from the point are one 
or more eyelet holes, through which the urine passes into the main tube. Each 
instrument is fitted with a stylet, a small thin wire, for cleaning out an obstruc- 
tion, or, in the case of an elastic catheter, for both cleaning it out and main- 
taining its curve. 

Caul. A term applied, first, to the membrane which covers the bowels, 
also called omentum ; second, it is applied to the membranes enveloping a 
new-born babe, when they extend over the head. There is a superstition 
that persons possessing the caul of a new-born babe will not be drowned at 
sea. and at the present day it is not an uncommon thing to see a caul adver- 
tised for sale. The origin of this superstition is obscure. 

Caustics. Under this head are included a number of very different sub- 
stances which possess the common property of burning and destroying any 
part of the living body with which they may be in actual contact. The best 
known of these agents, perhaps, are sulphuric acid, the malicious application 
of which to the face and eyes is occasionally cited in police reports, and the 
nitrate of silver, or lunar caustic, so much used in surgical practice. The ma- 
jority act either as oxidizing agents or by withdrawing water from the living- 
tissues. The chief objects for which these agents are used in surgery are the 
following: to set up counter-irritation; to keep down overgrown granula- 
tions or " proud fleslt • ;" to arrest the progress of ulceration ; to destroy can- 
cerous growths and ulcers ; to open abscesses ; to stay absorption in poisoned 
wounds. In dog bites it is advisable to cauterize the wound or wounds with 
some mineral acid applied on a glass tube or some non-vegetable conductor. 
Nitric acid is generally used for this purpose, but hydrochloric acid and the 
oil of vitriol answer equally well. For removing warts there is no better 
plan than cutting away the hard summit of the growth, and then applying ni- 
tric acid or strong vinegar to the raw surface. Chromic acid is sometimes 
used for this purpose, but it is a very powerful and painful caustic. Ju soft 
and painful corns seated between the toes, nitrate of silver is a useful applica- 
tion. 

Cautery is an agent employed for applying intense heat to superficial parts 
of the body. There are three kinds of cauteries, namely potential, actual, and 
galvanic. The first term was applied by old surgeons to the various forms 
of caustic applications described under the head of Caustics. The actual 
cautery consists of a rod or knob of iron heated to incandescence, and the gal- 
vanic cautery is formed of wires heated by a galvanic battery. Surgeons 
use the actual cautery with the following objects: to produce counter irrita- 



CAY 93 CER 

tion ; to arrest bleeding ; to destroy cancerous and other tumors on the sur- 
face of the body ; to stop the progress of hospital gangrene ; and to destroy 
the edges of large fistulous openings. 

Cayenne Pepper. See Capsicum. 

Cells. Minute parts of the structure of animals and plants, always micro- 
scopic, but assuming various sizes, forms, and conditions. The essential of 
every living cell is a particle of matter called protoplasm, containing the four 
elements, — nitrogen, carbon, oxygen, and hydrogen. From such particles, 
both in animals and plants, the cell-walls are formed. According to their age 
and functions, cells are solid or contain water with various contents floating or 
dissolved. What is called the " cell theory " supposes that both vegetable 
and animal organisms are built up of these minute cells, which, by their vital 
activity, make up the life of the being. All growth takes place by the multi- 
plication of cells, and diseases are produced by the cells acting in an abnor- 
mal way. 

Cellulose is an insoluble substance which composes the cell-wall of plants. 
It is the basis of all wood and timber. It is very hard in the stones of plums, 
apricots, etc., and very soft in oranges, pears, and other fruits. It is con- 
stantly taken into the stomach with unprepared vegetable food. It is not di- 
gested in the stomach of man, although it seems to supply food material to 
many of the lower animals. In estimating the quantity of alimentary mate- 
rial in any article of diet, the quantity of cellulose should always be deducted. 

Cephalalgia. See Headache. 

Cerate. A term applied to an unguent in which wax forms an ingredient. 
The white cerate of the druggists' shops is formed of white wax and pork lard. 
Yellow cerate consists of yellow wax and resin. 

Cerebellum. See Bkain. 

Cerebral Softening is a result of disease of the vessels in the brain, or of 
changes taking place in that organ consequent upon previous mischief. It is 
often associated with cerebral haemorrhage, and is one of the conditions which 
produce apoplexy. Hemiplegia, or paralysis of the arm and leg of one side of 
the body, is then of common occurrence, and this comes on with insensibility 
or coma. It is a very serious change, indicating long-standing disease in the 
constitution. It occurs in those who have had gout or chronic Bright's disease, 
and in those who have been intemperate ; sometimes, also, as a natural result 
of old age and great mental exertion. The mind before an attack is often 
impaired; the patient has loss of memory, giddiness, vertigo, occasional attacks 
of faintness, lownessof spirits, and irritability ; the countenance is often sallow, 
the person thin and shrunken ; the eyes are marked with an arcus senilis, and 
the general appearance is that of premature decay. See Apoplexy, Hemi- 
plegia, and Degeneration. 

Cerebro-spinal Fever is an acute, epidemic disease, characterized by 
profound disturbance of the central nervous system, and marked by shivering, 
giddiness, intense headache, delirium, and spasms of various muscles; there is 
great prostration, and occasionally a purple eruption appears on the skin. 
This disease is also known as epidemic cerebro-spinal meningitis, petechial 
fever, purpuric fever, etc. History : Cerebro spinal fever was but little, if 
at all, known before 1837, when it prevailed with great virulence in various 
parts of France, and several outbreaks were recorded from that time up to 
1848. In 1840, the disease appeared in Naples and the Papal States ; then it 
spread to Algeria and Gibraltar; it broke out in Sweden in 1854, and in Nor- 
way in 1859 ; since then it has been prevalent in Holland and Portugal. An 



CER 94 CER 

extensive outbreak occurred in North Germany in 1863, 1864, and 1865, and 
carried off large numbers of the population. From 1842 to 1850, a series of 
epidemics occurred in various parts of the United States ; in some sections it 
has prevailed more or less up to the present time. Age does not seem to have 
much influence upon this disease ; children, young people and adults, all suffer 
during an epidemic ; males, however, seem more liable to it than females. 
Season has a remarkable effect upon this malady ; it occurs especially during 
the cold months. Fatigue, cold, overcrowding, foul air, and dirty dwellings 
have been put down as exciting causes of this disease, but at present very little 
is known for certain on these points. Symptoms: In most cases the patient 
feels indisposed before the onset of the disease ; there are pains in the head 
and various muscles, loss of appetite and slight shivering. In some the onset 
is quite sudden. Acute shivering is followed by severe headache and giddiness, 
then by profuse vomiting without nausea ; with the sickness there is often 
neuralgic pain in the abdomen ; after the lapse of a short time, often only a 
few hours, the mind becomes confused, and the patient grows restless ; there 
is muttering delirium with occasional cries, or the patient falls into a state of 
apathy and stupor, or he may be violently delirious. With this mental dis- 
turbance there is pain along the spine and limbs, and chiefly in the muscles at 
the link of the neck and along the spinal column ; the head is drawn back- 
wards in consequence of the pain and spasm, and this retraction of the head is 
a marked and common symptom. The sensibility of the skin is increased. The 
expression shows acute pain, or is distorted by spasm ; the eyes are suffused 
and the face pale, with occasional flushings. The temperature of the body is 
higher thau usual, and the pulse weak ; the tongue is sometimes clean, some- 
times foul, and the bowels are either costive or loose. Purpuric spots appear 
on the skin, and do not disappear on pressure of the finger; at first pur- 
ple and circumscribed, they soon become black, and extend their margins, so as 
to form dark blotches. If the disease tends to a fatal result the spasms 
increase, coma comes on, and death may ensue in from twelve hours to seven 
or eight days ; if life exist longer, inflammation of the eyes and ears may be 
set up, as ulceration of the cornea and deafness ; or paralysis of one side or of 
one limb may ensue, or there may be an inflammatory state of the joiuts. If 
the disease go on favorably, recovery may take place in three or four weeks, 
but it the progress is interrupted by any complication, convalescence is much 
retarded. Inflammation of the lungs, pleura, and heart, swelling of the glands 
of the neck and under the ear, disease of the eyes and ears, bed-sores, and 
joint affections are met with as complications in this malady. The rate of 
mortality varies in different epidemics. Cerebro-spinal fever may be mistaken 
for typhus fever, but the history, rash, and progress of the disease will clear 
up doubt; spinal meningitis and cerebral meningitis may much resemble this 
malady, but the onset of cerebro- spinal fever is so much more rapid, and the 
fact of its coming as an epidemic will help to solve any difficulty ; besides, no 
rash is met with in the last two cases. Treatment. (1.) Preventive. Since so 
little is known as to the causes of this malady, all preventive efforts must be 
limited to those sanitary measures which are applicable to all epidemic disor- 
ders for the purification of houses and localities. (2.) Curative. The treat- 
ment of cerebro-spinal fever by remedies is very unsatisfactory ; it is doubtful 
if the administration of any medicine has been beneficial in doing more than 
relieving symptoms: for this purpose opium or morphia has been given to allay 
pain and spasm. Sulphate of quinine in large doses, and given early, appears 
to have benefited some cases ; bleeding and mercurial preparations are of no 



CER 95 CHA 

value, and may do harm. The diet must be generous and'nourishing, and con- 
sist of milk, beef-tea, soup, etc. During convalescence the usual principles of 
diet must be adopted which are detailed under the head of Fever. 

Cerebro-spinal Meningitis. See Meningitis. 

Cervix, a neck, is applied in anatomy to bones, as cervix femoris, the neck 
of the thigh-bone ; and to the neck of the womb, as cervix uteri. 

Chafing. See Abrasion. 

Chalk, or impure carbonate of lime, is used in medicine only after it has 
been thoroughly washed and purified, when it is called prepared chalk. It is 
mostly used in summer diarrhoea in the form of chalk mixture, consisting of 
chalk, gum acacia, syrup, and cinnamon water. Dose : a tablespoonful or more. 
Chalk is also used as the basis of most tooth-powders, either as prepared chalk 
or as precipitated chalk, the latter being a fine powder. If the gums are at all 
spongy, a little rhatany powder may be added, or a little powder of cinchona 
bark and some flavoring agent ; orris-root is perhaps that most used. Cuttle- 
fish bones, sometimes highly spoken of, consist almost entirely of carbonate of 
lime, with a little animal matter superadded. 

Chalk Stones. A white, insoluble substance, deposited in the textures of 
the bones, joints, or areolar tissue of gouty persons ; generally in the feet or 
hands. Its chemical composition is urate of soda. The swellings produced are 
very painful if inflamed, and discharge freely ; simple soothing dressings should 
be applied, and suitable constitutional treatment be adopted. Their removal is 
rarely possible. 

Chalybeate. Anything containing iron. See Iron ; Waters, Mineral. 

Chamomile is the flower of the Anthemis nobilis, a plant somewhat resem- 
bling a daisy. The single flowers, that is, those having most yellow in the cen- 
tre, are the best. It has long been a favorite in domestic practice, given as 
infusion or tea for a variety of complaints. It acts as a tonic. 

Champagne. See Wines. 

Chancre. See Syphilis. 

Change of Life. See Life, Change op. 

Chaps. Usually, the disagreeable condition of the skin known as chapping 
is produced by insufficiently drying it after washing, and exposing it in a wet 
or damp state to the influence of the weather and the winds. Persons affected 
with chapped hands should be very careful not to wash them too frequently, 
and to dry them very carefully, having rubbed a little glycerine over them 
before taking them out of the water, or dusting a little powder over after dry- 
ing, to remove any moisture that may remain. Sometimes chaps are the result 
of a scorbutic state of the body, in which case general treatment is necessary, as 
in the case of persistently chapped lips, which are sometimes very painful. 
Smoking a pipe will sometimes produce a painful crack in the lip, which is 
quite difficult to heal. 

Charcoal, or carbon, occurs in nature as black lead or plumbago, but is 
ordinarily made artificially from animal or vegetable substances. Wood char- 
coal is mostly employed externally, and that most frequently in the form of 
poultice, combined with linseed meal and bread. This poultice is of very great 
value when sores are fetid and parts are sloughing away, keeping them moist 
and warm, whilst preventing smell. The powder may be used with similar in- 
tent. It is sometimes given internally, when patients are suffering from organic 
diseases of the stomach and intestines accompanied with the formation of foul- 
smelling gases and acrid fluids. It is also recommended as a temporary anti- 
dote for certain organic poisons, as aconite and strychnine. In either case a 
table-spoonful should be given suspended in water. 



CHA 96 CHE 

Charpie. A French name given to a coarse kind of lint, or tow, which is 
prepared from coarser materials than are employed for the manufacture of lint. 

Cheese. An article of diet made from the milk of various animals, belong- 
ing to the class Mammalia. The milk of all animals contains water, saline 
matters, sugar, butter, and caseine. Cheese consists of a mixture of the two 
latter substances. When milk is allowed to stand, and acid or fermentable 
substances are added to it, the caseine and butter separate in the form of what 
is called curd. This curd on being strained is converted into cheese. Cheese 
is always made in this country from cow's milk. When curdled speedily and 
floating in the water and sugar, which is called the serum or whey of the milk, 
the product is curds and whey. The butter when removed from milk is called 
cream, and when milk is curdled quickly by heat and the cream taken off it is 
called clotted cream. When the curd is removed with the butter from the 
milk, and gently pressed, the product is called a cream or soft cheese. All soft 
cheeses may often be used, on account of the butter they contain, with great 
advantage as substitutes for cod-liver oil. When cheeses are made hard they 
are allowed to stand longer, and then submitted to pressure for varying periods. 
During this process they undergo various changes. In some a sweet substance 
is separated from the cheese, and collects in little vesicles, such as are charac- 
teristic of Gruyere and Dutch cheeses. In others a process of moulding sets 
in which very much alters the flavor. Frequently a portion of the butter is 
converted into butyric acid, which gives a strong flavor. Cheeses vary ac- 
cording to the quantity of butter they contain, and are valued and high priced 
as this substance prevails. In some cases, as in double Gloucester and Stilton 
cheeses, the cream of one milking is added to another milking, thus doubling 
the quantity of butter. In Suffolk, England, a contrary practice prevails, the 
cheese being made after the cream has been taken off and made into butter. 
Caseine when once dried becomes very hard and indigestible. Cheeses differ 
in color according to the quality of the food eaten by the cow, and as colored 
cheeses have been erroneous]}' supposed to be rich cheeses, many adopt the 
practice of adding annotto. In some countries flavoring substances are added. 
Cheese is very nutritious on account of the large quantity of caseine it con- 
tains. The indigestibility of the caseine sets a limit to its use. The caseine 
is, however, rendered more digestible by the butter it contains, and the richer 
cheeses are therefore the best for food. Mixed with other food, cheese has a 
tendency to promote digestion. This is, perhaps, better effected by decaying 
than by fresh cheese : hence the practice of taking decayed cheese, especially 
at the end of a meal. See Milk. 

Chest. The chest is one of the three large cavities of the body, contain- 
ing besides the heart and lungs the great vessels which convey the blood to 
various parts of the system, the oesophagus which carries the food to the stom- 
ach, and other smaller but important structures. In the skeleton, the chest, or 
thorax, is seen to be bounded behind by the spinal column, and in front by the 
sternum or breast-bone, while its lateral boundaries are formed by the ribs, 
which are affixed behind to the spine by movable joints, and in front join the 
breast-bone by their cartilaginous prolongations. Above, the chest is much 
diminished in area, and is bounded by the structures which form the neck; 
below, the diaphragm closes the thorax and separates its contents from those 
of the abdomen. In the living subject, the chest is lined by a thin, smooth 
membrane called the pleura, on which the lungs can glide with ease, while, 
externally, the ribs are covered by the skin ; between these two coverings are 
numerous muscles, called the external and internal intercostal muscles, by 



CHE 9T CHE 

which many of the movements of the chest are performed, and respiration is 
enabled to be carried on ; they are so called because they lie between the costa? 
or ribs ; the action of the external set is to raise, and that of the internal set 
is to depress, the ribs. The diaphragm is the most important muscle of respi- 
ration ; it is convex towards the chest, while its hollow or concave surface looks 
towards the abdomen : it is perforated in a few places, so as to allow vessels to 
pass from the chest to the abdomen and vice versa. The diaphragm, like all 
muscles, has the power of contraction, and its fibres are so arranged that dur- 
ing inspiration it descends and allows more air to enter the chest, but during 
expiration it rises, and so lessens the area of the chest. The contents of this 
cavity are numerous and important: at the back part is the gullet or oesopha- 
gus, a hollow, muscular tube, which allows food to pass directly down from the 
mouth to the stomach ; close to and in front of this tube is the wind-pipe, or 
trachea, which divides into two branches called bronchi, and these, entering the 
lungs, break up and subdivide into a vast number of smaller branches, which 
end in small, dilated, closed extremities called air-cells or air-vesicles : as they 
become smaller and smaller, so the wall of the tube becomes thinner and thin- 
ner, until at last it is of extreme tenuity ; and this is important, because the air 
can then readily interchange gases with the blood through this delicate mem- 
brane, for the blood runs outside the air-cells in vessels with extremely fine 
walls also. The greater portion of the cavity of the chest is filled up by the 
lungs : they are two in number, one on each side ; during life they are distended 
with air, and are of a light, spongy texture ; they are covered with a smooth 
membrane called the pleura, which also lines the walls of the chest. (See 
Lungs.) The heart is situated in front of the chest and at its lower part, just 
between the lungs ; it is made up of four compartments, the two right being 
quite distinct from the two left cavities in health. (See Heart.) On the 
right side the heart receives the venous blood from the inferior vena cava, 
and also from the superior vena cava, which, in a similar way, brings the venous 
blood from the head and neck and upper extremities ; it then .sends it on to the 
lungs and the pulmonary arteries to be aerated. On the left side the heart re- 
ceives the blood from the lungs and sends it on into the aorta, a large vessel, 
which, after ascending about two inches, curves backwards, and then passes 
straight down to the abdomen beside the oesophagus. Close by this large 
vessel runs a very small one, the thoracic duct, which comes from the abdomen, 
and, entering the subclavian vein at the root of the left side of the neck, supplies 
the blood with important elements. For convenience in finding the position 
of the heart and lungs during life, the back and front of the chest may be 
mapped out into districts. On each side are twelve ribs, which can easily be 
couuted in a thin person ; above, and in front of the chest, is a clavicle or collar 
bone, while behind, are the shoulder-blades or scapulae ; these are points which 
are easily recognized by any one. Take two pieces of tape, and, placing one 
end at the junction of each collar-bone with the sternum or breast-bone, let the 
other end hang vertically downwards ; there will then be a narrow central space 
and a wider one on each side ; next lay a piece of tape horizontally across the 
chest just above the nipples, and another piece parallel to it about three inches 
below or on a level with the seventh rib; the lower margin of the ribs is the 
lower boundary of the thorax. In this way nine spaces are marked out, the 
side ones being of equal size, but the central ones narrower ; the lateral ones 
are named on each side from above downwards — subclavian or infra-clavic- 
ular, from being below the clavicle, mammary or the breast region, and infra- 
mammary or the region below the breast ; the central spaces are termed upper, 



CHE 98 CHI 

middle, and lower sternal regions. Continue the horizontal tapes round into 
the axillary region, and then each is divided into three spaces, termed the ax- 
illary, lateral, and lower lateral regions from ahove downwards. In a similar 
way the back may be mapped out; the space over each shoulder-blade is called 
the scapular region, while that between the scapula and the spine on each side 
is termed the inter-scapular or vertebral ; below these are the dorsal regions, 
which correspond to the lower portions of the lungs. Further, the part above 
each clavicle is called supra-clavicular, and the space over the shoulder-blade 
is called the supra-spinous fossa. All these divisions are, of course, quite ar- 
bitrary, and are only of use for easy reference in describing the seat of the 
disease that may be present. In health, the lungs correspond to all these re- 
gions, except to the middle and lower sternal and part of the left mammary 
and infra-mammary regions, where the heart is situated. 

Cherry Laurel, the Primus lauro-cerasus, is a well-known shrub, the 
leaves of which, when distilled, yield small quantities of prussic acid. As the 
quantity varies much, the old-fashioned cherry-laurel water, which owed its effi- 
cacy to the prussic acid it contained, is now rarely if ever used, this acid being 
such a dangerous poison. 

Chicken-pox, or Varicella, is a contagious but harmless disease of 
childhood, unattended by any constitutional disturbance, as a rule, and after 
running its course for a few days ends in complete recovery. Often, several 
children of the same family have it one after the other, and it seems to occur 
in an epidemic form at some seasons of the year ; it affects both sexes and all 
classes indiscriminately. After a period of incubation, the length of which is 
doubtful, a number of little red points suddenly appear on the skin, and in the 
course of twenty-four hours each has become a small blister, or vesicle, raised 
above the surface and surrounded by a pink areola or zone. The next day 
more red spots appear, which also form blisters, and so on for about three or 
four days, fresh crops appear, the previous ones attaining a maturer stage. 
The eruption is most abundant on the back and front of the body; the small 
blisters are convex, and do not present the central depression seen in the pus- 
tules of small-pox. In about a week the vesicles begin to wither and dry up, 
and in a week or ten days longer the scabs fall off, leaving, as a rule, no scar, 
but if they are picked or irritated, a small white depression may be left in the 
skin. Eczema may be produced by rubbing the vesicles ; therefore the child 
should be kept from picking the scab. As a rule, the child need only be kept 
in the nursery, and not in bed all day long; occasionally the little patient is 
restless and feverish, but in most cases it will play about as cheerfully as usual, 
and appear to have nothing the matter with it. The temperature is generally 
normal, the tongue clean, and the appetite good. For a few days the child 
may be. kept indoors, and the diet should be plain and simple. This disease 
is by many called the glass pock. It is not prevented by vaccination, nor does 
it seem to have any connection with small-pox. One disease will not pre- 
vent the other from attacking the same individual. The absence of pain in 
the back, fever, and sickness, which are so common in small-pox ; the rapid 
development of the rash, which is mature in twenty-four or twenty-six hours, 
which comes out in crops, and is more common on the body than on the face, 
will help to distinguish this mild complaint from small-pox. However, when 
small-pox occurs in a modified form, it is occasionally difficult to know one 
from the other. 

Chicory is the name given more especially to the roots of Gichorinm inly- 
bus. It belongs to that division of composite plants which yield a milky juice, 



CHI 99 CHI 

and, like the lettuce, is supposed to possess narcotic properties. The roots 
when ground are used in infusion or decoction as a substitute for coffee. The 
chicory contains no active principle, like coffee or tea, to recommend it ; at 
the same time, the decoction, with the addition of sugar and milk, has an 
agreeable flavor, and is much cheaper than coffee. Chicory has been exten- 
sively employed in the adulteration of coffee. 

Chigoe, called also chigger, chiggre, or jigger, and by the inhabitants of 
Brazil titnga, is a troublesome epizoon or external parasite which attacks the 
inhabitants, both white and black, of the West Indies, and of the eastern and 
south-eastern coasts of South America. This creature, the scientific names for 
which are Pulex penetrans and P. irritans, lives in sand, and is an insect some^ 
what smaller in its body thau the common flea, and furnished with a proboscis 
equal in length to the body. The local disease caused by this parasite consists 
in one or more painful swellings, each about the size of a pea, and of a milk- 
white color, seated immediately under the toe-nails or immediately beneath 
the epidermis of the toes or other parts of the foot. These small tumors are 
attended by much irritation and inflammation in the surrounding soft parts, 
and finally degenerate into painful sores, which discharge matter. The way 
in which these symptoms are produced is this : the impregnated female of the 
chigoe enters by one of the ducts of the skin, and burrows for itself a passage 
under the scarf-skin or epidermis. When ensconced in its situation, the crea- 
ture becomes almost completely hidden in a relatively enormous bag, which 
grows from the under surface of its abdomen and becomes filled with eggs, 
which are here converted into larvae. If, in consequence of slight external 
pressure, this membranous bag be ruptured, the larvae escape into the soft tis- 
sues around, and set up irritation. The treatment consists in removal of the 
parasite together with its abdominal bag, before rupture of the surrounding 
membrane has occurred. This removal may be accomplished after a careful 
dilatation of the duct by which the creature first entered, or by making a small 
incision and extracting the whole mass entire. The sores formed after the 
rupture of the bag will be best treated by poulticing and the ordinary applica- 
tions used against local inflammation. 

Chilblain is a very common and troublesome affection in this country dur- 
ing the winter months. It commences as a mild and superficial inflammation 
of the skin in certain parts of the body, by preference the feet, hands, ears, 
and nose, and afterwards, when neglected, or badly treated, is converted into 
a blister or a deep sore. Its exciting cause is a sudden transition from ex- 
treme cold to warmth, or warmth to cold ; generally the former. The com- 
bination of moisture with cold, the friction of coarse stockings, and the press- 
ure of tight and badly-made boots are also to be regarded as active conditions 
in the causation of chilblain. The parts of the surface of the body generally 
affected are those in which the circulation is weakest and which are most ex- 
posed to the influence of external agencies. The most common form of chil- 
blain is a small red patch on the skin, which occasions heat and itching. If 
this has been neglected or scratched, and no pains taken to regulate the tem- 
perature of the affected part, the inflamed patch becomes darker in color 
and vesicates or blisters, this change being attended by intolerable itching. If 
the chilblain be still allowed to go on without treatment it passes into the stage 
of excoriation, and finally into that of ulceration. In badly-nourished and 
neglected children of the poorer classes, the affection in some instances rapidly 
progresses to a state of gangrene. Much may be done to prevent chilblain. 
At the approach of winter, the feet as well as the hands should be frequently 



CHI 100 CHL 

washed with cold water, or, if this cannot be used on the lower extremities 
without danger or discomfort, Goulard water or a solution of alum or spirits 
of wine should be rubbed into the skin night and morning. The socks or 
stockings should be thick and warm, and the boots loose and furnished with 
good soles. Sudden exposure to cold and wet should be carefully avoided, and 
the temptation guarded against of suddenly bringing a benumbed hand or foot 
into close proximity to a tire. Wet feet should be well washed with fresh cold 
water or Goulard water, and then scrupulously dried. The painful and in- 
flamed part must be guarded against extremes of temperature, and against 
friction and pressure. In the mildest form of the complaint, the inflamed part 
should be well washed with spirits of wine and cold water, carefully dried and 
then painted over with a lotion composed of one drachm of carbolic acid, one 
ounce of glycerine, and four ounces of water. "When the chilblain is more 
inflamed and painful, either of the following lotions will prove serviceable ; 
spirits of turpentine, two drachms ; castor oil, three drachms ; collodion, two 
ounces : or, camphor, one drachm ; eau de Cologne, three ounces. When 
there is much hlistering, simple starch powder, Goulard water, or zinc oint- 
ment will be found the best applications. An ulcerated chilblain requires 
poulticing, and when there is much discharge, and the sore is covered by large 
granulations or proud Jles//. the application of Peruvian balsam, carbolic acid 
ointment, or wine of aloes. In cases where the sore is deep and obstinate 
under treatment, and the skin around inflamed, attention should be paid to the 
general health of the patient, and wine aud good nourishment liberally sup- 
plied. When the discharge from the sore is very fetid, one may combine 
with the above-mentioned dressing a solution of chloralum, or one of perman- 
ganate of potash (Condy's Fluid), or apply a layer of cotton wool, or carded 
oakum powdered with charcoal. 

Chills. Cold chills are always one symptom of mischief to the system 
which should not be neglected. Sudden shiverings. known by this name, are 
often premonitory of an attack of fever of some kind, and it is wise to take 
early notice of the warning, and endeavor either to ward off* the attack or to 
mitigate it- violence by the administration of a hot bath and good rubbing, so 
as to restore action to the skin, a purgative pill, a basin of gruel, and a warm 
bed. 

Chimaphila is the name given to the American winter green, Pyrola um- 
heUaia, This plant has bitter properties, and is celebrated as a tonic and an- 
thelmintic. 

Chin-cough. See Whooping-cough. 

Chiretta is the entire plant of the Aguthotes chirayia, growing in North- 
ern India. It is imported in bundles, with flowers and roots attached. The 
plant is very bitter, with a somewhat peculiar twang about it, and is one of the 
safest tonics which could be recommended for domestic use. The dose varies 
from one in two ounces of the infusion. 

Chloric Ether, now known as Spirits of Chloroform, consists of a mixt- 
ure of chloroform and alcohol, and is the form in which chloroform is most 
frequently given by the mouth. As a remedy it is of great value where there 
i- much sickness and disturbance of the stomach, and it is a useful adjunct 
to nauseous medicines. It is also of great use in certain spasmodic affections, 
as cough and prolonged hiccup, asthma, and the like. For a dose, twenty or 
thirty drop- may he given in sugar, or along with some other substance of the 
same kind. 

Chlorine and Chlorinated Lime may best be considered together, see- 



CHL 101 CHL 

ing that the latter is hut a convenient form wherehy the other is rendered 
portable. Chlorinated Lime, commonly called Chloride of Lime, is prepared 
by pouring gaseous chlorine over quicklime, which absorbs the gas and ac- 
quires certain of its properties. It is mostly used as a disinfecting agent. It 
acts by virtue of the chlorine, which it slowly evolves when exposed to the at- 
mosphere, or gives more speedily when spread in a saucer or other flat ves- 
sel (non-metallic), and a little acid, such as hydrochloric, is added. For or- 
dinary purposes, such as cleansing close rooms, there is nothing more effectual 
than chlorine generated from chlorinated lime. But as it attacks many things, 
being a powerful bleaching agent, readily destroys colors and affects metal- 
work, including gilding, it is somewhat at a discount ; but in privies, work- 
houses, ships, etc., it is of much value. To keep down ordinary smells the 
powder need only be exposed in a flat dish, and renewed from time to time. 
For the purposes of active disinfection, it is better to add to the lime some 
acid, and shut up the doors, windows, and chimneys for a time, taking care 
that the place has been well ventilated before reentering. Chlorine is also 
used as a gargle, especially when there is much fetor from the throat, as scar- 
let fever, diphtheria, and the like. Here it is exceedingly useful. 

Chloroform. In its way there is no chapter in the romance of science 
more interesting than the discovery of chloroform, and its speedy adoption all 
over the civilized world, so as to become synonymous with the history of 
anaesthesia. Sir James Simpson did not discover chloroform, and did not in- 
troduce anaesthesia, but he did introduce chloroform as an anaesthetic, and so 
did more for the success of anaesthesia than any one before him. Anaesthesia 
by ether had been introduced in the United States, and Sir James himself had 
used it in midwifery practice ; but ether was bulky ; much was required to 
produce anaesthesia, and a long time was consumed in bringing people fairly 
under its influence. The discovery of chloroform revolutionized the whole 
matter. Chloroform is produced in the crude state by distilling rectified spirit 
from off chlorinated lime. In appeai'ance, it is a clear, transparent, watery- 
looking liquid, not, however, mixing with water, and if poured on its surface, 
forming a layer at the bottom of the vessel. Its odor is also peculiar. It is 
commonly administered by inhalation, and its use is not unattended with 
danger. No exact quantity can be assigned as proper to be given, as some 
people speedily become insensible under its influence, others again requiring 
a very much longer time, and a much larger quantity of the drug. The great 
danger in its use, apart from peculiarity of constitution unknown to us, or 
actual disease, consists in the insufficient admixture of air with the vapor of 
chloroform, and to secure this admixture various instruments have been pre- 
pared. Perhaps the best of these is what is known from its inventor as 
Clover's Apparatus, which consists of a large air-tight bag, into which is 
driven, and there stored, a due proportion of chloroform and air (not more than 
four per cent, of the former), and this mixture the patient inspires. The 
apparatus used by Sir James Simpson consists merely of a clean towel, or, 
better still, of a clean white cambric handkerchief, either folded into a cone, or 
laid flat over the patient's face. About a teaspoonful of the chloroform is 
poured into the cone, and it is placed so as practically, but not completely, to 
cover the patient's nose and mouth. If the handkerchief be spread over the 
face, more care with regard to the quantity must be taken, and it must be 
sprinkled over a wider surface. Ordinarily the first stage of chloroform in- 
halation gives rise to pleasurable sensations. There is no loss of consciousness, 
but often a sense of relief caused by comparative freedom from pain. This 



CHL 102 CHL 

is followed by another stage, where there is often a good deal of excitability. 
The patient may laugh and talk at random, and will sometimes fight and strug- 
gle. This is most marked in powerful individuals. There is also a loss of 
sensibility, but hardly of consciousness, though sensations of pain are greatly 
lessened. There is still power of motion. Beyond this stage the use of chlo- 
roform in midwifery practice should not in ordinary cases be carried, otherwise 
the labor will be retarded. Of course, if operative interference becomes 
necessary, anaesthesia must be carried to complete insensibility and incapability. 
If we divide the ordinary results of inhaling chloroform into three groups, the 
total insensibility and complete loss of voluntary motion constitutes the third ; 
but in strong young men there often intervenes a condition apparently of com- 
plete rigidity, sometimes accompanied with trembling, and the patient will 
become dark in the face. To those unacquainted with the use of chloroform, 
this condition is sufficiently alarming, but it speedily passes away, the limbs 
become relaxed and totally devoid of power, and respiration is resumed, 
though often stertorously for a time. Now is the time for operation ; there 
is neither sense, feeling, nor power of motion. Beyond this stage the inhala- 
tion of chloroform should never be c;irried. Even this may be dangerous, for 
sometimes suddenly the tongue falls back, breathing ceases, and the pulse stops. 
Death may result before efficient aid can be rendered. If these symptoms oc- 
cur, artificial respiration (which see) should be used, and the patient turned on 
his face and rolled from side to side ; water should be thrown on the face, and 
smelling-salts applied to the nostrils. The application of electricity to the 
diaphragm and side of the neck is also of great service, but prompt measures 
are always the best. Often, as the patient begins to recover sensation, there 
is a fit of vomiting, which may injuriously be repeated. To avoid this, the 
purest chloroform alone should be used ; the patient should have eaten noth- 
ing for at least four or five hours, and the last meal should have been light. 
Ice, or iced champagne, or brandy and iced water, are the most grateful 
remedies for the sickness. Of late a combination of vapors, that is, a mixture 
of chloroform, ether, and alcohol, with or without an aromatic, in certain pro- 
portions, has been strongly commended for midwifery purposes, for which, no 
doubt, it is safer ; but it is not likely to come into general use as an anaesthetic 
in operative surgery or midwifery. Chloroform is also largely used to enable 
the practitioner to make a correct diagnosis when there is much pain and spasm. 
It has also been given in asthma and in tetanus. In spasmodic and irritable 
strictures of the urinary passages, chloroform often proves of very great ser- 
vice in enabling an instrument to be passed. Tic douloureux and other forms 
of neuralgia often yield to its influence. So in toothache arising from a de- 
cayed tooth, chloroform often acts a double part : to the part itself it acts as 
an irritant, and so in many cases does good, while the sedative effect which 
follows is none the less beneficial. Chloroform has been of most signal service 
in enabling the surgeon to reduce dislocation and strangulated hernia or rup- 
tures. In such cases the patient should be brought thoroughly under the 
influence of the vapor before anything else is done. 

Chlorosis is a disease in which the complexion becomes of a yellowish- 
green tint, and in which there is a diminution of the coloring matter of the 
blood. It occurs chiefly in young women who lead sedentary lives, or sit in 
close workshops, or in any place where light and ventilation are deficient ; 
such people have a dark border under the eyes, pale complexion, a feeling of 
lassitude and weakness, headache, pain in the back, and amenorrhoea. The 
treatment is the same as for auaiuiia. Anaemia is a term used when the patient 



CHO 103 CHO 

becomes pale from other diseases, as cancer, consumption, and kidney disease ; 
chlorosis is used when the alteration in the blood is the primary change, and 
not dependent upon mischief elsewhere. See Anaemia. 

Chocolate. See Cocoa. 

Choke-damp is a name given by miners to all irrespirable gases ; but it 
more especially applies to carburetted hydrogen. Carbonic acid gas is called 
fire-damp. 

Choking. This is an accident liable to happen to hungry persons eating 
hastily, or to children, and requires the greatest self-control and presence of 
mind on the part of those who are present in order to be of any use. The 
substance which causes the choking may either be at the top of the throat, at 
the entrance to the gullet, or lower down. If at the upper part of the throat, 
prompt action will often remove it, either by thrusting the finger and thumb 
into the mouth and pulling the obstruction away, or, if it cannot be reached 
so as to pull it away, a piece of whalebone, a quill, or even a penholder — any- 
thing at hand — should be seized and pushed down as a probang, so as to 
force the substance down the gullet. Tickling the back of the mouth with a 
feather, so as to produce sudden retching, will sometimes dislodge it ; a sharp 
blow on the back will perhaps displace it, or a sudden splashing of cold water 
in the face, causing involuntary gasping. Should the patient become insensi- 
ble before relief can be afforded, it must not be assumed for certain that death 
has taken place, and such remedies as dashing cold water in the face and on 
the chest, applying ammonia to the nostrils, and inflating the lungs by bellows, 
etc., should be continued till medical aid arrives. 

Cholagogues are medicines which act on the liver and increase the flow 
of bile. Among the most powerful of these are the various preparations of 
mercury, such as blue pill — mercury with chalk and calomel. The remedy 
commonly called Podophyllin is of use in the same way. 

Cholera, as known to us, is of two kinds, — what is known as cholera 
morbus, a disease bad enough, but not particularly fatal, and that terribly fatal 
disorder, Asiatic, malignant, or epidemic cholera. This last disease seems to 
have been known in India for centuries, and to have its natural home or head- 
quarters in the Delta of the Ganges. In 1817 the disease first attacked Eu- 
ropeans in India, and ravaged Lord Hastings' army; but it was not till 1831 
that it reached England. In this country the disease has almost invariably 
prevailed in its worst form in poor, crowded dwellings, among those whose 
food supply was bad, whose hygienic conditions were otherwise unfavorable, 
and especially among those who had a tainted supply of water. Very fre- 
quently when cholera prevails, diarrhoea also does ; and in point of fact, in a 
case of ordinary intensity, the disease is ushered in by an attack of diarrhoea. 
This may last a longer or a shorter period, but speedily the matters passed by 
the bowel assume a peculiar flocculent or rice-water character. Vomiting, too, 
comes on, the fluid being thin and colorless. Then follow severe cramps, 
especially of the abdominal muscles and legs. The flow of urine ceases, the 
body becomes icy cold on the surface, the tongue is cold, and so even is the 
breath. The lips are blue and shriveled, the face pinched, the voice is hardly 
audible, the very eyeballs are flattened. This is called the cold or algid stage 
of the disease. The condition may go on getting worse till the heart stops, 
the patient being quite conscious to the end. Frequently it is impossible to 
tell whether the patient is to live or die, when suddenly the sickness lessens, 
the body begins to get warm, the face flushes, and restlessness subsides. The 
patient seems on the very verge of getting well. But sometimes the urine 



CHO 104 CHO 

does not flow, or there may be congestion of the lungs or brain, and so, though 
reaction has set in, the man may yet perish. Thus, in an ordinary mild case 
of cholera a man will pass through three stages: first, that of premonitory 
diarrhoea ; secondly, that of collapse ; and thirdly, that of reaction, — probably 
in about forty-eight hours. The disease is produced by some particular poison, 
which may be transmitted through the air, by water, or communicated by 
one individual to another. There can be no doubt that the discharges are one 
main source of this poison, and hence should be most carefully disinfected. 
He who would avoid cholera during a cholera season ought to live by rule 
and method. First, see that his water-closets are in good order, and that every 
precaution is taken in cleansing and disinfecting them. Calvert's carbolic 
acid powder, or the diluted acid itself, is best for this purpose. See that the 
house is clean, sweet, and airy ; let no foul and decaying matters of whatever 
kind remain upon the premises. See that the water supply is pure. Let no 
stale meat or vegetables, no sausages, game, or substances likely to create di- 
gestive disturbance, be used ; especially avoid unripe fruit, prolonged abstinence 
from food, excessive fatigue. Avoid strong aperient medicines of every kind. 
The astringents to be used should not be powerful ; chalk mixture, sulphuric 
acid, lemonade, or these with a little opium added, are best. No diarrhoea in 
cholera time is to be neglected. It is quite useless to give medicines internally ; 
they only accumulate there, for they are not absorbed. The only thing is to 
try to keep up the heat in eveiw way which will not disturb or fatigue the 
patient ; that is material. The patient is consumed with thirst, and there is 
no reason under the sun for refusing him drink, if of a wholesome kind. 
Should reaction occur, he must be kept quiet. If his head trouble him, and 
his face is flushed, apply cold to it. Jf there is much sickness, let him have a 
little ice or ice-water. If his lungs get gorged, warm poultices of turpentine 
stupes will be best. But the great anxiety is the kidneys. If they do not act, 
warmth must be tried, perhaps as a warm bath; but this is a delicate matter, 
and requires caution. If they are acting well, and the patient requires a 
stimulant, let him have some sal volatile. The food given is of special im- 
portance ; broths, soups, and jellies may be given, but certainly not meat. 
Small quantities, too, at a time must be given, and repeated as frequently as 
necessary. 

Cholera Morbus is frequent enough in the summer months. It may 
almost invariably be traced to some injudicious article of food, some unhealthy 
occupation, or some distinct cause. The symptoms are vomiting and purging; 
the vomit being bilious, and utterly unlike the colorless vomit of true Asiatic 
Cholera. The question to be decided is usually this : Have the vomiting and 
purging lasted long enough to expel the offending matters ? If so, they had 
better he stopped ; if not, something should be given to favor their expulsion. 
Rhubarb and gray powder are perhaps the best things to give if laxative med- 
icine is necessary ; if not, a few drops (ten or so) of laudanum and sulphuric 
acid, or five grains of Dover's powder, or ten or fifteen grains of compound 
chalk and opium powder, will be best to stop the purging. Ice or an effer- 
vescing drink will be best to allay sickness, should these be required. The 
disease may prove fatal to children, but rarely to adults. 

Chondrous Crispus, better known as Carrageen or Irish Moss, contains 
a large quantity of vegetable jelly, which may be extracted by boiling, and 
this product, sweetened with sugar, has been commended in certain diseases, 
as rickets. Its efficacy is doubtful. Like other sea-weeds, it contains a trace 
of iodine, which may be of service. 



CHO 105 CIC 

Chorea is a disease generally met with in children between seven and 
twelve years of age, but occasionally it occurs in adult life. The disorder is 
often dependent on a fright, the disease appearing in the course of two or 
three days after by twitchings of the arm and leg and the muscles of the face : 
generally one side is more affected than the other, and sometimes the choreic 
twitchings are confined to one side. The twitchings of the muscles are worse 
when any one is observing them, or when the child is excited ; they always 
cease during sleep. Since the child cannot contrpl its movements, it is unable 
to write properly, or walk across a room, or take hold securely of any object ; 
the tongue is protruded and drawn back with a jerk, and the head is never 
steady because the muscles of the neck jerk it about constantly. In most 
cases the appetite is not affected, nor does the general health seem much im- 
paired ; there is, as a rule, no fever, and generally a recovery may be looked 
for ; in a few others, which are of somewhat rare occurrence, the twitchings 
are so violent that the elbows, knees, and hands become sore and abraded by 
constantly striking surrounding objects; there may be fever, delirium, and 
sleepnessness ; these are signs of grave importance, and are usually associated 
with heart disease, or follow on an attack of rheumatic fever. Chorea, or, as 
it is popularly called, St. Vitus's dance, is a vny curable disease in ordinary 
cases. Early treatment is always advisable, and it should consist of taking a 
cold bath every morning, to be followed by friction with a rough towel ; tonics 
are of great service, and more especially those containing iron. A simple but 
nourishing diet should be taken, and a certain amount, daily, of out-door ex- 
ercise. For those cases in which fever and delirium are present, rest in bed, 
sedatives to allay the sleepnessness, and a fever diet are desirable. Chorea 
occurs in nervous, excitable children, and in those whose parents or other 
members of the family have suffered from nervous diseases, as paralysis, epi- 
lepsy, and neuralgia. 

Chronic Hydrocephalus. See Hydrocephalus. 

Churchyards are still to be found in towns and large cities, and, though 
it cannot be proved, doubtless deteriorate the health of the neighborhood. 
Where they do exist, churchyards should be carefully drained ; if drains can- 
not be driven through them, they can at all events be surrounded by a deep 
drain leading to some favorable sewer or similar sewage conduit. 

Chyle is the fluid found in the lacteals of the small intestine, being ab- 
sorbed by them as the food passes down the intestinal canal. It is of a milky, 
opalescent appearance, from containing a large quantity of finely-divided oily 
matter. After passing through the mesenteric glands, it enters the receptacu- 
lum chyli, and then goes on to join the blood-current by ascending the thoracic 
duct. 

Chyme is the name given to the partially digested food after it has left 
the stomach, and while passing down the intestinal canal; during its passage 
various soluble substances are absorbed by the vessels of the small intestine, 
and the remainder, which is called feces, leaves the rectum as excreta. 

Cicatrix. A wound or sore invariably leaves, after healing, a distinct 
mark upon the skin. This mark is called a cicatrix or scar. It is of a pale 
pink or white color, is made up of firm, gristly material, and is covered by a 
transparent, smooth, and shining layer of cuticle. The appearances of cica- 
trices vary immensely, according to the part of the body on which they are 
seated and the nature and depth of the wound or ulcer from which they have 
been developed. The scars from burns, from scrofulous sores, and from malig- 
nant or lupoid ulceration have each their special characters. After a sore 



CID 106 CIN 

has healed, the resulting cicatrix loses its ruddy or pink color and becomes 
whiter ; as it gets older, it glides more freely over the tissues beneath, and at 
the same time becomes smaller in superficial extent, drawing upon the neigh- 
boring soft parts, so as to produce in some instances much distortion and de- 
formity. Scars frequently become diseased. They are sometimes the seat of 
severe pain, which is more intense in damp, cold weather. Obstinate ulcer- 
ation and cancer are frequently met with in the seats of old wounds. 

Cider is a fermented beverage made from the juice of apples. Perry is 
made iu the same way from pears. The quantity of alcohol contained in cider 
and perry varies according to the amount of sugar in the juice, and the com- 
pleteness of the fermentation. The quantity of sugar also varies. Cider and 
perry contain malic acid. The quantity of this acid contained in a pint is 
about one hundred and fifty grains. There is nothing special in the action of 
cider on the system. It may be frequently taken with advantage instead of 
beer, especially the rough cider, which contains less sugar and saline constit- 
uents, which differ from those contained in beer. Perry has more flavor than 
eider, and more care is taken in its preservation. 

Cinchona, better known par excellence as bark, is the product of different 
species of trees growing naturally in the Andes of South America, but now 
cultivated in Java and Jamaica, and with great success at Ootacamund in the 
Neilgherries, a range of hills in the southern part of India. Three varieties 
of bark are recognized in our Pharmacopoeia, namely, the yellow, the pale, 
and the red. In these are found two chief alkaloids, namely, quinine and 
cinchonine ; most quinine being found in yellow bark, most cinchonine in pale 
bark, whilst the red bark yields both. It is chiefly to these substances that 
the barks owe their great virtue. Quinine is used in medicine as a sulphate, 
cinchonine as a hydrochlorate, the alkaloids themselves being but little solu- 
ble. Of the two, quinine is the more powerful, and the more employed. -The 
discovery of the properties of bark was made in a curious fashion. As the 
story goes, an Indian, sick unto death of the fever of the country, dragged 
himself from the spot in the forest where he had fallen, exhausted, to the 
nearest pool to quench his thirst. In this pool a tree had fallen, and its 
waters were strangely bitter, but their effect was magical ; the fever fit left, 
and as the man returned to drink again and again, he was speedily cured. 
This led to the discovery of the effects of. as it was then called, Peruvian 
bark, and on the occasion of the illness of the viceroy's lady, it was recom- 
mended. The effects were so satisfactory that, returning to Europe, the 
viceroy carried with him some of the bark, whose praises were soon spread 
abroad, and to it his own name of Chinchon, slightly modified, was given. 
From that date to the present, the tropical fevers, which used to be so deadly, 
have been comparatively kept under hand. These fevers are of the intermittent 
or remittent type, and just before an attack quinine should be given, in a dose 
of not less than five grains. Smaller doses should be given during the whole 
of the interval. On the west coast of Africa, where fevers of this kind 
prevail, and are exceptionally dangerous, a dose of quinine is ordinarily given 
the first thing every .morning to ward off the fever. Cinchonine has similar 
effects, but requires to be given in larger doses. Quinine does not appear to 
have the power of arresting what are called continued fevers, such as typhus 
and typhoid, but it is of undoubted service during the period of convalescence, 
and it is considered to have the power of reducing high temperature even in 
these diseases. In neuralgia and tic-douloureux, especially when they come on 
at stated periods, quiniue is often of immense service. It is useful also iu brow 



CIN 107 cm 

ague. Quinine is the great remedy in most forms of debilitating disease, 
especially for the sake of giving an appetite. For this purpose, one or two 
grains should be given for a dose, a few drops of dilute sulphuric acid being 
added to enable it to dissolve more speedily. When given in very large doses, 
quinine produces a singing in the ears and throbbing in the temples which 
is far from pleasant. These are signals for a diminution in the dose given. 
Quinine is now usually prescribed instead of bark, except in certain instances. 
In certain forms of disease accompanied with great debility, nothing better 
can be given than a decoction of bark with carbonate of ammonia in large and 
repeated doses. A draught of this kind will also frequently relieve headache, 
and give appetite. 

Cinnabar is the red sulphuret of mercury found native, and is one of the 
chief sources of that metal. 

Cinnamon Bark, as used in medicine and confectionery, is the inner 
bark of the young shoots of a tree growing mostly in Ceylon. From it is dis- 
tilled an oil called oil of cinnamon, which has the fragrance of the bark as 
well as it pungency. In medicine it is mostly used as cinnamon water, which 
may be made from the bark or oil. This with many is a favorite means of 
disguising the flavor of unpleasant remedies. The powder is also used as an 
adjunct to relieve fl.ituleuce or prevent griping. The dose of the bark is 
immaterial .; that of the oil is from one to five drops. 

Circulation of Blood. See Heart. 

Circumcision. The operation of removing the foreskin is frequently 
necessary, either from its preternatural length, or for disease. The operation 
has been practiced by the Jews from the earliest times ; doubtless on account 
of the resulting cleanliness, and probable immunity from infection of venereal 
disorders. 

Cirrhosis of the Liver is the name given to a disease in which that organ 
becomes smaller and firmer than usual. It is known more commonly as the 
" hob-nailed " or " gin-drinker's liver." Cirrhosis occurs but rarely in chil- 
dren, but is not uncommon in adult life. Amongst the many evils caused by 
drunkenness, this gradual wasting of an important organ, together with an 
increase of the fibrous tissue of the viscus, must take its place ; in other cases 
it seems brought about by syphilis, or in other diseases where there has been 
going on for some time a deterioration of the blood. This disease is always 
chronic in its course, and begins somewhat insidiously. Loss of appetite, sour 
risings from the stomach, a feeling of sickness in the morning, and fetid 
breath are often the earliest signs ; and the skin, in addition, may have a 
slightly jaundiced color. The patient may go on for many weeks or months 
without being much distressed, but he will notice that he is gradually losing 
flesh, and that his strength is failing. After a time, the abdomen will become 
distended, because the circulation through the liver is obstructed, and the 
• serum in the over-full vessels behind passes through their walls and causes an 
accumulation of fluid in the abdominal cavity; the patient is then said to have 
" dropsy of the abdomen." (See Ascites.) The veins, also, over the sur- 
face of the abdomen become very full, and the skin is marbled over with blue 
ramifying lines. The patient is usually emaciated, and the skin has a sallow, 
yellow color ; the pinched expression of face and the absence of fat under 
the skin contrast markedly with the distended abdomen. The patient feels 
weak, and cannot undergo any exertion ; his appetite is bad, and the tongue 
dry and red ; the presence of the dropsy prevents him from breathing with 
ease, and the tightly-stretched skin gives him pain ; generally, too, the intestines 



CIT 108 CIT 

are very full of gas, and so flatulence adds to his discomfort. Treatment: 
In the early stage, before dropsy comes on, the patient must abstain from any 
excess in stimulants; the food be takes must be light and nutrient; cold 
milk for breakfast is generally well borne on the stomach, with some dry toast, 
or biscuit, or bread soaked in it. Mutton and roast beef may be taken, but 
pork, salt beef, cheese, pastry, and vegetables are not good. If a chop, or 
steak, or a piece from a joint cannot be taken, strong beef-tea, or broth, or 
chicken, etc., may be given. Coffee is better than tea, and cocoa with milk 
forms a pleasant beverage. Rich food and made-up dishes should be avoided. 
The mineral acids (as hydrochloric or nitric acid) may be given with some 
bitter infusion twice a day. An occasional aperient should be given, and for 
this purpose a rhubarb mixture may be prescribed. When there is much 
ascites, the urine passed is high-colored, diminished in quantity, and deposits 
a pink sand on standing ; this, as well as the pain in the abdomen and the 
difficulty of breathing, arises from the pressure of the fluid : hence the object 
must be to remove the fluid as far as possible ; for this aperients may be 
given which produce copious, watery evacuations; such drugs are called hvdra- 
gogues, and amongst them may be named jalap, scamm'ony, colocynth, and 
elaterium. As the patient will probably be thirsty, a drink made of lemon- 
juice, cream of tartar, sugar, and boiling water is very grateful. If the 
dropsy be so great that drugs seem to be of insufficient avail, recourse may 
be had to tapping the abdomen and letting out the fluid ; this operation is 
termed " paracentesis abdominis" (which see). A bandage must be applied 
afterwards round the abdomen so as to give it support, and it mny aid in pre- 
venting another accumulation. For a time the person will recover in a great 
measure, but at some future period the fluid may again be effused, and after 
every tapping there is a diminished chance of ultimately doing much good • 
yet in many cases careful diet and judicious treatment may prolong life for 
many years. 

Citrates are favorite forms of giving many remedies ; as such they can 
ordinarily be given in an effervescent state, enabling them to be more readily 
retained by the stomach. The most common form is technically known as 
Citro-tartrate of Soda. To this many remedies may be added : it is itself a 
gentle laxative, and is often used as such in doses of about sixty grains or more. 

Citric Acid is the substance which gives the pleasant acid flavor to 
oranges, lemons, and most of our fruits. It is found pure in the lemon, citron, 
and other fruits of the natural order Aurantiacece. Its action on the system 
is like that of other vegetable acids. It is cooling and refreshing to the taste, 
and is decomposed in the system, acting probably in the same manner as sugar. 
When taken in the form of lemon-juice, lime-juice, or in the fruits of the orange 
family of plants, it is eminently anti-scorbutic. On this account ships going a 
voyage of more than six weeks are compelled to take a supply of lemon or 
lime juice, and sailors should take at least half an ounce a day. The crystal-, 
lized citric acid does not appear to act as an anti-scorbutic. Citric acid and the 
juices which contain it are employed for making effervescing draughts, when 
mixed with alkalies. Fourteen grains of citric acid, or half an ounce of lemon- 
juice, mixed with twenty grains of bicarbonate of potash, makes, with one 
ounce of water, an excellent effervescing draught. 

Citron is the fruit of a variety of the Citrus medica, or common lemon. 
Its juice contains citric acid, and its peel, or external covering of the fruit, is 
preserved in sugar, and called candied citron peel. The peel of all the fruits 
of the orange family of plants contains a volatile oil, which gives it a pleasant 
flavor, and renders it slightly stimulant. See Oranges. 



109 





Fig. xvi. 



Fig. xvii 




Fig. xix 



CLA 111 CLI 

Clavicle. See Collar-bone. 

Clavus is the name given to a kind of nervous headache confined to one 
spot, and met with in hysterical girls. See Hysteria. 

Clergyman's Sore Throat. See Sore Throat. 

Climate is used to express a multitude of conditions, some known, some 
unknown ; but on the whole the idea of heat or temperature is uppermost. 
Next to that comes humidity or dryness, so that we speak of a hot climate or 
a cold climate, a moist or a dry one. But to know whether a given place 
possesses a good climate, that is to say, on the whole a healthy one, we must 
know something more than is told by the thermometer and rain-gauge. Then, 
as regards cold, it is quite possible, by shutting up an invalid for the winter, 
and by exercising due care, to keep the surrounding atmosphere at any tem- 
perature we like, and maintain it evenly so. If we send him abroad, we seek 
to send him to a part of the world where he will be able to spend a consid- 
erable portion of his time out-of-doors. In choosing a climate, it is not the 
mean temperature we have to study, but the extremes, the highest and the 
lowest points, and we must judge of its eligibility by these. But this is not 
all. Still air, whether hot or cold, is much more bearable than is moving air 
or wind. So we may have a windy place with a tolerable temperature in the 
shade altogether unsuited to the wants of the invalid. Moreover, the situa- 
tion of the proposed residence must be considered with regard to the prevail- 
ing winds ; even in windy regions some sheltered nooks are to be found which 
will exhibit a vegetation characteristic of regions possessed of apparently a 
much higher temperature. So, too, with regard to humidity, the rain-gauge 
is no great criterion. In certain regions a vast quantity of rain pours down, 
fills up the rain-gauge for two or three inches, and then passes away, not to re- 
turn for many weeks. In other regions it rains more or less every day, and 
the whole atmosphere is impregnated with moisture. Here there may, by the 
rain-gauge, be a smaller rain-fall than in the other instance, but the climate 
will be as different as may be. The mode in which the rain disappears after 
falling is of the first importance. Here soil comes in. Suppose the soil a 
clay soil up to the surface : the rain-water cannot percolate through it, and so 
if the land slopes it runs off at once ; if the land is flat, it lies on its surface. 
If instead of a clay soil we have a sandy one, the rain-water will sink through 
the porous earth almost as soon as it has fallen, but its ultimate destiny de- 
pends on other circumstances. If the sandy soil slopes, the water will speedily 
run off, but if it forms a valley, let us say, and has beneath it a bed of clay, 
the ground water will only sink as far as the clay and remain there. In cer- 
tain districts, instead of the surface being made up of sand or gravel, it is com- 
posed of vegetable debris, resting on a subsoil of mud. This constitutes a 
marsh, and such an association of things gives rise, under the influence of the 
sun's rays, to what we call malaria. Certainly, for invalids suffering from 
diseases like consumption or chronic rheumatism, localities characterized by 
excess of ground water are to be avoided. Exposure to the sun is another 
thing to be taken into account, though not, perhaps, quite so much as exposure 
to the prevalent winds. Finally, in forming an estimate of the value of a 
given place as a health resort, we must not forget to take into account the 
conditions which man himself imposes on a locality. The very great impor- 
tance of drainage in adding to the healthiness of a locality is daily becoming 
more and more appreciated. It has been as clearly demonstrated as a thing 
can be that bad drainage brings in its train diseases of the class called Zy- 
motic. Many cities are notoriously deficient in drainage, and these should be 



CLI 112 CLO 

carefully avoided by the traveler in search of health. Taking the two great 
factors in climate as our guide, we might classify climates by them, especially 
if we take into consideration one other alluded to, namely, wind. Where the 
atmosphere is moisr, and the temperature tolerably and uniformly high, we 
have a climate which is commonly called relaxing. Supposing, now, the tem- 
perature is high, and the air excessively dry, we have a kind of climate of 
which Nice affords a good example. It is customary to call such climates ex- 
citing. Taking now the element wind into consideration, we find certain cli- 
mates characterized by stillness of atmosphere and tolerable dryness, without 
this being excessive. Such is Pau in the Pyrenees. Finally, we have cli- 
mates, tolerably common in this country, where they are ordinarily associated 
with sea air. These are characterized by a temperate atmosphere, neither too 
hot nor too cold, fresh breezes, and the absence of all oppressiveness or hu- 
midity. Mountain air, too, belongs to this class, which is denominated brac- 
ing. Bracing climates are, perhaps, more used by tired people than by in- 
valids. There is another thing, too, which must not be lost sight of in selecting 
a health spot for an invalid ; that is, the possibility of procuring proper food 
for the patient. In many parts this is impossible, so that places otherwise un- 
exceptionable may be ineligible on this account. The kind of climate best 
adapted for an invalid having been settled on, it is desirable that he should un- 
dertake his journey with due care and attention. The grand rule is to avoid 
fatigue as far as possible. It is of much less importance to arrive at the des- 
tination rapidly than to arrive at it in a condition to be benefited by the change. 
Flannels next the skin should always be worn on such journeys, and fre- 
quently also after the destination has been reached. A small medicine chest 
is often found very useful, except the patient be going to regular invalid re- 
sorts, where proper medicines are always obtainable. The maladies most 
likely to be improved by change of climate are diseases of the lungs, as chronic 
bronchitis, consumption, inflammation of the air-tubes and larynx, asthma ; 
neuralgia, gout and rheumatism, derangements of the functions of the womb, 
and certain diseases of the kidneys. Delicate strumous children are often very 
greatly benefited by change of air, especially to the seaside, if an appropriate 
place can be found. Above all, change is benelicial in convalescence from 
acute disease. See Health Resorts. 

Climacteric is a term derived from ancient writers on disease. It was sug- 
gested that there was a tendency in the human body to certain diseases at the 
end of a definite period. This period was usually fixed at every seven years, 
when peculiar diseases occurred. The ninth period, or sixty-three years of 
age, was the time of the commencement of what was called the " grand cli- 
macteric." In some instances teeth appear between the sixty-third and eighty- 
first years of age, after the disappearance of the second or permanent set of 
teeth. This is called " climacteric teething." 

Clothing is, perhaps, too much a matter of fashion to be touched on with 
great advantage in a work like this. Nevertheless certain sound rules may be 
laid down. In civilized lands certain materials and shapes are supposed to be 
incumbent on every one, whereas abroad every one endeavors to suit his dress 
to the climate. Hence it is that Anglo-Indians complain much more of the heat 
in England than in India. The great thing is to avoid extremes of heat and 
cold, and if vre are unable to change our clothes to suit the altered conditions, 
we must endeavor to wear such as will suit either emergency. There is only 
one thing that will enable everybody to do this (the strong may not need it), 
and that is flannel. In winter it is desirable that we should not wear the same 



CLO 113 COC 

clothing in doors as we do out, hence the general use of overcoats in this 
country. Abroad, extremes of heat and cold are often experienced in one 
day, and then mantles of some kind are generally used. One of the most im- 
portant articles of clothing for health's sake are shoes. It is of the utmost im- 
portance, especially to delicate people, to keep the feet dry. For this pur- 
pose nothing is so serviceable as india-rubber overshoes. If the body cannot 
be kept dry, the great rule is, Change as speedily as possible. 

Clove-hitch. A knot in use amongst surgeons for the purpose of re- 
ducing dislocations, on account of the very firm hold it has upon the limb to 
which it is applied. It may be made either with a cord or a jack-towel. It 
is made thus : a good-sized loop is taken, held by both hands ; that portion held 
in the right hand is then twisted under that held in the left, again looped and 
twisted upon itself, and the resulting loop placed upon the former one ; the 
limb is then placed in the double loop thus formed, and the two ends drawn 
up. The knot thus formed cannot slip. 

Cloves are the unexpancled flower-buds of a tree growing in the East In- 
dian Islands. They yield an oil, generally when we see it brown, but at first 
much lighter in color. This has the hot, burning taste of the cloves, which, 
indeed, chiefly owe their properties to it. Their virtues are described as stimu- 
lant, aromatic, and carminative ; they are useful for relieving flatulence and 
the distension it causes. The oil is most frequently used to allay the pain of 
hollow teeth. 

Club-foot; Club-foot, or talipes, signifies a deformity of the foot, caused by 
the contraction of the muscles or tendons of the leg ; mostly congenital. The 
different forms are : (1.) Talipes equlnus, that is, when the heel is raised and 
the individual walks on the ball of the foot. (2.) T. varus, when the patient 
walks on the outer edge of the foot. (3.) T. valgus, when the inner edge is 
trodden on. And (4.) T. calcaneus, when the patient walks on the heel. The 
treatment of these cases requires surgical and mechanical interference, such as 
the cutting of the tendons which interfere with the proper direction of the 
foot, and the application of suitable apparatus. 

Clyster. .See Enema. 

Cobra de Capello is the Portuguese name for the Hooded Snake (Naja 
vulgaris). It is common in the East Indies, and is the cause of great mortality 
amongst the natives. Its poison, like that of all venomous snakes, is contained 
in two small bags found under the poison fangs, which are hollow, and permit 
of the exudation of the poison into the wound produced by their bite. The 
absorption of the poison is attended by delirium, coldness of the extremities, 
sickness, extravasation of blood in the skin, and eventually syncope and death. 
"When persons are bitten by the cobra or other poisonous snake, a ligature 
should be applied between the part bitten and the heart, or a cupping-glass 
may be employed to prevent absorption. The wound should be enlarged, or, 
if possible, immediately cut out, and the parts well washed. If the part is 
swollen, it should be smeared with oil. Brandy and ammonia should be given 
to prevent depression, and the wound should be dressed with lunar or other 
caustic. 

Coca is an intoxicating agent used by the natives of South America. It 
is extensively cultivated in Peru, and is used by the natives in the same way as 
tobacco is chewed elsewhere. Wonderful effects are attributed to this poison. 
It is said to increase the strength of those who take it. It produces a delirious 
effect on the system, and the Indians are in the habit of secreting themselves 



COC 114 COD 

in the woods, and abandoning themselves for days together to the pleasures of 
intoxication from this agent. 

Cocculus Indicus is the fruit or berry of a climbing shrub growing in 
India and the East Indian Islands. It contains an active principle called Pi- 
crotoxine. In medicine it is sometimes used as an ointment for the destruc- 
tion of vermin. It is used by brewers to adulterate beer, thereby adding to its 
intoxicating qualities. The powder is also sometimes employed by poachers 
to destroy fish. 

Cochineal can hardly be said to be a medicine. It is, however, used to 
color certain tinctures. It is the product of a certain insect found on the cac- 
tus growing in Mexico. Carmine is prepared cochineal. 

Cocoa. The substance known by tins name is prepared from the seeds of 
a plant known to botanists as the Theobroma cacao, and is a native of South 
America. The seeds, several of which are produced in a long pod, are roasted 
before being used. When thus prepared they are called cocoa nibs, and are 
sometimes boiled, and made into a decoction in this form. More frequently, 
however, the seeds are crushed and made into a' paste, and sold as " cocoa 
paste.'' When flavoring matters, such as vanilla, are added, the preparation 
is called " chocolate." Sugar is sometimes added to cocoa, and always to 
chocolate when sold in the form of a sweetmeat, of which there are great 
varieties. Whilst cocoa differs greatly from tea and coffee in its composition, it 
nevertheless resembles them in possessing an alkaloid called theobromine, 
which acts in the same manner on the system as theine (tea). In addition to 
this substance cocoa contains a half part by weight of a fixed oil or butter, 
which gives a very decided character to its action on the system. Cocoa also 
contains in every pound three ounces of flesh-forming matter, so that it consti- 
tutes a food at once heat-giving and flesh-forming, and admirably adapted to 
all the wants of the system. Cocoa as an article of diet is to be recom- 
mended in all cases where a nourishing and heat-giving diet is required, and 
with milk and sugar forms a very healthful food for breakfast or supper. The 
fat does not agree with some persons, and it is in these cases that an infusion 
or decoction of the " cocoa nibs " is recommended. 

Cocoa-nuts are the product of a species of palm which grows in the East 
Indies and Ceylon. The seed is large, with a thin shell. The shell is lined 
with a white flesh, and the interior contains a fluid which is called the milk of 
the cocoa-nut. The flesh contains oil and albumen, and is used extensively as 
an article of diet in the countries wh<5re it grows. It is eaten in this country 
to a limited extent, and made into puddings, cakes, etc. The seeds of all 
palms contain a clear fluid in their interior, which is regarded by the natives, 
as well as Americans and Europeans, as a very agreeable and cooling bevc-nige. 

Codeia is one of the alkaloids contained in opium. (See Opium.) It has 
recently been recommended in diabetes. 

Cod-liver Oil is one of the most valuable remedies we possess, and yet 
it should be looked upon rather as a food than as a medicine. It is prepared 
chiefly from the liver of the cod-fish, which at certain seasons of the year is 
richer in oil than others. The. first and most important point in preparing it is 
to see that the livers are absolutely fresh ; the slightest taint spoils the oil, and 
renders it nauseous. Roughly it may be said that to procure a satisfactory oil 
it is only necessary to slice the livers thus selected, to keep the temperature a 
little above blood heat, and to allow the oil to drain away of its own accord. 
This oil is quite colorless, as should be all cod-liver oil; the oil containing 



COP 115 COP 

liver-coloring matter' has been procured by an inferior process, and does not 
suit the stomach so well as the pure variety. The great virtue of cod-liver oil 
probably lies in its easy digestibility. Probably in those cases where it does 
so much good, it reestablishes the balance of nutrition, enabling other sub- 
stances to be made use of in the animal economy which were before rejected. 
Under its use patients sometimes marvelously increase in weight and general 
appearance, their blood becoming richer, and their complexions ruddier. Its 
use is thus indicated in a great variety of exhausting diseases, especially those 
where there is chronic wasting and gradual emaciation. Individuals, too, with 
swollen glands, which themselves interfere with nutrition, are almost invariably 
benefited by its administration, and one of the most obstinate complaints 
known — chronic rheumatism and rheumatic gout — frequently yields to its 
influence. Where there is scrofula and a tendency to phthisis, cod-liver oil is 
invaluable. Nor is it of less value in treating the diseases of bones and joints 
occurring in scrofulous persons. In the wasting diseases of childhood, there 
is no remedy to be compared with cod-liver oil. In rickets and chronic hydro- 
cephalus, that is, water in the head, its effects are very marked, but perhaps 
even more so in the disease known as tabes mesenterica, where nutrition is 
impaired by disease of the lymphatic glands in the abdomen. It is a common 
assertion on the part of patients that they cannot take the oil because it makes 
them sick. The first thing to be done under such circumstances is to secure 
the purest and most palatable oil possible ; it should be perfectly clear, and 
have not the slightest trace of rancidity about it. Good oil has a slightly 
fishy smell and a slightly fishy taste ; that is all. Next it should be given in 
small doses : let the patient begin with a teaspoonful, or even less, — a few 
drops, if necessai-y ; only begin without making him sick. It may be given 
in anything the patient fancies, water, milk, orange wine, curacjoa, etc., and it 
is best given within half an hour after a meal ; some like it best immediately 
after. Even this may upset the stomach, and then it must be tried the last 
thing at night, after the patient has lain down in bed. The patient once ac- 
customed to it, the dose must be gradually and carefully increased, taking- 
care not to overload the stomach, until he can take a tablespoonful or more 
three or four times a day. When everything fails, it is to be rubbed into the 
stomach and bowels with the hand or a warni flannel. This plan is especially 
adapted for children. Supposing, however, that cod-liver oil cannot be borne, 
two other oils may be tried, namely, almond oil and the best salad oil ; or, 
again, that old-fashioned remedy, rum and milk, may be recommended. 

Coffee is the name given to the seeds of a plant known to botanists as the 
Caffea Arabica, and belonging to the order Cinchonacece. The seeds are con- 
tained in a berry, which when ripe is of a red color. Each berry contains two 
seeds, which are covered over with a tough membrane called the " parchment." 
The coffee plant is indigenous in Southern Abyssinia. It has, however, 
been introduced into Ceylon, the East and West Indies, and South America, 
from all of which places we now get coffee. The seeds vary in size, and the 
best are obtained from Yemen, which yield the best Mocha coffee. They are 
brought into this country in their green state, and subjected to a process of 
roasting. They are then ground and boiled, and made into the decoction which 
we call coffee. The coffee beans or seeds contain an active principle, called 
caffeine, which is identical with theine, and acts powerfully on the nervous 
system. During the roasting of the coffee bean, the constituents of the seed 
are converted into certain empyreumatic oils, one of which, called caffeic acid, 
gives a peculiar odor to the roasted seeds. These oils are stimulant, and give 



COL 116 COL 

the flavor to coffee. Coffee acts as a stimulant, and when taken with milk 
and sugar it is one of the most popular and beneficial of beverages. In cases 
of narcotic poisoning, after the stomach has been emptied of the poison by 
emetics or the stomach pump, the administration of strong coffee without milk 
or sugar is an excellent remedy. Coffee is often adulterated with chicory, 
which diminishes the taste of the caffeic acid of the coffee. See Chicory. 

Colchicum, as employed in medicine, is either the bulbous underground 
portion (more correctly termed a corm) or the seeds of the meadow saffron. 
From the corm are prepared an extract and a wine cf colchicum, and from the 
seed a tincture. Colchicum seems to have the effect of increasing the flow of 
bile, of diminishing the force and rapidity of the heart's action, and if large 
doses are used causes vomiting and purging. The specific action of colchicum 
is chiefly on the pain of the gouty paroxysm, which it relieves in a marvelous 
manner. Its use is followed by some prostration, and a tendency to faintness 
which is far from agreeable, even though the pain has gone. It is sometimes 
used in acute rheumatism, but does not produce the same wonderful effects as 
in gout. There is, however, one fact which is of vital interest to those who 
Buffer from gout : they may kill the pain with colchicum, but they do not cure 
the disease, and in all probability this will return sooner or more violently after 
being choked off with colchicum than bad it been allowed to exhaust itself, 
or other remedies, as alkalies and alkaline purgatives, employed. Of the ordi- 
nary extract about a grain should be given for a dose, of the wine and tincture 
ten or fifteen drops every four houi s. 

Cold, of which catarrh is the most prominent symptom, is perhaps the most 
frequent malady in this country. Its causes are manifold, and as its causes so 
the consequences of catching cold are infinitely various, from merely a slight 
temporary inconvenience to speedy death. Colds are frequently felt to date 
from some particular period, but frequently their onset is not appreciated for 
a time. Very likely there is some shivering and sneezing, with lassitude, pains 
in the back, loins, and limbs, with tightness of the forehead, and an unnaturally 
dry state of the lips and nostrils. These speedily give way to excessive dis- 
charge from the nostrils : first watery and acrid, later mucus or mucous and 
purulent matter. There is hoarseness and slight sore throat, the eyes water, 
ievenshness, loss of appetite, thirst, and quick pulse. Sometimes small vesicles, 
called herpes, appear ou the lips or about the nose. These symptoms do not 
last long ; they either pass away, or become aggravated if the inflammation 
passes onward into the interior of the lung. If the latter, there will probably 
be some difficulty in swallowing from the pain of the inflamed parts, and there 
may be loss of voice — temporary merely — and some difficulty in breathing. 
Not much treatment is needed for such cases; perhaps the best is for the patient 
to put his feet in hot water, take ten grains of Dover's powder, or three grains 
of James's powder, with a good glass of " something hot," and get straight into 
bed. If the throat is bad, a water compress had better be used. Most likely 
the patient feels better in the morning, either from the attack passing away, or 
as the result of the remedies. A seidlitz powder, or some such slight laxative, 
had better be taken, and the patient may return to his usual routine. 

Colic is a form of disease characterized by a severe twisting pain in the 
bowels, especially in the region of the navel, and occurring in paroxysms. This 
pain, though severe for the time, and alarming, is not of a dangerous charac- 
ter. It indicates no iuHammatory mischief, and whereas the pain of colic is 
relieved by firm pressure, that from inflammation in the same region is greatly 
aggravated thereby. It is accompanied by constipation, and frequently by 



COL 117 COL 

vomiting, but there is no fever, and no quick pulse, as in inflammation. Such 
attacks commonly arise from some indigestible article of food, or some portion 
of the food has decayed in the bowel, and occasioned foul gases, which distend 
the bowel and give rise to pain. As a rule such painful conditions are signs 
of intestinal disturbance which necessitate some opening medicine, of which for 
this purpose castor oil is best. An ounce may be given with a few drops of 
laudanum, not more than ten, or a little spirit of chloroform ; or yet again it 
may be followed by a glass of hot spirits and water. Besides this simple form of 
colic, there are others associated with the introduction of mineral poisons into 
the body. Chief among these is lead colic or painter's colic. It was at one 
time common among cider drinkers. Its cause was long unsuspected. Among 
painters, especially those engaged in working white or red lead, and who are 
not exceedingly cleanly in their habits, the disease is of frequent occurrence. 
One way or another lead is introduced into the system ; by and by a blue line 
forms on the gums, and they begin to be tormented with obstinate constipation 
and colic. If the poison continues to be absorbed, paralysis of the muscles 
of the fore-arm which act on the back of the hand follows, giving rise to what 
is technically known as dropped wrist. If the influence of the poison continues, 
the muscles waste, and paralysis may extend to other parts of the body. The 
signs of lead colic resemble those of ordinary colic, but the pain is more severe, 
more twisting in character, and more persistent. The constipation, too, is very 
obstinate, and it is not very easy to get the bowels to act at first. The best 
plan to effect this is by giving full doses of Epsom salts and Glauber's salts, 
mixed, — a couple of drachms each, — repeated every two hours till the bowels 
are moved. Sulphate of magnesia (Epsom salts) and dilute sulphuric acid, in 
the form of a purgative lemonade, should be continued for a time, until the 
bowels begin to act more comfortably. As soon as the bowels have been freely 
moved it is advisable to set about removing the lead which has been absorbed 
and deposited in the system. For this, iodide of potassium in full doses — ten 
grains or so — should be given, and continued for a considerable length of 
time, so as thoroughly to remove all traces of lead from the system. The ap- 
plication of electricity to the bowels has been found useful, but it is more val- 
uable as an application to the wasted and stiffened muscles of the fore-arm. 

Collar-bone is the bone which on either side is situated between the sternum 
and the shoulder-joint. 

Collodion is the product of gun cotton dissolved in ether and spirit. When 
exposed to the air, the ether speedily evaporates, and leaves the dissolved gun 
cotton in a thin film on the surface to which it had been applied. This film 
is air-tight, and is useful for cuts or other trifling injuries about the face. A 
preparation called flexible collodion, made by adding Canada balsam and castor 
oil to ordinary collodion, is, however, much more useful in many instances than 
ordinary collodion, as it does not crack on being bent or stretched. 

Collyrium. An eye-water lotion, or wash for the eyes. Collyriums are 
of two kinds : one to subdue inflammation in the ball or coats of the eye, and 
the other of a stimulating nature, such as is used in chronic affections of the 
organ, to excite the vessels to a healthier action. A very useful eye- water for 
inflamed eyes is made of rose-water, sulphate of zinc, and sugar of lead. 
Lotions for weak eyes that require stimulating are made by mixing about six 
grains of sulphate of copper with six ounces of water or elder-flower water. 
Nitrate of silver in solution, very weak, is also a valuable application, but 
must be carefully used. 

Colocynth is the pulp of a kind of gourd growing along the southern and 
eastern shores of the Mediterranean. The fruit itself is shaped something like 



COL 118 COM 

an orange, and the pulp is exceedingly tough and felt-like. It is only used in 
the form of pill, but there is an extract for combining with other similar sub- 
stances, and a pill containing hyoscyamus as well as colocynth. Colocynth 
itself is a powerful purgative, giving rise to much griping and plentiful watery 
evacuations. It is mostly used when a speedy and effectual opening of the 
bowels is desirable. Three or four grains of compound extract of colocynth, 
with one or two grains of calomel, or, better still, two pills, each containing four 
grains of the pill of colocynth and hyoscyamus, with one grain of calomel, form 
a very desirable compound when the liver is deranged from overloading of its 
portal vessels, or when the bowels have been long confined, and their action is 
irregular and torpid. 

Colon. See Abdomen. 

Colostrum. S^e Milk. 

Colotomy is an operation devised for opening the bowel in the left loin, 
in cases where there is an obstruction in the lower part of the intestines. 
See Obstructions. 

Colt's Foot. The common name of a plant known to botanists as Tus- 
silago farfara. It is a compositous plant, and has had a great reputation as a 
remedy in diseases of the lungs. 

Columba. This valuable remedy is the product of a plant growing in 
Zanzibar and Eastern Africa. The part used in medicine is the root, which is 
sliced and dried, and then imported. It contains a large quantity of starch. 
In itself it is an excellent tonic, very mild and unirritating to the stomach, and 
as it does not blacken with iron constitutes a remarkably good vehicle for that 
remedy. The best mode of taking it is in an effervescing draught, a teaspoonful 
of the tincture for a dose. The infusion is also much used ; it should be 
freshly prepared. The powder, combined with carbonate of soda and rhubarb, 
is an excellent domestic remedy for irritative dyspepsia; fifteen or twenty 
grains might thus be given. 

Coma is a state of deep sleep or insensibility, in which the patient lies 
perfectly unconscious of what is going on around. It is caused by a great 
many conditions ; it is not a disease, but a symptom of disease. (1.) Coma 
may proceed from drunkenness, because the blood is for a time poisoned by 
the amount of alcohol taken, and the brain suffers in consequence ; this state 
usually passes off in a few hours. There is a history of the patient having 
taken too much ; the breath, will smell of spirit or beer, the face is flushed, 
the breathing is noisy, accompanied with puffing of the cheeks, and the man 
will be in a helpless, stupid state. It is often difficult to distinguish this state 
from apoplexy or from fracture of the skull, but in the latter case there will 
be a history of a fall, and in both it will be very difficult to rouse the patient, 
while a drunken man can be roused if he be galvanized, or put under a stream 
of cold water, or made to vomit. (2.) Coma may result from apoplexy, or, 
in other words, from a clot of blood in the brain, or white softening of 
tli.it organ, or from a plug in the vessels supplying it. (See Apoplexy and 
Hemiplegia.) (3.) Coma comes on in cases of poisoning by opium or car- 
bonic acid : the one may be induced by taking morphia or laudanum, the other 
by exposure to the gas, as when persons have been suffocated by burning 
charcoal in a non-ventilated room. In cases of opium poisoning every means 
should be used to rouse the patient, by walking him about, slapping him with 
towels, giving hot and strong coffee, and applying mustard poultices to the 
calves or hot bottles to the feet ; where carbonic acid is the poisonous agent, 
the person affected should at once be taken into the. open air, the mouth 
opened, and the tongue drawn forward, and artificial respiration must be 



COM 119 COM 

resorted to. (See Artificial Respiration.) (4 ) Coma is often met with in 
the last stage of kidney disease ; the urine is diminished in quantity, and per- 
haps hardly any is passed ; the patient complains of headache, sickness, con- 
vulsions, and in three or four days he may pass through a state of stupor with 
coma and death. (5.) Coma ensues from a blow on the head, with or without 
a fracture of the skull ; in such cases blood is generally poured out between 
the dura mater and the skull, and this, pressing on the brain, will cause the 
insensibility. Little can be done beside keeping the person perfectly quiet in 
bed, and applying ice to the head. (See Fractures.) (6.) All the forms of 
Meningitis are accompanied by coma before death, and this condition is also 
met with in many cases of fever, as typhus, typhoid, and scarlet fevers, 
pyaemia, etc. (See Meningitis, etc.) (7.) After an epileptic fit the individual 
is insensible and in a comatose state for a short time, varying from a minute 
or two to twenty minutes or half an hour. (See Epilepsy.) During an 
hysterical attack the patient may go off into an insensible state, but the timely 
administration of cold water or a galvanic current will usually have a most 
beneficial effect. Finally, some persons may feign this condition from a mor- 
bid desire to create sympathy. 

Coma. This word is used in two senses : (1.) It is applied to conditions 
of the nervous system accompanied with a deep lethargic sleep, from which 
persons cannot be awakened. (See the preceding article.) (2.) It is used in 
botany to express anything like a head or bunch of leaves tenanting a stem. 

Combustion, Spontaneous, rests upon somewhat doubtful authority. 
At various times it has been reported that individuals have taken fire and 
been consumed to ashes. Such a fate is described in one of a popular novel- 
ist's works, but if ever such a case did occur, no one certainly has heard of 
one recently. The fact, however, that the bodies of living persons may, under 
exceptional circumstances, attain to an extraordinary combustibility, rests on 
somewhat better authority. The individuals who have been supposed to 
attain to this superior combustibility have ordinarily been inordinate spirit 
drinkers. 

Common Salt can hardly be called a medicine. Yet on occasion a 
handful of it in lukewarm water may serve as an efficient stimulant emetic. 
It is sometimes used as an enema to destroy small worms, and is added to hot 
water for bathing the feet and legs in chronic rheumatism and the like. 

Composition of the Human Body. The human body is composed 
of the same elements as are found entering into the composition of the mineral 
substances found on the earth's surface. The following is a list of the quan- 
tities of the various elements found in a human body weighing one hundred 
and fifty-four pounds : — 

Lbs. Ozs. Grs. 

Oxygen Ill 

Hydrogen 15 

Carbon 20 

Nitrogen 3 9 

Phosphorus 1 12 190 

Sulphur 2 217 

Calcium 2 

Fluorine 2 

Chlorine 2 382 

Sodium 2 116 

Iron 100 

Potassium 290 

Magnesium 12 

Silicon . _0 _0 2 

Total 154 



COM 120 COM 

It will be seen that the first four elements are oxygen, carbon, hydrogen, and 
nitrogen. These are non-metallic elements, and enter largely into the com- 
position of all organic beings. No organic being can be developed without 
these four elements ; hence they have been called organic elements. The next 
elements of importance are, undoubtedly, phosphorus and sulphur. Chlorine, 
fluorine, and silicon are non-metallic elements. The rest are metals. Of 
these, sodium is most abundant, and iron and silicon are least so. Neverthe- 
less they are necessary. Even the absence of the small quantity of silicon is 
accompanied by diseased conditions. Thus the enamel of the teeth, in a 
healthy condition, contains silicon, but if this is absent the enamel is not 
properiy formed, and the teeth quickly wear away and become comparatively 
useless. The elements, however, are not found in the body in their pure 
state, but are mixed together, forming the following compounds: — 

Lbs. Ozs. Grs. 

Water Ill 

Gelatine 15 

Fat 12 o o 

Albumeu 4 3 

Fibrin 4 4 

Phosphate of Lime 5 13 

Carbonate of Lime 1 

Fluoride of Calcium 3 

Chloride of Sodium 3 376 

Chloride of Potassium 10 

Sulphate of Soda 1 170 

Carbonate of Soda 1 72 

Phosphate of Soda 400 

Sulphate of Potash 400 

Peroxide of Iron 150 

Phosphate of Potash 100 

Phosphate of Magnesia 75 

Silica ....' 3 

Total 154 ~~ ~~ 

The above are the principal permanent compounds found in a human body. 

Witter is composed of oxygen and hydrogen, and constitutes four parts of the 
bulk, and sometimes even more of the whole organic kingdom. Gelatine is 
composed of the four inorganic elements, and is found in the cell-walls of the 
animal tissues. It is especially abundant in the bone-cells and the skin. Fat 
is a compound of carbon, hydrogen, and oxygen- It is distributed over the 
body in the adipose tissue, and is also found in the marrow of the bones, in 
the joints and other parts. Albumen contains the four organic elements. It 
is found in the blood, and is the principal substance entering into the com- 
position of the nerves. Fibrin differs but very slightly from albumen. It is 
not found dissolved in the blood like that substance, but is suspended in it, 
and coagulates when the blood is allowed to stand. It enters into the com- 
position of the muscular tissue. Phosphate of lime is found in the bones. A 
half part, by weight, of the human skeleton is composed of phosphate of lime. 

Carbonate of lime is found also in bones, in the proportion of about ten per 
cent. Fluoride of calcium is also found in the bones of human beings. It is 
often found in large quantities in fossil bones, and the quantity of fluoride is 
said to be a guide to the age of the bones in which it is found. Chloride of 
sodium is found in the blood. It is necessary to the life of human beings as 
well as all other animals. Its use is universal amongst mankind, and they 
suffer from disease when deprived of it. Carbonate, sulphate, and phosphate 
of soda are other forms of sodium which are found in the blood and tissues of 



COM 121 CON 

the human body. Chloride of potassium and the same salts as of sodium are 
also found in the body, but they are not so abundant as the latter. A still 
smaller quantity of magnesia than of the alkaline metals is constantly found 
as a constituent of the human body. See Food. 

Compression. This term is used by surgeons to imply pressure upon 
the brain caused through severe injury. The symptoms indicating this condi- 
tion are : total insensibility and loss of motion ; slow, noisy, and deep respira- 
tion ; a slow and laboring pulse ; partial or general palsy, one side of the body 
being usually paralyzed; involuntary discharge of the contents of the bowels 
and retention of urine ; dilatation of the pupils and closing of the eyelids. 
These symptoms are sometimes associated with delirium, restlessness, convul- 
sions, and vomiting. The causes of this state are various: it may be clue to 
fractured skull and depression of bone upon the surface of the brain, to effu- 
sions of blood within the skull, to internal suppuration, or to the presence of 
some foreign body, as a bullet or piece of exploded gun barrel. See Injuries 
of Head. 

Concretions may occur in many internal organs, but the most important 
are those which occur in the intestine, gall-bladder, and kidney and urinary 
bladder. Intestinal concretions rarely occur in the human being, but in rumi- 
nant animals they are not uncommon. In man they occur in the great gut 
most frequently, and consist for the most part of imperfectly crystallized salts 
and indigestible fibrous or other matters arranged round a nucleus, which may 
be a gall-stone, the stone of a fruit, or any such foreign body. Some concre- 
tions consist entirely of hardened faecal matter, or, if chalk and magnesia have 
been largely swallowed, they may form something of the kind. Hair, cotton, 
and paper may be found in mass, having been swallowed owing to a depraved 
appetite. In Scotland, when oatmeal was imperfectly purified from the gray 
matter surrounding the grain, that used not unfrequently to give rise to such 
stones. In animals, balls composed of hair which has been removed by lick- 
ing are perhaps the most common form of concretion. These may occur 
either in the stomach or in the intestines. Occasionally these concretions are 
passed by the bowels, or, if they get very low down, they may be broken up, 
but they are at all times dangerous. As to biliary concretions, see Gall- 
stonks and Stones. 

Concussion. This term is used by surgeons to express a severe shatter- 
ing of some internal organ in consequence of a fall or heavy blow. It is 
probable that the symptoms of concussion are always due to some local injury. 
In concussion of bone, for instance, there is frequently some separation of the 
external membrane or periosteum, and in concussion of the brain, rupture of 
the small blood-vessels and effusion of blood. The best known form of this 
injury is concussion of the brain. This condition varies very much in in- 
tensity, and may manifest itself either as a simple stunning or by complete 
bodily prostration and loss of consciousness. In all instances the symptoms of 
concussion follow an injury either from direct or indirect violence to the head. 
In the first form the patient experiences a sudden weakness and muscular 
trembling in the limbs, especially the lower, and cannot walk without stagger- 
ing ; at the same time there is a ringing sound in the ears and dimness of 
sight. These symptoms soon pass away after the patient has rested for a time 
in a darkened room. In the second form of concussion, the patient becomes 
deadly pale, and is at once deprived of consciousness, of hearing and sight, 
and of the power of motion. The skin is cold and the pulse weak. The eye- 
lids are closed, and the arms and legs bent upon the body. The breathing is 



CON 122 CON 

slow and regular, and the patient, when spoken to loudly and called by his 
name, will open his eyelids or give some other sign of recognition. In some 
cases there is slight, and transient shivering. This state lasts in the majority 
of instances but a short time after the injury, generally about one hour, when 
the patient wakes up for a time, and then passes into a lethargic condition, 
which varies in duration according to the age and constitution of the patient 
and the severity of the injury. Recovery is indicated by increased temperature 
of skin and by movement of the limhs, but chiefly by vomiting, which should 
be looked upon as one of the most favorable symptoms of this injury. It is 
doubtful whether uncomplicated concussion ever causes death directly. It 
often leaves in its train, however, a set of symptoms and certain chronic a'ffec- 
tions which may render the patient permanently disabled, or even hring on 
early death. The following are the chief points to be remembered in the 
treatment of concussion: to place the patient upon a bed or couch in a dark- 
ened room ; to free the neck and chest from all articles of daily clothing ; to 
keep the head raised; and to apply »cold wet cloths over the forehead. In 
cases where there is intense prostration, and the surface of the body is cold, 
the patient should be placed in bed between blankets, and hot-water bottles be 
placed near the feet and armpits. Friction with the hand may also be used 
to keep up the circulation. Spirits and other stimulants must not be given. 
As soon as the patient has become sensible, some hot broth or beef-tea may 
be administered. The after-treatment of concussion consists in perfect rest, 
both of mind and body, free purgation, and a mildly nutritious diet. Alcoholic 
stimulants are still to be avoided. If severe headache come on, or slight im- 
pairment of the mental faculties be observed, a blister or strong mustard 
poultice should be applied to the back of the neck, and the bowels be freely 
opened. In the treatment of concussion, as of other severe injuries of the 
head, there is no urgent necessity for removing all the hair. Cold may be 
readily applied to the head by means of ice or cold compresses over the fore- 
head, and in the female considerable relief may be given by allowing the long 
hair to keep moist by constant immersion in a vessel of cold water. In con- 
cluding these remarks upon concussion of the brain, it is necessary to state 
that in very many instances this affection is complicated with or followed by 
certain symptoms that indicate serious injury to the skull or its contents. 
Hence the popular dread in cases of this kind, and the frequent reports of 
death from this cause, which is due not to concussion merely, but to concussion 
plus compression or laceration of the brain. Even stunning may be followed 
by fatal brain mischief. Concussion of the Spinal Cord. Of this affection 
there are two forms: one in which several well-marked symptoms immediately 
follow a severe blow upon the spine or a fall upon the buttocks or back ; and 
the other in which the injury, generally a violent shaking of the whole body, 
gradually results in the course of months in paralysis of the lower extremities, 
and other grave disorders. The latter affection will be described in the arti- 
cle on Railway Accidents. The first or acute form of spinal concussion 
is marked by the following symptoms : pain in the back at the seat of injury, 
general bodily prostration, weakness of the lower limbs and difficulty in walk- 
ing. Dumbness in the feet and diminished sensation of the skin of the lower 
extremities, difficulty in making water, swelling of the abdomen due to disten- 
sion of the intestines with gas. These symptoms usually subside in the course 
of two or three weeks, and the patient makes a good recovery. In some in- 
stances, however, concussion of the spinal cord terminates in permanent weak- 
ness or even complete palsy of the lower limbs, with retention of urine. The 



CON 123 CON 

treatment of this injury consists in keeping the patient in bed and in cupping 
the back or loins or applying leeches, and afterwards giving tonics and nour- 
ishing food. 

Condiments. Those substances which are added to food with which salt 
is taken are called by this name. They are mostly derived from the vegeta- 
ble kingdom, and contain peculiar vegetable oils. They act beneficially by 
their effect upon the nerves and secretions of the stomach. The principal 
vegetable condiments are pepper, Cayenne pepper, mustard, horse-radish, on- 
ions, garlic, peppermint, thyme, caraways, anise, dill, fennel, samphire, etc. 

Confections are preparations of medicines ordinarily semi-solid, and con- 
taining sugar or honey. They are chiefly used for making pills, and some of 
them have no active power ; confection of roses, for example. Confection of 
senna is a useful purgative. 

Confinement. See Labor. 

Confluent Small-pox is said to occur when the pustules run together and 
form large and unsightly scabs. See Small-pox. 

Congestion implies" a fullness of blood and a retarded circulation in a 
region or organ of the body. This condition is called by pathologists 
local hypercemia, whilst a tendency to general fullness of blood — an excess, 
as it were, of this fluid in all parts of the body — is called plethora. In local 
congestion the following changes take place : the amount of blood circulating 
through the affected part is much increased ; the temperature is raised, and 
there is usually pain and a sense of heaviness ; the veins and the minute tubes 
between these vessels and the arteries are over-distended with blood, which is 
frequently poured out through rents into the tissues around ; the blood is of 
a darker color. In advanced local congestion there is complete arrest of the 
circulation in many of the minute vessels. The principal cause of local con- 
gestion is obstruction to the return of blood by the veins from the affected 
part of the body. In addition to this, debility from fever or some other 
severe illness, mal-nutrition, and senile decay are frequent causes of local con- 
gestions. Internal piles from obstruction to the circulation through the liver 
and the veins of the abdomen, swelling of the feet during a prolonged conva- 
lescence, and the inflamed and ulcerated legs so frequently observed in old 
persons are well-marked instances of congestion due to the above causes. The 
treatment of painful congestion consists in the removal of any cause of ob- 
struction to the blood-flow, in application of leeches or cupping-glasses to the 
affected part, and in attention to the general health and condition of the patient. 

Conia is the active principle of Conium maculatum, or hemlock. See 
Hemlock. 

Conjunctiva is the anatomical name for the thin and sensitive membrane 
that covers the front of the eyeball, and is reflected above and below along the 
posterior surfaces of the lids. At the inner junction of the eyelids this mem- 
brane forms a small red fold, called the semilunar fold, which represents in 
man the large nictitating membrane or third eyelid found in birds. In chil- 
dren the conjunctiva is quite transparent, but as age advances it becomes 
dusky and yeilow, and is rendered more and more opaque by the presence of 
large blood-vessels. 

Conserves are preparations in many respects analogous to confections, 
and used like them. 

Constipation is a symptom which may be due to disease of the bowels, or 
to an imperfect performance of their function. In the natural course, the 
food, after digestion by the stomach, passes down into the intestines, and by 



CON 124 CON 

the contraction of their muscular coats it is propelled onward, to be discharged 
once or twice a day from the rectum as excreta or faeces. Any disease, as 
ulceration or cancer of the bowel, which obstructs the passage of the food 
will therefore cause constipation, and any condition which produces a para- 
lyzed or sluggish state of the muscular walls of the bowel will likewise cause 
constipation, by removing or interfering with the propelling power. (1.) Habit- 
ual constipation is not unusual in women after a confinement, in people of a 
nervous temperament, and in those who lead a sedentary life; those also who 
are in the habit of frequently taking opening medicine, pills, etc., are liable to 
it. In such cases an altered diet will nearly always suffice, and cause no after 
ill-effects. A glass of cold spring water taken the first thing in the morning 
has a most beneficial effect on some ; brown bread has a marked laxative 
action, and should be eaten instead of white bread ; roast apples, figs, prunes, 
and stewed fruit are valuable auxiliaries. With these simple remedies 
should be combined a sharp walk every day, and, when advisable, a cold-water 
bath should be used every morning. Habit is a most important element in 
preventing constipation ; no one should postpone the process, and in health 
the performance of the function ought to occur regularly about the same hour 
every day. An occasional aperient may be required, and then a mixture con- 
taining Epsom salts, or some similar preparation, can beoidered; the efferves- 
cent citrate of magnesia is often given, and better still, for those who can afford 
it, a wineglass or two of Pullna water may be taken the first thing in the morn- 
ing with great benefit. By the use of these means habitual constipation may 
nearly always be cured, if it has not lasted too long. In children a similar treat- 
ment may be adopted, while in infants an altered diet, and a little magnesia oc- 
casionally mixed with the milk, will suffice for a cure. (2.) Constipation may 
come on from some growth or ulceration in the intestines which prevents the 
progress of the excreta ; there will be then more or less vomiting, which will 
for a time relieve the distension ; pain over the seat of mischief, swelling of 
the abdomen, loss of flesh, and frequent sickness will accompany the constipa- 
tion. If the obstruction be high up, as in the stomach, nothing can be done 
for the constipation ; if low down, and in the rectum, means may be taken to 
make an artificial opening in the loins to let out the frcces, but this can be done 
only in extreme cases. See Colotomy. (3.) Constipation may be only occa- 
sional, and due to taking indigestible food, as nuts, unripe fruit, etc., or to 
taking too large a quantity at once; the tongue will then be foul and white or 
yellowish, the abdomen full and painful, and a feeling of sickness may ensue. 
If the pain is very intense, so as to make one suspect enteritis, an opiate 
should be given to allay the urgent symptoms, and the constipation may be left 
alone for two or three days ; then a small dose of castor oil or some mild pur- 
gative may be given. In cases of peritonitis, some liver diseases, emphysema, 
and other chronic affections, this symptom may prevail, but the treatment must 
then vary with the special cause. A regular action of the bowels should 
always take place in health every day, and for this purpose fresh air, light, 
active exercise, and a wholesome diet are the best provocatives. 

Consumption, or Pulmonary Consumption, is the disease to which 
technically the name of Phthisis, or wasting, is applied. By it is meant that form 
of lung disease where first of all there is a deposit of new material in the sub- 
stance of the lung. After a time this softens and breaks down. It is expecto- 
rated, and leaves behind cavities. This process is accompanied by fever of a 
peculiar kind, and general wasting of the boily, whence the name. The pro- 
cesses which lead to this deposit are two in number : one is inflammation of the 



CON 125 CON 

lung substance, and the other is a deposit of a new growth, called tubercle. 
Most frequently the two processes are associated, for the deposit of the new 
growth sets up inflammation and its consequences. The disease may assume a 
very acute form, such as cannot be mistaken, or it may steal on insidiously, es- 
pecially if it spreads from the air-tubes to the lung substance. The conse- 
quence of such an inflammation is the choking up of the little cavities of which 
the lung consists in a portion of its substance, and the material thus deposited 
may either remain there for a length of time, or at once proceed to soften and 
break down. In this process the damaged material of the lung, too, may take 
part. It may soften as well as the newly deposited substance, and, breaking 
down and being expectorated, leave behind a cavity in the substance of the 
lung. This process may go on quickly or slowly, sometimes very slowly, 
especially if other changes go on at the same time such as indurate the text- 
ure of the lung, as what has been called fibroid phthisis, a very slow form of 
the malady. But again, there may be a deposit of new substance, the process 
being by no means inflammatory, and this new growth, which is laid clown in 
the substance of the lung, is called tubercle. Once deposited, its history 
is the same, or nearly so, as that of the inflammatory material laid down in 
the lung cavities. There is yet another mode and kind of deposit, — that due 
to syphilis. That is, perhaps, if a diagnosis can be made, the most hopeful 
variety of the disease. To both the former varieties of disease there may be a 
strong hereditary proclivity.; if so, this is a circumstance which tells most un- 
favorably on behalf of the patient. It is of the very first importance that this 
disease should be diagnosed in the earliest stages, for it is then that certain of 
its forms may be treated with tolerable confidence of success, and all can be 
dealt with to most advantage. That form which promises most by timely 
treatment is the inflammatory form, especially that which comes on in a 
patient who has long been in depressed health, from whatever cause. It com- 
monly begins with a slight cough, which, however, persists, and will not go 
away, and the patient gets gradually thinner. The respiration indicates feeble- 
ness, being wavy in character, or even jerking. Besides this, there are certain 
sounds to be appreciated only by a skilled ear. If with all this there is a bad 
family history, the case is one demanding prompt action. This may be taken 
with good hope of success. If the fever keeps high, the chances do not im- 
prove ; if it gradually diminishes and totally disappears, the patient may be 
said to have regained his health. Take now a case of tubercular consumption. 
It may arise from the former, or it may be developed from the products of 
some long-standing disease of other organs, or one lung may infect the other. 
This form is not so common as the other. Its origin is very insidious ; but 
having begun, it goes on. There is considerable uneasiness. At night the 
temperature is high, and there are troublesome night-sweats. There is a per- 
sistent cough, and very likely pain in one side. The appetite is very capri- 
cious, and very likely there is diarrhoea. With such cases, too, a huskiness or 
even loss of voice is by no means uncommon. This rarely occurs in any other 
variety of consumption, and so may be looked upon as proof positive of the 
existence of this form, if any consumption be present. The earliest symp- 
toms of consumption are very probably connected with digestion ; the appetite 
becomes capricious ; there are pains in the chest, with some cough, often dry 
and hacking, with a small quantity of frothy expectoration. There is debility, 
flushing of the face on the slightest exertion ; at other times the countenance 
is pale, except there be a hectic patch of red in the middle of the cheek. The 
eyes look unusually white and pearly ; there is some fever at night, and a 



CON 126 CON 

tendency to night-sweats. Very likely there is some spitting of blood. This 
occurs in a very considerable proportion of cases, and is often the earliest 
symptom calling for attention. As the disease advances, emaciation advances, 
so that the joints become enlarged by shrinking of the limbs, and the lingers 
commonly become clubbed at their points. The night-sweats and diarrhoea 
are the great means of reducing the bodily strength and substance; but in 
some instances excessive expectoration aids materially in this untoward pro- 
cess. At the same time the capricious appetite and the imperfect digestion 
leave the bodily supply very deficient. During all this time the spirits of the 
patient are good. A very troublesome complication often seen is fistulas in 
the lower bowel, which, if not relieved, taxes the patient's strength sadly. 
On the other hand, there is always a risk that, if an operation be attempted, 
the wound will not heal, a trouble that would be worse than the first. Usually, 
if the disease be not arrested, the patient dies of exhaustion ; sometimes he is 
suffocated or bleeds to death, — consciousness continuing to the last. But this 
result is by no means necessary ; and the dread of the disease as being univer- 
sally and unerringly fatal, which was wont to prevail, has been shown to be with- 
out just foundation. Undoubtedly, if a patient with a bad family history is 
seen for the first time when the disease is well advanced, we have little 
ground for hope. True, also, that the tubercular form of the disorder is less 
amenable to treatment than is the inflammatory. Yet, due care being exer- 
cised, there are few cases which cannot be benefited, and a goodly number 
which can be cured completely, or the lungs so healed that the patient may 
be enabled to lead a good long life in moderate comfort and with considerable 
carefulness. The first and greatest point of all is the selection of the condi- 
tions under which the patient is to live. In America and Europe, there may 
be found, in different health resorts, people who have all their lives had bad 
chests, but who, by wandering from health resort to health resort, according to 
the season of the year, are able to maintain life comfortably. If such a 
thing is not possible, we must try next to select the most favorable conditions 
attainable. The first great point in selecting an abode is the avoidance of 
damp ; it should be situated in a dry and porous soil. Such patients must 
take the greatest possible care of themselves ; no risks must be run. They 
must live plainly, but their food must be nutritious. They must avoid excite- 
ment, but cheerful society is of the greatest possible value. They must not 
fatigue themselves, but daily exercise is incumbent. They must not be ex- 
posed to too great heat ; but cold is even more to be dreaded. They must try 
to keep the skin open, but they must avoid perspirations. Hence baths must 
be 'regulated in temperature for the individual, — tepid, cool, or cold, as the 
case may be. The bowels must be kept open, but if they are loose the diar- 
rhoea must be checked. Finally, such patients should on no account go with- 
out flannels ; whilst the outer clothing should be changed, if desirable, to suit 
the. different periods of the day and year. At all times it must be warm, so as 
to avoid risks from cold. The health resorts best adapted for the subjects of 
consumption are those characterized by an equable climate, like that of South- 
ern France. Madeira used to be the great resort for Europeans, but has fallen 
into disrepute. It is, perhaps, best adapted for those cases where the throat, 
as well as the lungs, is affected. In summer, St. Moritz and Tarasp have be- 
come favored residences ; but many other similar sites might be selected, if the 
accommodation be good and the food suitable. For those in the very early 
stages of phthisis, nothing, perhaps, does so much good as a se i voyage to a 
mild climate — to the West Indies, for instance, though many may prefer the 



CON 127 CON 

longer voyage to Australia or New Zealand; often these do great good, but 
they must be undertaken early, or the result will be the reverse of favorable. 
Change of climate in females is apt to provoke derangement of the menstrual 
function. This should be seen to, as any excessive flow would be very weak- 
ening. This, moreover, has to be borne in mind, that in consumption this 
function almost entirely ceases, and generally does so altogether. Patients, 
the subjects of consumption, have often, early in the disease, a rooted objection 
to fat as an article of food. This is the more important, as of all substances it 
is to them the. most necessary. If, therefore, they refuse to take fat as food, 
we must endeavor to give it as medicine. The form of fat which is most 
easily digested is cod-liver oil. It is to be given to the patient cautiously. 
Cod-liver oil is food rather than medicine, and the best time of taking it is 
just after a meal. The fish oil used in this way should be entirely devoid of 
color ; every trace of color is an impurity. Next to cod-liver oil as a remedy 
comes iron. This, too, is best dealt with as a food ; that is to say, given along 
with the meals. The best preparation is the reduced iron, which can be taken 
in soup. If this is not attainable, the freshly prepared carbonate should be 
given. Pepsine, as procured from the pig's stomach, is exceedingly useful in 
enabling the food to be digested with ease and comfort, when otherwise it 
would only pass into the intestines, there to putrefy and ferment, and so set 
up diarrhoea. Four or five grains may be taken for a dose just after a meat 
meal. If that does not suit, meat digested beforehand might be tried. When 
cod-liver oil cannot be taken, other kinds of oil may be tried. Of these, the 
best are cream and salad oil. When no oil can be taken, rubbing it into the 
skin does good. Syrup of the iodide of iron may be given along with the oil, 
and often does good. Iodide of potassium seldom does, except the disease be 
syphilitic in its origin. If prescribed at all, it had better be given in decoction 
of bark. But of bark, the best preparations are the compound tincture and 
the liquid extract, given in doses of a drachm or so three or four times a day. 
It is often well to combine some acid with the bark ; the best is the dilute 
nitro-muriatic acid, in doses not exceeding twenty minims. If the perspirations 
be very troublesome, it is customary to give dilute sulphuric acid ; but any 
acid does good. On the other hand, it is very frequently good to give al- 
kalies instead of acids. These certainly, combined with bitters, very greatly 
strengthen the appetite and aid digestion. Liquor potassas is commonly given 
in doses of five, ten, or twenty minims, sometimes with bark, sometimes with 
gentian or other bitter. Certain remedies called hypophosphites have been 
highly extolled in the earlier stages of the disease. Counter-irritation is of 
most benefit when the pleura is concerned, and the patient cannot lie in cer- 
tain positions on account of pain. It must, however, be employed cautiously ; 
best by some liniment, as croton oil and turpentine mixed, or flying blisters, 
kept on only for a few hours ; but the most convenient are D'Albespeyre's 
plasters or Rigollot's mustard leaves. Of the complications to be dealt with, 
one or two yet remain to be noticed. First comes bleeding. When it comes 
on, absolute rest must be enjoined, cold applied to the chest, ice taken inter- 
nally, and gallic acid with sulphuric acid freely imbibed. Oil of turpentine is 
also of service, though perhaps less directly. Night-sweats have been alluded 
to ; mineral acids, if not otherwise forbidden, are best for them. Diarrhoea 
must be dealt with carefully. It must never be allowed to weaken the patient ; 
chalk, opium, and acids are the best remedies. If the throat be bad, nitrate 
of silver is the best application. For the cough, a little opium, or hyoscyamus, 
or belladonna may be given ; but it is better treated on general principles. 



CON 128 CON 

Contagion. A name applied to the poison which is supposed to be the cause 
of many fevers, and also to the mode in which it spreads, namely, by contact 
with the infected person. Scarlet fever, measles, typhus fever, etc., are thus 
said to be contagious. See Fevers. 

Continued Fevers. A name applied to a group of febrile disorders, in 
which the duration of the feverish period is prolonged for several days or 
weeks. The group includes typhus, typhoid, and relapsing fevers. See Fe- 
vers. 

Contusions. By this term is generally understood a form of injury in 
which there is more or less laceration of the soft parts near the surface of the 
body, whilst the skin is unbroken. When, in connection with much crush- 
ing and tearing of the soft parts, the skin is broken, the injury is then called 
a contused wound. With fracture of bones, dislocations, sprains, and other in- 
juries from violence, there is always some amount of contusion. There is pain 
over the seat of injury, increased by pressure or movement of the limb ; there 
is also considerable swelling, with more or less discoloration, due to rupture 
of blood-vessels and accumulation of poured-out blood. Contusions vary much 
in extent and severity. The prospects of speedy recovery from a severe con- 
tusion depend upon the amount of laceration in the subcutaneous soft tissues, 
and upon the age and general condition of the patient. In children and 
healthy persons, very large collections of effused blood are absorbed with ra- 
pidity, provided that there be no communication with the external air through 
a wound in the skin. In persons with a tendency to so-called rheumatic pains 
in the limbs and back, contusions are frequently followed by persistent stiff- 
ness of the injured part, and a dull heavy pain, which is more severe during 
wet weather, or with an easterly wind. When the system has been weakened 
by chronic alcoholism, bad or insufficient nourishment, or by some chronic dis- 
ease, the contused parts become inflamed, and the seat of a large diffused ab- 
scess. In the most severe cases of contusion, where all the soft parts of a 
limb are crushed and thoroughly disorganized, and the large blood-vessels torn, 
gangrene is an inevitable and often fatal result. The treatment consists chiefly 
in rest of the injured limb in an elevated position, in the application of cold 
lotions, or iced water, and tincture of arnica. In cases of superficial bruising, 
the last-named agent is of great service. 

Convalescence means the period of recovery from an acute or chronic 
disease. 

Convalescent Hospitals are institutions kept up by charitable people, 
so as to enable those who are recovering from any disease, after leaving a 
general hospital, to have the advantage of fresh country air, when they cannot 
afford to do so at their own cost. Some are at the seaside, so that children 
suffering from scrofula or joint disease may go and improve their health, 
which has been impaired by their town life ; others are in healthy parts of the 
country, where, either free, or for a small payment, patients can go for a 
month. 

Convulsions may be said to mean violent and involuntary contractions of 
the muscles of certain parts of the body, or of the whole of it, lasting for a 
longer or a shorter time, and very frequently returning in paroxysms. They 
may last a considerable length of timo without relaxation, and the term tonic 
is applied to them. The disease called lock-jaw or tetanus is an example of 
this. Common cramp is an affection of the same kind, but of more limited 
duration, and affecting only a small part of the body. If the spasms alternate 
with relaxations, they are described as clonic. Such spasms or convulsions as 



CON 129 COP 

are associated with complete insensibility constitute an epileptic or epilepti- 
form seizure. The causes of convulsions are manifold, hut it would seem as 
if there is a certain amount of evidence to support the notion that all act by 
suddenly depriving the motive part of the brain of a due supply of blood. 
This arrest of blood-flow may be brought about in many ways, by plugging of 
the vessels, by powerful contraction of their muscular coats, etc. Sometimes 
poisonous matters in the blood, as in the condition known as uraemia, give rise 
to convulsions, especially in pregnant women. In children, irritation in a re- 
mote part of the body may be reflected in the brain and cause convulsions. 
Such is the explanation of convulsions from teething, worms, etc. In dealing 
with convulsions in an adult, perhaps the best plan is to wait quietly till the 
convulsion is over, and then try to prevent its recurrence. He should never be 
held or further controlled than is necessary to prevent him from hurting himself. 
His dress should be loosened, plenty of fresh air allowed to circulate around him, 
and none save those engaged in looking after him should be allowed to come 
near him. As he begins to revive, a little cold water to swallow may do good, 
but as soon as possible he ought to be got to bed and undressed, — if not previ- 
ously so — and left to himself. Very likely he will fall into a quiet slumber, 
and when he awakes there should be an urgent inquiry into the cause of the 
convulsions ; among which albuminuria should never be forgotten. Should 
he not recover consciousness, but pass from convulsions to coma, as it is 
called, very probably the cause of the attack has been the rupture of a vessel 
and the effusion of blood into the brain substance. Nevertheless, it is quite 
true that urasmia may take the same course, and terminate, too, in coma or 
complete insensibility, with dilatation of the pupils of the eyes. Salaam, or 
nodding convulsions, are very rare forms of the malady, peculiar to children. 

Convulsions, Puerperal. See Puerperal Fever and Pregnancy. 

Copaiba is a mixture of oil and resin obtained from various species of 
trees growing in South America. It is of a thickish consistence, and is yellow 
in color ; its odor is characteristic and disagreeable. Copaiba acts as a stimu- 
lant, especially to mucous membranes ; and as it is discharged from the body 
chiefly by the lungs and urinary organs, it acts chiefly on the mucous mem- 
branes of these. Hence it is of use in the bronchitis of elderly people who 
want stimulation, and in discharges from the urinary passages. In large doses 
it produces a peculiar rash on the skin. Sometimes it is given for thread- 
worms. The dose of the balsam, as it is called, is about thirty drops ; of the 
oil, ten. The balsam is best given in capsules. ■ It communicates its smell to 
the breath. 

Copper itself is not used in medicine, but as copper vessels are much used 
in cooking, and are liable to be attacked by their contents so as to produce a 
poisonous compound, it is of some importance. The compound so formed is 
verdigris, an impure acetate ; it gives rise to vomiting and purging. This salt 
is formed by introducing anything containing vinegar into the copper, or al- 
lowing its contents to ferment. Sometimes the acids of fats separate, and in 
like manner attack the containing vessel ; for this reason nothing should be 
allowed to stand in the copper, and it should be carefully cleaned after each 
time of using. The oxalic acid sometimes used for cleaning the outsides of 
kettles is a dangerous poison, and should not be used. If anything of the 
kind be employed, exceedingly weak nitric, acid is best, and the vessel should 
be carefully rinsed out with water immediately. Sulphate of copper, better 
known, perhaps, as bluestone, is the most important preparation of copper 
used in medicine. It occurs in somewhat irregular crystals, and is sometimes 



COR 130 COR 

known by the name of blue vitriol. It is sometimes given internally, in small 
doses, as an astringent in obstinate cases of diarrhoea. Given in large doses, 
it acts as a speedy emetic, and is used for this purpose in narcotic poisoning. 
Externally it is used as a kind of stimulant application to sores. It is also 
used in lotion for some discharges, or as an application to flabby ulcers. The 
dose as an astringent is about half a grain; as an emetic about five grains. 
The strength of the lotion should ordinarily be about a grain or two grains to 
the ounce of water. In poisoning with copper, vomiting should be promoted 
by copious draughts of warm water and a solution containing tannic acid pre- 
pared, such as tincture of galls, tannin itself, or oak bark, which should be 
given as an antidote to any of the substances not expelled by the vomiting 
which itself has produced, for it may be said at all times to act as an irritant 
to the stomach. 

Coriander is the fruit of an umbelliferous plant ; its properties are similar 
to those of caraway and a variety of other seeds and fruit, etc. Jt is stimulant 
and carminative. 

Cornea. See Eye. 

Corn-flour is a preparation of starch, and so called because it was origi- 
nally prepared from maize or Indian corn. The term has also been applied 
to starch prepared from rice and oilier grains. In the preparation of the 
maize and other grains, in order to make corn-flour, the husk and gluten of 
the seed are separated by grinding and the action of water. As corn-flour 
contains little else than the granules of starch, it acts on the system only as a 
heat and force giver, but not as a flesh former, and should therefore always 
be given with milk. 

Corns. If a portion of the cuticle or scarf skin becomes greatly thickened, 
and penetrates into the true skin, causing great pain and annoyance, it is 
called a corn. Corns are commonly spoken of as hard and soft ; the hard are 
those situated on the more exposed surfaces of the foot, where the cuticle gets 
dry and hard, and the soft where the cuticle is moist, generally between the 
toes. With regard to treatment, the first thing to be attended to is to have the 
boots or shoes made accurately to fit the feet, of soft leather ; the feet should 
be washed often, and the inside of the socks just over the corns rubbed with 
slightly moistened soap. Pure acetic acid, applied to the surface frequently, 
' will generally be found to disperse them. The parts around the corn should 
be covered with oil or soap, to prevent injury of the surrounding tissue. 

Coroner's Court. This is one of the most ancient institutions, and took its 
rise at the time of Alfred the Great. It was originally instituted for the pur- 
pose of inquiring into the cause of the death of those who had suddenly or 
unaccountably died, or had been found dead, or were known to have been 
slain by others. With some variations in practice, the court exists in England 
at the present day. In all cases where persons have suddenly and unex- 
pectedly died, and there has been no medical attendance, or the medical man 
has been called in so late that he cannot give a certificate of the cause of 
death, an inquest should be held. Only a " legally qualified " practitioner can 
be called on by the coroner to make a post-mortem examination of the body. 
With regard to persons "found dead,' if a coroner refused to hold an in- 
quest, he might be impeached for a neglect of duty. The Coroner's Court is 
called into action in various ways. The registrar of deaths in any district, 
when a certificate of death is irregular or unsatisfactory, is required to refer 
such a certificate to the coroner. The police are enjoined to give notice to the 
coroner of any sudden death, or of persons found dead or dying, or of any kind 



131 




FlGb XXII 



Fig. xxi 





Fig. xxiv 



JIG. xxv 



COR 133 COR 

of violent death by accident or design. Any person can inform the coroner of 
the death of an individual, if the deceased is suspected in any manner to have 
improperly come to his death. The coroner has power to hold inquests in 
cases of natural deaths if there is reason to believe the disease could have 
been prevented, or was aided and abetted by neglect or malice or the break- 
ing of a law. In all cases of accident, however slight, which lead to death, 
the Coroner's Court must be put in action. Medical men and other persons 
certifying to death without mentioning the accident may be proceeded against 
for misdemeanor, and the coroner may order the exhumation of the body for 
the purpose of holding an inquiry, should he deem it necessary. All persons 
found guilty of manslaughter or murder in the Coroner's Court are sent, upon 
the coroner's requisition, to take their trial at the next criminal sessions before 
a petty jury. The proceedings in the Coroner's Court are as follows : On 
receiving notice of a death, the coroner forwards the notice to a constable, 
who then proceeds to inquire into the circumstances of the death, and forwards 
all the information he can obtain to the coroner. If the coroner deems the 
case one for inquiry, he sends his precept to the constable, requiring him to 
call a jury at a certain time and place. When the jury is assembled, their 
names are called over, they choose a foreman, and an oath is administered to 
them to the effect that they shall deliver a " true and impartial verdict." 
They then proceed with the coroner to view the body, which is the most nec- 
essary part of the proceedings, as the inquiry can proceed only upon view of 
the body ("super visum corporis "), and the dead body is a part of the evi- 
dence. At the view the jury are expected to examine the body to see if there 
be any marks of violence upon it, or any other indications of how the person 
may have come to his death. On the reassembling of the jury after the view, 
evidence is taken on oath of all parties who know anything of the cause of the 
death under investigation. The most important evidence is that of the med- 
ical man. The coroner determines if a, post-mortem examination be necessary, 
and gives a special order for that purpose. Post-mortem examinations are not 
necessary when persons have been seen to be killed or drowned, except in 
.cases where it will be thought to throw light on the cause of the suicide, as 
revealing a diseased condition of the brain. After the examination of the 
witnesses, the coroner sums up, and the jury deliver their verdict, which is 
entered upon an inquisition, and signed first by the coroner, then by the fore- 
man and at least eleven of the jury. The coroner then issues his warrant for 
the burial of the body, which up to that time is in his custody, and cannot be 
removed without his sanction. In cases where criminal verdicts are returned, 
as of manslaughter or murder, the coroner makes out his warrant, and com- 
mits any person accused to take his trial at the next sessions. Accused per- 
sons are tried on the coroner's inquisition, independent of any inquiry before a 
grand jury. The coroner has a right to be present at the trial before the 
petty jury, and direct the indictment. 

Corpulence. See Obesity. 

Corrosive Sublimate, known to chemists as perchloride of mercury, at 
once partakes of the nature of mercury (which see) and possesses distinctive 
features of its own. Apart from its property as a mercurial, it is a powerful 
irritant or corrosive, and is consequently a dangerous poison. By virtue of 
its irritant character, it may be used as a wash or lotion to indolent ulcers, 
and here, its mercurial character coming in, it is of much value in those of a 
syphilitic nature. It is also used as a collyrium or eye-wash, and a gargle in 
sore throats. A weak solution (one grain or two grains to the ounce) is an 



COS 134 CRA 

excellent remedy for scabies and that condition of lousiness so troublesome in 
old people. This lotion is also the best remedy for crab-lice. In poisoning 
with corrosive sublimate, the great remedy is white of egg, an antidote with 
which it promptly combines to form an insoluble compound. 

Costiveness. See Constipation. 

Cotton Wool is of use not only as a means of applying remedies directly 
to some one spot, as, for example, a carious tooth or a suppurating ear, but is 
also valuable for protecting exposed surfaces. In this way it is often used for 
burns. It is of much benefit applied to a joint, the subject of rheumatism or 
gout. It ought to be covered with oiled silk or gutta-percha tissue, so as to 
form a kind of steam bath. For these purposes carded cotton rather than cot- 
ton wadding should be used. 

Couching. See Eye. 

Cough is an exceedingly troublesome symptom of very various diseases. 
It may arise from irritation of the air-passages or of the lungs, from aneurism 
or from heart disease ; or it may be connected with indigestion, or be merely 
hysterical, and due to no cause in particular. Sometimes, as in whooping-cough, 
it constitutes the main part of the disease. Cough is mainly due to a kind of 
reflex or reflected irritation, the source of which may be in the lung or out of 
it, though most frequently in it. This, conducted by some nerve or other to 
the breathing nerve centre, sets up violent expiratory efforts, whilst at the 
same time the chink between the throat and windpipe is nearly closed. These 
efforts are renewed until all the available air is exhausted in the chest, and 
the patient is forced to desist until he can draw a breath. To a worn patient, 
as one in an advanced stage of consumption, such attacks of coughing are in- 
expressibly wearing, and to be avoided at all hazards. On the whole, the 
best thing for this purpose is a regulated temperature, as far as it can be, kept 
even, and inhalation of steam is advisable. 

Counter-irritants. A system of remedies intended to relieve internal in- 
flammations by the pain and action excited in the skin immediately above the 
part affected. Mustard plasters, blisters, and embrocations are examples of 
counter-irritants. 

Coup-de-soleil (sun-stroke). This sudden and dangerous disease chiefly 
attacks those who are not careful to keep their heads well covered when ex- 
posed to the direct rays of the sun. The seizure is so sudden that the only 
symptom of which the patient is conscious is an agonizing pain in the head 
before he sinks down in an unconscious state, as if struck by apoplexy. The 
treatment is usually to bleed and apply cold lotions to the head, cupping, and 
aperient cooling medicine, with perfect quiet and rest in a darkened room. 

Cowhage or Cowitch consists of minute hairs from the pod or fruit of a 
plant growing in the West Indies. It used to be given to get rid of worms. 
It is not now officinal. 

Cow-pox, or Vaccinia, is a disease which is met with on the teats and 
udder of the cow ; it forms an eruption made up of numerous little blisters 
with watery contents, and this fluid, when introduced into the system of man, 
will produce a similar affection, and such persons are not liable to suffer from 
small-pox. It was an important observation made by Jeuner, nearly a cent- 
ury ago, that those who had cow-pox, from milking cows affected with this 
disease, were free from the danger of small-pox ; and this great discovery led 
him to adopt vaccination as a means for preventing man suffering from that 
dangerous disease. See Vaccination. 

Crab, the vulgar name for the Pediculus pubis, and so called from its 



CRA 135 CUE 

resemblance to the crustacean, is a loathsome insect, which gets into, the roots 
of the hairs about the pubes, and produces an intolerable itching ; it is readily 
got rid of by rubbing in any mercurial ointment, the best being the white pre- 
cipitate (ammonio-chloride), and taking a hot bath soon after. 

Cramp means violent and involuntary muscular contraction. It is, per- 
haps, more readily induced by cold, especially after prolonged exercise. The 
best remedy is rubbing, especially with some stimulant application, as spirit. 
See Convulsions. 

Cream is the name given to the butter of milk, when cow's or other milk 
is allowed to stand, so that the butter floats. It consists principally of butter, 
and when placed under the microscope is found to consist of little globules, 
which, from their peculiar action on light, give the white appearance to milk. 
Cream is more digestible than butter, and may be taken with advantage in 
cases where cod-liver oil is needed, but cannot be taken. See Milk. 

Cream of Tartar, or Bitartrate of Potass, is deposited in an impure 
condition (Argol) in wine casks when the wine has been allowed to stand for 
a time. The sediment is purified by washing, etc., and, as cream of tartar, is 
employed in medicine ^n various ways. In small doses it is cooling, and tends 
to increase the flow of urine ; in larger closes it is a purgative, producing copious 
watery stools. For the latter purpose it is commonly combined with jalap 
(as compound powder of jalap) or scammony. Such a combination is largely 
used in certain forms of dropsy, especially such as depend on acute inflamma- 
tion of the kidney, as after scarlet fever. As a refrigerant and diuretic, 
cream of tartar is best given as a habitual drink. An ounce of the substance 
may be added to a quart of boiling water, sugar added to taste, and a few 
slices of lemon allowed to float in the mixture ; a wineglassful or more to be 
taken now and again. 

Creasote is one of the numerous substances produced in the destructive 
distillation of wood for the purpose of obtaining acetic acid. It is, or ought 
to be, a colorless, transparent liquid, with a peculiar odor and burning taste. 
It is largely used for rendering wood less liable to decay. In medicine, a drop 
or two of creasote has been found most useful for arresting vomiting con- 
nected with fermentative changes in the food. Again, it has been found of 
use in arresting the excessive formation of sugar, characteristic of saccharine 
diabetes. Diarrhoea depending on fermentative or putrefactive changes in 
half-digested food may be arrested in like fashion. In hemorrhage from the 
stomach, creasote is often of use, provided, of course, it does not arise from 
liver disease. Its vapor, mixed with that of hot water, has been highly com- 
mended in chronic bronchitis and phthisis with excessive or fetid expectora- 
tion. Carbolic acid may be used in the same way. As an application to 
wounds and sores, creasote, like carbolic acid, when properly diluted, is very 
valuable. For a lotion or gargle, half a drachm may be added to a pint of 
water, with which, however, it does not mix readily and does not at all dis- 
solve. Acetic acid aids the combination. 

Creatine is a substance composed of carbon, hydrogen, nitrogen, and oxy- 
gen, and*- is found in the juice of the flesh of all animals. A pound of flesh 
yields upon an average about five grains. The quantity varies in different 
animals. The flesh of fowl yields the largest quantity. The flesh of fish con- 
tains it in larger quantities than beef or mutton. Creatine is obtained in color- 
less transparent crystals, and, dissolved in water, it has a slightly bitter taste. 
It unites with the various acids forming salts. If creatine is boiled with 
alkalies, a new alkaloid is produced, called sarcosine. If boiled with hydro- 



CRE 136 CEO 

chloric acid it produces creatinine. This substance also forms salts with the 
various acids, and is found normally in flesh. These alkaloids are probably 
the result of the decomposition of the flesh of animals. They ;ire found with 
the extract of meat, but whether they exert any power on ths system is not 
known. 

Creche. See Nurseries. 

Creta Preparata. See Chalk. 

Cretinism. In many parts of Europe, and more especially in the valleys 
lying among hills, this disease prevails, which combines the extreme of bodily 
deformity and degeneracy with deficiency of intellect. In Switzerland and 
Savoy, persons thus affected are cretins, and in France eagots. Dr. Guy gives 
the following account of cretins : " The morbid feature by which they are chiefly 
distinguished is the enlargement of the throat, known as goitre or bronchorelc ; 
but to this several bodily defects and deformities are superadded. The stature 
is dwarfed, the belly large, the legs small, the head conical, the arch of the 
palate high and narrow, the teeth irregular, the mouth large, the lips thick, 
the complexion sallow 7 , the voice harsh and shrill, the speech thick and indis- 
tinct, the eyes squinting, the gait feeble and unsteady, the sexual power weak 
or wanting. This physical degeneracy, with the coexisting mental deficiency, 
commonly dates from a period subsequent to birth. About the fifth or sixth 
month, the bodily development seems to be checked. The child looks un- 
healthy, and seems weak; the head is large and its bones widely separated; 
the belly swells and the limbs shrink; teething goes on very slowly, and the 
child cannot stand or speak till its fifth or sixth year. The victims of this 
singular affection are usually divided into three classes, cretins, semi-cretins, 
and the cretinous, or cretins of the third degree. The fust class are idiots, and 
in addition have the peculiar deformity of the throat. Their life is automatic ; 
they have no intelligence ; their senses are dull or wholly wanting ; they are 
unable to speak ; they do not possess the power of reproduction. The next 
class, or semi-cretins, show a higher intelligence. They can be taught to read 
and repeat prayers, but without understanding what they learn ; they have no 
idea of numbers. Cretins of the third degree show glimpses of a higher nat- 
ure, and are capable of attaining a certain degree of proficiency in mechanical 
employments and contrivances, in drawing, painting, and in music; but arith- 
metic is a very rare acquirement. They are said to be acutely alive to their 
own interests, extremely litigious, unable to manage their affairs, but obstinate 
and unwilling to be advised. Cretins of the first degree are incurable; those 
of the second and third degrees, if removed from their birthplace early in life, 
and put under judicious superintendence, may be greatly improved both in 
body and mind, and become useful members of society." See Idiocy. 

Criminal Abortion. See Abortion. 

Crocus. See Saffron. 

Croton Oil is the oil expressed from the seed of a plant growing in the 
East Indies. It is of a lighter or deeper yellow in tint, varying with expos- 
ure. Its odor is unpleasant, and its taste exceedingly acrid. This oil is ex- 
tremely irritant, and as such is employed both externally and internally. Thus, 
a drop is frequently added to five grains of compound colocynth pill as a 
remedy in obstinate constipation, or again in seizures of an apoplectic nature. 
A drop or two is let fall on sugar, and deposited in the back of the throat to 
lie swallowed. Externally, croton oil rapidly brings out a crop of small 
pustules, and acts as a counter-irritant, but is rather painful. It is therefore 
better to add a small quantity of the oil to some liniment, and rub in the mix- 



CRO 137 CUP 

ture. Thus a drachm may be added to an ounce of soap liniment or turpentine 
liniment. Such a combination is of great use in certain stages of consumption, 
when there is pain in the walls of the chest, or again in certain forms of neu- 
ralgia or muscular rheumatism. 

Croup is an inflammatory disease of the larynx or upper part of the wind- 
pipe, and occurs in children, being very common between two and rive years 
of age. It is attended by very noisy inspiration, and this, which is a marked 
symptom, is due to spasm of the glottis, which, by being thus narrowed, pre- 
vents the free entrance of air into the lungs. The child feels as if it were go- 
ing to be choked, and it makes violent efforts with the muscles of the chest, so 
as to increase the supply of air within. The symptoms, although alarming at 
first, will often pass off in a few hours. Croup must be distinguished from 
diphtheria, which is catching, is far more fatal, and is attended with the forma- 
tion of a false membrane in the air-passages, and also in the throat and nose ; 
such cases, however, are too often called croup. Croup is a disease in which 
no delay should take place in treatment, as imminent danger may ensue from 
suffocation. Sponges wrung out of hot water should be at once applied to the 
throat, and the~patient should be made to inhale steam by putting before him 
a jug of boiling water. A small mustard poultice may be applied to the front 
of the throat, and when the urgent symptoms have subsided a large hot lin- 
seed-meal poultice should be wrapped round the throat, and renewed until the 
breathing is all right again. Vomiting is a source of great relief in many 
cases, and for this purpose ipecacuanha wine may be given. Medical advice 
should be obtained as early as possible, as it may be necessary to make an 
opening into the trachea or larynx to allow air to enter the lungs. When a 
child is attacked more than once with this complaint, less fear need be enter- 
tained, as it is probably spasmodic, and will go off again if treated early. 
After an attack, care should be taken not to expose the child to draughts ; 
flannel should be worn next to the skin, and a comforter wrapped around the 
throat, regular diet should be given, and the bowels should be kept open 
once a day, and any cause likely to set up nervous irritation should be re- 
moved. 

Cubebs are a kind of pepper cultivated in Java. They have a taste some- 
thing like pepper, and a disagreeable odor. They are almost exclusively 
employed for arresting discharges from the urinary passages. Cubebs have 
also been used for chronic inflammation of the bladder, and for the relief of 
internal piles. The dose varies from fifteen grains to a couple of drachms. 
An oil is obtained from the fruit, which has similar properties. Its dose is 
about ten drops. 

Cubic Space. See Space. 

Cumin is the fruit of an umbelliferous plant, having properties like car- 
away. 

•Cupping is a method of local blood-letting, practiced for the relief of in- 
flammation and congestion in internal organs. The instruments used are bell- 
shaped glasses, varying in size, and a scarificator, which is a brass case con- 
taining ten or a dozen lancets, the edges of which can be made to start out by 
touching a spring. The operation is performed in the following manner : 
After the skin over the affected part has been well washed with a sponge dipped 
in hot water, it is covered by one or more cupping-glasses, the air within 
which has just been rarefied by the flame of a small spirit lamp, or by pieces 
of blotting paper steeped in spirits of wine and then ignited. Up to this 
point, the proceeding is called dry cupping ; but if it be desired to draw blood, 



CUR 138 CYA 

each glass is removed, the scarificator applied and discharged, and the glass 
again heated and placed over the small lined wounds formed by the lancets. 
As the rarefied air within the cupping glass cools and becomes condensed, the 
skin rises up as a dome-shaped swelling, and blood is sucked out from the nu- 
merous lancet-wounds. 

Curcuma. See Turmeric. 

Curry Powder is a compound of condiments and spices introduced from 
the East Indies, and is employed to give flavor to stewed meats, which are 
usually mixed with rice. Genuine curry consists of turmeric, cardamoms, gin- 
ger, allspice, cloves, black pepper, coriander, cayenne, fenugreek, cumin. 
Curry powder, when used in small quantities, is an agreeable aromatic, and 
certainly acts beneficially in hot climates by recalling to the stomach the cir- 
culation, otherwise exclusively excited by the action of the sun on the skin. 
Curry powder is much preferable to alcohol as a stimulant of the stomach in 
hot countries, as it does not affect generally the nervous system, nor act de- 
structively on the secreting surfaces of the stomach or bowels'. 

Cusparia, better known, perhaps, as Angostura, is the bark of a tree 
growing in South America. It has some aromatic and antiperiodic properties, 
but is chiefly used as a tonic. A kind of " bitters " made from it, called An- 
gostura hitters, have attained a certain reputation. 

Cusso, or Kousso, are the flowers of a plant growing in Abyssinia, where 
they are largely used as a remedy for the tape-worm so prevalent there. Half 
an ounce of the flowers is to he infused in half a pint of water, and swallowed 
fasting, flowers and all. Half an hour after, a dose of castor oil (half an 
ounce) should he taken. 

Cut-throat is generally the result of an attempt at suicide' or murder with 
a knife or razor. In such cases, supposing that the escape of blood has not 
caused immediate death, the first object is to prevent further effusion. The 
wound must be cleansed with a sponge and warm water, and the bleeding 
vessels secured by ligatures ; next, the edges of the wound or wounds should 
be brought together by stitches, care being taken to keep the patient's head 
forwards by means of suitable bandages, so that the cut edges may he ap- 
proximated. If the air-tube (trachea) he divided, care must he taken that 
matter from the gullet does not interfere with respiration; and if the gullet 
itself be wounded, sufficient nourishment must be allowed to pass downwards, 
and possibly a small tube, leading from the mouth, or from the wound to that 
part of the gullet below the injury, may be required for a time. 

Cuts. See Accidents. 

Cyanides ai'e salts of metals and the compound radical cyanogen. The 
cyanides of the metals, when placed in contact with organic substances con- 
taining hydrogen and oxygen, are accompanied by hydrocyanic acid, and an 
oxide of the metals is formed. Cyanide of potassium is employed by photog- 
raphers for the purpose of washing their plates, and is now a common article 
of commerce. 

Cyanogen. See Cyanides. 

Cyanosis is a term applied to the blueness or lividity of the skin which is 
so often observable in children who are born with malformation of the heart. 
The blueness is most marked in those parts where the circulation is slowest 
and most languid. It is due to the veins and small vessels being too full of 
blood as a consequence of the obstruction to the circulation through the heart. 
The malformations are of various kinds, and will hereafter be considered. 
(See Heart.) Cyanosis is seldom noticed until a month or two after birth, 



CYN 139 DAN 

and often it is associated with convulsions ; at the same time the child suffers 
from shortness of breath, which is worse on coughing or making any exertion. 
This disease also hinders the development of the child, and hence the tissues 
become badly nourished. There is generally some ceclema or swelling of the 
extremities, because the serum of the blood oozes through the coats of the 
distended vessels into the loose tissue under the skin. Very little can be done 
in the way of treatment, as cyanosis depends upon a condition of tilings which 
is incurable ; yet life may be prolonged, and certainly distress may be alle- 
viated, by taking care that the child is not exposed to whooping-cough or to 
cold, so as to catch bronchitis or pneumonia, or to the contagion of measles 
and scarlet fever. The child should be fed in the usual way, and maybe 
taken out in the open air on fine warm days. The extremities should be kept 
nice and warm by thick woolen gloves and socks, and friction with the hand 
may be daily used to those parts in order to encourage the flow of blood 
through tiiein. Persons who have suffered from emphysema and bronchitis, 
who are short of breath, and have had a cough every winter for many years, 
become blue about the lips and ears, and often have swelling of the legs. 
Here, again, these people are suffering also from an obstructed circulation, and 
they also are really cyanotic ; but usually the term cyanosis is confined to 
children who are laboring under malformation of the heart. 

Cynanche Tonsillaris. See Quinsy. 

Cynara. See Artichoke. 

Cystitis. The technical term for inflammation of the bladder. The symp- 
toms are great pain in the region behind the scrotum, or purse, in the groins 
and lower part of the back, and tenderness over the bladder; very frequent 
desire to pass water, attended with great efforts to do so, and a whitish ropy 
mucus deposited in the urine, accompanied with feverish symptoms. Treat- 
ment : Hot baths and hot fomentations, the administration of calomel and 
castor oil, to relieve the abdominal circulation, the pain to be allayed by opium 
or morphia, either internally or as a suppository, and copious draughts of bi- 
carbonate of potassa and lemon juice ; infusion of buchu, pareira, uva ursi, etc. 

Cysts are tumors consisting of a limiting bag, or sac, which contains either 
solid, semi-solid, or fluid matters. See Ganglion. 

D. 

Daft, a name given to Blue John or Derbyshire Spa. This mineral is 
sometimes used for adulterating confectionery. It is composed of fluorine 
and calcium. 

Dalby's Carminative is a popular empirical carminative. Tt contains 
carbonate of magnesia, tincture of assafoetida, tincture of opium (laudanum), 
and the oils of anise and peppermint, and other volatile oils. 

Daltonism is a condition of the eye in which the individual is not able to 
distinguish one color from another. 

Dandelion is the root of the common dandelion of our fields gathered dur- 
ing the winter months. It yields when cut a bitter milky juice, to which some 
rectified spirits may be added to make it keep (one pint to three of juice), and 
the whole used as a medicine. It is ordinarily given in cases where the liver 
is supposed to be out of order, but generally with other remedies of a more 
powerful character. To give it a fair trial, the juice above referred to should 
be given in teaspoon ful doses three or four times a day. 



DAN 140 DEA 

Dandruff, a disease of the scalp, attended with the production of scales on 
the skin. See Pityriasis. 

Dandy Fever. See Dengue. 

Dates. The fruit of the date palm (Phoenix dactyliferd) which grows in 
Syria, Arabia, Egypt, and the north of Africa. In some of these districts the 
date forms the principal subsistence of the inhabitants. 

Datura. See Stramonium. 

Dead, Disposal of. The mode in which the dead are disposed of varies 
infinitely with different nations. Among some it has been customary to pre- 
serve the body as nearly intact as possible, as the mummies of ancient Egypt. 
Among others, burning, or cremation, has been customary, the ashes being 
carefully preserved. Some tribes dispose of their dead on lofty scaffolds ; 
others sink them into the earth ; whilst, yet again, others throw them into the 
water. Among ourselves, it is needless to say that burial is the plan adopted. 
In disposing of the dead during epidemics, or where it is desirable to destroy 
the body as quickly as possible, quicklime is sometimes scattered over the 
body. It is, however, no easy thing to get rid of a dead body in such a way 
as to leave no trace ; hundreds have attempted this, and failed. The only 
plan which has proved available is by means of enormously strong furnaces, 
in which even the bones would be calcined and destroyed. Some soils are so 
exceedingly dry that bodies buried in them do not decompose, but dry up, and 
so remain for years unchanged. See Mortuary. 

Deadly Nightshade. See Belladonna. 

Deafness may arise from obstruction of the outer ear, from perforation of 
the membranes of the tympanum or drum of the ear, from inflammation of the 
middle and inner ear, from paralysis of the nerve of hearing, or from obstruc- 
tion of the Eustachian tube, from whatever cause. A word of explanation is 
required as to the structure of the ear, to understand this aright. The ear con- 
sists, then, of three portions besides those which we see externally. The 
opening we see, which leads into the skull, is the outer ear, and it reaches to a 
certain depth. There it is terminated in a membrane which completely blocks 
up the passage, and which is called the membrane of the tympanum, or drum 
of the ear. Beyond this comes the middle ear, which contains air, admitted 
to this portion of the ear by a tube which reaches down and opens into the 
back of the throat. This tube is called the Eustachian tube. Between the 
drum of the ear and the wall of the innermost cavities of the ear are three 
little bones, which are jointed and movable, so that, being attached to the drum 
of the ear and to a corresponding membrane between the middle and inner 
ear, any movement of the one is immediately communicated by them to the 
other. In the inner ear, which is filled with fluid, are expanded fine mem- 
branes, in which the nerve of hearing terminates, so that any movement in the 
fluid. is at once communicated to the nerve and from the nerve to the brain. 
Vibrations in the atmosphere being the cause of most sounds appreciated by 
us, these vibrations or waves act upon the drum of the ear, then through the 
small bones on the membrane between the middle and inner ear; its vibra- 
tions set the fluid in motion, whereby the nerve is affected and the sound ap- 
preciated. Anything which interferes with this process will cause deafness. 
Hence we may divide the causes into those affecting the outer, middle, or inner 
ear. Children often put foreign bodies, as peas, glass beads, slate pencil, etc., 
into their ears. These may, by obstructing the passages, interfere with hear- 
ing. They should not be rashly interfered with if they cannot be removed by 
syringing with water. One of the most common causes of deafness is the ac- 



DEB 141 DEB 

cumulation of the substance we call wax in the ear. This sometimes becomes 
very hard, and gives rise to noises in the head, deafness, etc. It can generally 
be removed by syringing with soapsuds. If not, put in a drop or two of gly- 
cerine and a bit of cotton wool for a day or two, till it softens, and then try 
again. The injected fluid should be warm, and should not be sent in violently, 
but gently. Sometimes after fevers there remains behind a discharge from 
the ears in children which is apt to occasion deafness. The ear may be in- 
flamed and give rise to much pus, and the tympanum may be perforated. 
Another affection of the outer ear is a fleshy growth called a polypus. This 
always requires surgical treatment, and often special skill, in order to remove 
it without injury to the parts concerned. It has already been pointed out that 
the drum of the ear or membrane of the tympanum may inflame ; if so, in all 
probability the middle ear will become affected in the same way, as the mem- 
brane which lines the middle ear lines also the drum on its inner side. Sud- 
den and intense pain are characteristic of this lesion, which in all probability 
goes on to destruction of the drum of the ear and complete deafness. There 
may also be a chronic inflammation of the inner cavity, leading surely to per- 
manent deafness. Leeches to the back of the ear generally do good in these 
affections ; but other remedies are generally required. Rupture of this mem- 
brane may be accidental, from blows on the ear, loud noise, etc. It is shown 
by the fact that if the patient hold his nose and breathe out with all his might 
the air will escape by the Eustachian tube and outer ear. Such an injury 
can in great measure be impaired by introducing a little cotton wool into the 
ear, quite down to the pei'forated drum. Should the discharge persist, the 
organ must be washed out by a very dilute solution of Condy's fluid or carbolic 
acid. Another form of deafness is produced by the growing of the little bone 
which terminates the series in the middle ear, and which is called the stapes, 
to its attachments by bony union. The Eustachian tube, already spoken of, is 
not unfrequently blocked up and deafness is caused. This happens when we 
have a cold. In inflammation of the back of the throat the disease may spread 
upwards and affect the middle ear. These maladies are to be dealt with by 
healing the throat in the first instance, when probably the ear will get well. 
Certain varieties of deafness, the origin of which is not well known, are called 
nervous. In old persons, in whom nervous deafness is supposed to be most 
common, there is usually thickening adhesion or other changes in the bony 
structure to account for the dull hearing. Finally, we may have complete 
deafness from destruction of the nerve. That sometimes follows blows on the 
head, or fracture rupturing the nerve, or disease of the brain, affecting the part 
where the nerve comes or whence it arises. Little or nothing is, however, 
known of diseases affecting the innermost ear of all. We have purposely said 
little as to the treatment of maladies giving rise to deafness, for if a little 
syringing fails, measures must be taken which imply great skill ; and the risk 
is great, for inflammation may readily spread from the ear to the brain, and 
life be forfeited. 

Debility or Weakness. Frequently the onset of a serious disease is 
marked by unusual debility, whilst recovery from it is always accompanied by 
the same. Thus in fever an individual naturally strong and robust begins to 
feel out of sorts, has headache and what he fancies is indigestion. Often he 
thinks to shake off these uneasy feelings by a good long walk ; he sets out in 
good spirits, but soon finds to his astonishment that what used to be the easi- 
est of tasks has become an insurmountable difficulty. He returns home and 
takes to bed, very probably not to rise till he has passed through a dangerous 



DEC 142 DEG 

encounter with death. When he begins to recover and the fever leaves him, 
his most marked symptom is debility ; but whereas formerly this was the pre- 
lude to disease and was irremediable till the disease was over and gone, his 
debility may now be combated with great success. Nourishing food and good 
wine will do wonders, but the food must be very nourishing and very easily 
digested: perhaps the best to begin with is essence (not extract) of meat; 
of wine, perhaps the best to begin with is old madeira, but this is scarce. A 
dry sherry like Manzanella will do. The debility of childhood and old age 
differ from these in this : they require, as well as appropriate food, considera- 
ble warmth, and that is all-essential. 

Decline. See Consumption. 

Decoctions are preparations of remedies which have been prepared by 
boiling the substance in water for a longer or shorter period. The length of 
time required for preparing a decoction should partly, at least, depend on the 
solubility of the substance to be extracted from the drug. This and the quan- 
tity of the drug used are generally so adapted the one to the other as to make 
the dose of a decoction about two tablespoonfuls. Most decoctions should be 
strained while hot ; otherwise, on cooling they deposit a sediment. In the Phar- 
macopoeia there are but two compound decoctions ; that is, decoctions which 
contain more than one ingredient. These are, the compound decoction of 
aloes and the compound decoction of sarsaparilla. 

Defecation. This term is applied in pharmacy to the removal of the lees 
or sediment of any liquid. It is also used to express the act of discharging 
the faeces from the bowels. 

Defervescence is a name applied to signify the fall in the temperature 
which occurs when convalescing from acute disease. 

Deformities. See Anchylosis, Club Foot, Flat Foot, Hare Lip, 
Knock Knee, Spina Bifida, Rickets, Wry Neck. 

Degeneration. During the development of the foetus active changes go 
on, and the simple elements which are found in the very early stages of the 
embryo are developed into the more complex structures which are met with in 
childhood and adult life. But in old age the various organisms of the body 
are much less vital, and naturally decay. Degeneration may, however, take 
place much earlier in life, either from hereditary causes, from bad living, or 
from disease acquired in adult life, as syphilis, excessive drinking, etc. Thus, 
an individual may be subject to (1) fibrous degeneration ; (2) fatty degenera- 
tion ; (3) waxy degeneration ; (4) melanotic degeneration. (1.) Fibrous 
changes take place naturally in old age, but they occur earlier in life in those 
who are the subjects of syphilis, and in those who drink much. This form of 
degeneration is met with in various parts of the body. The liver becomes 
cirrhosed. (See Cirrhosis.) The kidneys waste and become uneven and 
granular on the surface ; the urine is light in color, and there may be found 
albumen in testing for it : such a state is known as chronic inflammation of the 
kidney. (See Brigiit's Disease.) The heart is generally larger than usual 
from having more work to do. and there is often disease of the outer or inner 
coat ; sometimes the valves are diseased, and death ensues from the serious 
mischief engendered. The brain does not escape ; in some the membranes be- 
come opaque and thickened, and •the organ itself shrinks ; there is loss of 
memory, giddiness, pains in the head, sleeplessness, and flashes of light before 
the eyes. The lungs become adherent to the chest-wall, and the respiratory 
power is diminished. These changes do not take place equally in all organs, 
and the amount of disease varies much in different individuals: in some, one 



DEG .143 DEG 

organ is more particularly affected ; in others, general disease is present. The 
arteries, too, share in the degeneration ; their inner coats become roughened 
and brittle, and yellowish opaque patches are seen ; they are then said to have 
become atheromatous. Often, too, there is a deposit of lime salts in the coats 
of the vessels, and then the walls become brittle and may rupture, or the wall 
may dilate at one point and form an aneurism or dilated sac on one side of the 
artery. Such vessels are said to have undergone calcification or calcareous de- 
generation, and the tissues nourished by them undergo degeneration as well, in 
consequence of not being properly nourished ; in this way cerebral hcemorrhage 
may occur from the rupture of a diseased artery in the brain, or white soften- 
ing of that organ may come on from the nerve-tissue being badly nourished ; 
or, again, a thrombus or clot may form in one of the vessels from fibrin be- 
ing deposited on the roughened internal surface, and then also softening may 
occur. All these changes generally come on in advanced life, and set up the 
condition known as apoplexy ; if recovery take place, the patient may still be 
incapacitated from work by the consequent paralysis of one side or other, and 
he is then said to be suffering from hemiplegia. (2.) Fatty degeneration is of 
very common occurrence, and is often found in parts which, having done their 
duty in the economy, are no longer wanted ; thus it occurs in a normal way in 
the womb after a confinement. Fatty degeneration is generally found in scrof- 
ulous' or consumptive people, in those who drink much, and in those who are 
the subjects of any urinary disorders. The liver is very often the organ 
chiefly affected ; it becomes larger than usual, of a pale fawn color, and greasy 
to the feel. The changes go on very slowly : there is no pain, no jaundice, 
and, in fact, very little inconvenience ; but after a time there is dyspepsia, loss 
of strength, pallor of skin, and dropsy of the abdomen or skin may occur ; 
often, too, the kidneys share in the mischief, and become much larger than 
usual, and the tubes of those organs are full of oil ; less water is passed than 
usual, and the urine, beside being scanty, is dark in color, of high specific 
gravity, and deposits albumen on boiling, and a sediment on standing. Just 
as the fibrous degeneration brings on a cirrhosed liver (see Cirrhosis) and 
the contracted kidney of Bright' s disease (see Bright's Disease), so the 
fatty form of degeneration brings on a fatty liver (see Liver) and the fatty 
form of Bright's disease. But it seldom happens that this change attacks one 
organ only ; and in general the heart, muscular system, and vessels suffer, as 
well as the liver and kidney, and sometimes it is associated with the fibrous 
degeneration. The heart becomes flabby and weaker than usual, and often 
dilates in consequence of being unable to bear up against the pressure of the 
strain ; such people are in general of middle or advanced life, and are subject 
to fainting fits of an alarming nature, to palpitation on exertion, and general 
distress of breathing ; this, too, is a common cause of sudden death, for the 
left ventricle may become over-distended, and then is unable to contract, so 
that the patient dies of syncope. The muscles of the body in these cases are 
flabby and badly nourished, so that there is loss of strength and inability for 
exertion. The minute vessels in the different organs undergo, likewise, a fatty 
change, and may produce symptoms and diseases like those mentioned under 
the head of Atheroma, above. (3.) Waxy degeneration is much less com- 
mon than the varieties named above. It is met with in rickety or scrofulous 
children, in those who suffer from disease in the joints, as hip-disease, etc., 
and in those who are the subjects of syphilis, inherited or acquired, or in those 
who have had ague, cancer, or some chronic wasting disorder. This form 
generally attacks the liver, spleen, kidneys, and intestinal canal. The liver is 



DEG 144 DEG 

much larger and firmer than usual, and is translucent in appearance ; it may 
become so large as to fill up a great part of the abdomen, and cause a feeling 
of weight in the right side ; pain is seldom present, and never severe ; jaundice 
does not occur, and there is seldom any dropsy. There is a feeling of fatigue 
and general debility ; the appetite is impaired, and the patient may suffer 
from dyspepsia ; the skin is often of a deadly pallor, but there is not much 
loss of flesh ; when the blood is examined, under the microscope or chemically, 
it is found to be deficient in red corpuscles, and more watery than usual. 
When the kidneys are affected, the patient passes a very large quantity of 
water, free from deposit or nearly so, very pale in color, and containing albu- 
men ; often at first there may be some blood present, but this does not last 
long ; it is the daily drain of albumen from the system in these cases which is 
so exhausting to the patient. The result of the intestinal canal being affected 
is shown by a troublesome diarrhoea, sometimes accompanied by bleeding from 
the bowels, and this may easily be excited by any error of diet. The spleen 
becomes large, but does not cause pain, nor, in fact, any symptoms easily no- 
ticeable by the patient ; but it aids in causing those changes in the blood which 
are met with in this disease. These three forms of degeneration are all 
chronic in their nature, and may last for years before they cause death. Often 
such patients seem in very good heahh, and men wonder why in the midst of 
such apparent vitality death may so suddenly in some cases take place ; but it 
is not really the acute change or disease which kills, but the slowly-proceed- 
ing course of events which, beginning years previously, finally carry off the 
patient in an unexpected manner. These changes are often the result of fol- 
lies in early life, and proceed from an excess in eating or drinking, or in the 
too eager pursuit of pleasure ; and while for a long time the system does not 
seem to be affected by such a course of living, yet in the end disease is sure to 
supervene. The physician may do much to relieve any symptoms that may 
arise, but he cannot give back health. The diet should be carefully regulated, 
and no excess of any kind allowed. Each meal should be light and nourish- 
ing, and easily digested, consisting of meat once, and, if possible, twice a day, 
light puddings, fruit, toast, or bread, milk, cocoa, or tea and coffee ; salt meat 
is not so good, nor are vegetables of much service. A rich dish should be 
avoided, and the cooking should be made as simple as possible. A pint of 
beer a day, or two or three glasses of sherry or claret, or some light wine, may 
be taken with advantage. Open-air exercise is very valuable, and a daily 
walk or ride should be ordered. Early rising and a cold bath every morning 
is of much service, if the patient be well enough to take one, while late hours 
must be avoided, and also hot, overcrowded rooms. Medicines may be taken 
if there is much debility, and for this purpose iron and quinine are the most 
valuable ; or a mixture containing hydrochloric or nitric acid, with some bitter 
infusion, may be taken before a meal for the purpose of inducing an appetite. 
(4.) Melanosis is the name given to a condition in which coloring matter, or 
pigment, is found in various parts of the body. In infant life very little pig- 
ment is met with, so that the lungs are of a pink color, and the iris is blue in 
tint ; but as years roll on, the iris becomes colored of various tints, and the 
lungs become of an iron-gray color, or even black. This is quite a natural 
process, and is a result of the various tissue changes which occur in advanced 
life. Nevertheless, coloring matter may be deposited as a result of disease. 
Thus in the lungs of coal-miners, knife-grinders, etc., much pigment is de- 
posited. In cancer of different organs, and more especially of the liver, pig- 
ment is found in large quanties, and gives a black appearance to the disease. 



DBG 145 DEL 

Very little is known as to the cause of this change. Sometimes the brain and 
spinal cord are the subject of this peculiar change ; it may depend in some 
cases on the alteration in the coloring matter of the blood ; in others it seems 
to be influenced by the inhalation of injurious materials by the air-passages, 
as in knife-grinders' disease. Under the term of degeneration some include 
atrophy, but this has already been considered. (See Atrophy.) By this 
term should be meant simple wasting, without any disease being present in 
the tissue itself, just as a leg or an arm wastes from paralysis. In a similar 
way various organs waste when they are not wanted, as the thymus gland, 
which is large in the infant, but nearly absent in the adult; and in the case of 
various vessels which were useful in carrying on the circulation in the embryo, 
but, not being of service in the adult, waste in consequence, and finally disap- 
pear. Atrophy occurs .in almost all forms of degeneration ; but this is itself 
part of the disease, and one condition cannot be dissociated from the other. 

Deglutition is the act of swallowing food after mastication, and is per- 
formed by the joint action of the muscles of the cheek and tongue, assisted by 
the throat; so that when the food has been softened in the mouth and 'incor- 
porated with the saliva, it is carried down the gullet by the act of deglu- 
tition. 

Deliquescence is the condition in which certain substances become damp 
and absorb moisture from the atmosphere. Many preparations of potash are 
liable to this condition, unless well protected from the air. 

Delirium means that accompaniment of acute disease wherein the mind 
wanders, and incoherent talk is the result. It is common in many acute dis- 
orders, especially fevers, and is more common in the young than the old. We 
speak of two kinds of delirium, active and passive. The active is something 
merely indicative of mental derangement, without any tendency to action, 
but in the fierce delirium of some diseases there is violent exertion to get 
out of bed, shouting, and rage depicted in the countenance. This is some- 
times the case in certain inflammations of the brain. The other form of 
delirium, in which the mind seems to be wandering, is generally seen in exhaust- 
ive fevers, such as typhus. These patients will often, however, if desired, 
answer questions correctly. The delirium seems due to the circulation of 
poisoned blood or of imperfectly aerated blood in the brain. If, therefore, 
the circulation be relieved in any way, it will probably pass off, at least for a 
time. Delirium is most frequent in the night, and is of very various omen. 
In acute disease it may merely indicate a sharp attack of the malady ; but in 
other instances, as in inflammation of the lungs, the onset of delirium is a very 
bad sign, showing, as it does, that the lungs are no longer capable of purifying 
the blood sent to them. 

Delirium Tremens, or Mania a Potu, is one of the consequences of 
chronic alcoholism. There may be said to be two varieties of the malady : 
one of spontaneous origin after prolonged drinking ; the other coming on as 
the result of an accident to those who are habitual drinkers without being 
drunkards. The malady consists inevitably of hallucinations and trembling 
of different parts of the body. The chief symptoms are sleeplessness and 
restlessness, with delirium generally busy, but not very often violent. The ob- 
jects seen are very often loathsome creeping things, rats and serpents and the 
like, in the existence of which the patient fully believes. When hearing is 
affected, — and that is generally the case, — he hears people calling him names, 
taking away his character, and so on. He will not rest in bed, and is con- 
stantly getting up, but will lie down again quietly if told to do so. As to his 



DEL 146 DEM 



physical condition, the face is usually pale and wild-looking, the skin moist 
or clammy, the tongue coated and tremulous, and the pulse quick and soft. 
There is complete loss of appetite, and the bowels are generally confined. 
During the night he is worse than during the day. This does not continue 
long ; if spirits are abstained from, the condition ordinarily ends, in eight- 
and-forty or two-and-seventy hours, in profound sleep, from which the patient 
wakes weak, but in his right mind, and ordinarily very repentant. Occasion- 
ally the condition terminates fatally ; if so the temperature rises and he gets 
no' sleep; feebleness increases till the delirium is muttering merely. Death 
commonly comes in weak convulsions. The cause is almost invariably excess- 
ive spirit' drinking. The other kind of delirium tremens is not unfrequently 
seen in brewers' draymen, who might be looked on as splendid specimens of 
men, yet if they meet with any accident they are very liable to a kind of 
delirium which adds considerably to the risk from their injury. In the treat- 
ment of delirium tremens, the strength of the patient is the great thing to look 
to ; if that is good, all should go well. U the attack comes on after a spree 
of six or eight days, during which the patient has eaten nothing, or but little, 
the first thing is to get him to take food. If stimulants are necessary, the 
aromatic spirit of ammonia and spirit of chloroform will be found best. With 
these precautions, giving too a little brandy, if necessary, the patient will do 
well enough for eight-aud-forty hours, very miserable, it may he, but in no risk 
whatever." At the end of that time, his bowels having been well opened in the 
interval, let him have a good dose of morphia, subcutaneously, half a grain 
or so, and be put quietly to bed. Tipplers, if they have had a debauch^ after 
a long course of habitual tippling, make perhaps the worst patients. Their 
'appetite and digestive powers are" completely gone, and they have no reserve 
of strength; very likely they have had one or two attacks previously, but 
disregarded them. Such must be handled with care; their strength must be 
kept up, and stimulants of any or every kind given, if necessary, and the 
critical period must be watched for with care. If it comes, then opium in Cull 
dose ; or if it does not come, opium or chloral must still be given to try to 
bring it on. It is in such cases that the injection of morphia under the skin 
is of most manifest benefit. If the temperature go up, cold must be applied, 
best, perhaps, in the form of the tub pack ; but if the head is very hot and the 
face flushed, the shower-bath may he tried, or perhaps, what is better, ice 
applied, while the rest of the body "is packed. But nourishment must be given 
hour by hour, or even oftener, or the patient may sink. The other variety 
is comparative! v mild ; a little extra drink may have induced an attack of the 
" horrors." For this, perhaps, the best remedy is a good emetic and purge, 
or a good long walk. 

Delitescence is a term sometimes used to signify the sudden termination 
of an inflammation. 

Delivery. See Labor. 

Dementia is that form of insanity where the mind gradually fades away 
or becomes a perfect blank. The other kind of insanity allied to it is imbecility 
or idiocy; but by idiocy we imply a total absence of reasoning powers from 
the birth, and hy imbecility we mean a marked absence throughout life of 
such powers as are possessed by the average of mankind. In dementia there 
is marked apathy to everything and everybody, though sometimes the patients 
are subject to fits of restlessness. Dementia constitutes the last stage of 
many forms of madness, and is altogether beyond hope of recovery. In old 
people, however, there may be a brightening up before death. 



DEM 147 DEN 

Demodex Folliculorum is the name given to a little animal found in the 
follicles of the skin. The function of these follicles is to secrete oil, with 
which the skin is naturally lubricated. In these follicles, especially those on 
the sides of the nose, the minute animal in question is found to reside. It is 
perfectly harmless, only occasioning a slight inflammation, which produces a 
minute pustule and destroys the animal. It must not be confounded with 
the itch mite, which is much smaller, and quickly spreads over the whole 
body. See Itch. 

Demulcents are a class of medicines composed of bland, unirritating sub- 
stances, most of which form with water a viscid solution. They are given in 
cases where the alimentary canal is irritated or inflamed, and are supposed to 
have an effect on even the respiratory passages when taken by the mouth. 
Pearl barley, Iceland moss, licorice, marsh-mallow, oatmeal, linseed, gum 
acacia, and tragacanth are a few examples of this class of substances. 

Dengue or Dandy Fever is a disease unknown in this country, but it 
prevails in tropical regions, and has often visited India in an epidemic form. 
The attack is very sudden. Lassitude, frequent yawning, slight giddiness, 
numbness in the extremities, a feeling of cold in the back, and rigors rapidly 
come on ; then acute pain in the head, in different parts of the body, in the 
fingers and toes, or in the muscles and larger joints, are most marked symp- 
toms. There seems to be often no distinct line between perfect health and the 
disease, so that in two or three hours the patient may find himself with acute 
pains in nearly every limb; a feeling of stiffness often precedes the pain, and 
this may be followed by swelling oi; the joints ; the eyes are watery and the 
conjunctivae suffused; the face is scarlet and swollen, and the surface of the 
skin everywhere flushed; in some the headache is terribly severe ; the eyeballs 
seem too large for the head, and the pain is increased by pressing them. The 
pulse rapidly becomes 120 or 140 in a minute, and its force is greatly in- 
creased ; the breathing is hurried ; there may also be bleeding from the nose, 
confusion of ideas, and delirium. The tongue is white and furred in the centre, 
and scarlet at the sides, and then becomes coated with a dirty-white moist fur; 
the appetite is often impaired, and there is much thirst. Great prostration 
prevails, and the debility, restlessness, and general aching and soreness are 
the chief sources of distress to the patient. Towards the end of twenty-four 
hours the symptoms begin to abate ; the flushing and headache diminish, and 
the pain changes to one of a dull aching character ; very little sleep is obtained, 
and so exhausting is the malady that sudden death may occur from debility 
during a remission of the disease. This apparent convalescence is followed 
on the third day by an increase of the febrile phenomena, aud a rash appears 
on different parts of the body ; in some it bears a resemblance to the eruption 
of measles or scarlet fever, or it may occur in blotches of red-colored skin, or 
cause a general redness all over the body ; the rash fades on the second day 
and goes away on the third, to be generally followed by a desquamation or a 
peeling of the cuticle ; in other cases the rash is more raised, and has the look 
of nettle-rash, accompanied by itching or tingling of the skin, while, in some 
cases, no eruption is noticed. Relapses occur in this disease, and a patient is 
not considered to be free from the complaint until he has had two or three 
paroxysms of the fever. No difference seems to exist as to the class of persons 
attacked ; men, women, and children are all liable to it. The disease runs a 
specific course, and can only be relieved by treatment; after the acute attack, 
tonics and a generous diet must be given ; during the febrile paroxysms, the 
general treatment will be that described under Fevers. This disease is known 
under many names, such as red fever, broken-bone fever, etc. 



DEN 148 DEN 

Dentition, or the process of teething in children, begins generally at the 
sixth or seventh month of infant life, and is not usually completed until the 
twenty-fourth or thirtieth month. The first indication of teething is shown by 
the increased flow of saliva into the mouth. Teeth have come through at the 
fourth, or even as early as the third, month; but in these cases, when the first 
are so forward, the rest come out at the usual time, and there is a longer inter- 
val between each appearance. The two middle incisors of the lower jaw 
generally appear first, then the corresponding teeth in the upper jaw, and next the 
lateral incisors of the lower jaw. There is no definite order about the cutting 
of the remainder, but usually the four anterior molars next appear, then the 
four canine teeth, and lastly the four posterior molars. Children, therefore, 
have only twenty teeth, and these are called " deciduous or milk " teeth, because, 
during childhood, they gradually fall out and make way for the "permanent" 
teeth, which are more numerous. The arrangement of teeth in each jaw of an 
infant is, therefore, the following : 1 posterior molar, 1 anterior molar, 
1 canine, 1 lateral incisor, 2 middle incisors, 1 lateral incisor, 1 canine, 1 ante- 
rior molar, 1 posterior molar. The "permanent" teeth are thirty-two in 
number; each "milk " tooth is replaced by a " permanent" one, and in addition 
three molars are developed in each jaw on each side, so that in adult life there 
are two rows, each row containing sixteen teeth instead of ten. The process 
of development in the infant as regards dentition does not go on regularly. 
Three or four months may elapse between the appearance of the lateral incisors 
and the anterior molars, while a still longer interval may intervene between the 
latter and the posterior molars. Dentition is generally attended with more or 
less suffering and constitutional disturbance. When teeth appear, mothers not 
only suckle their children, but give them thickened food, or even .solid food, 
under the idea that such food is more strengthening for them than milk or liquid 
diet ; and herein arises a great mistake, in consequence of which many infants 
suffer ; it is not the teething in those cases that does the harm, but it is because 
the delicate stomach is overloaded with food which it cannot digest ; an altera- 
tion of the diet soon gives great relief. Yet dentition is attended with disorders 
of its own. Many a child cuts a tooth without any more discomfort than an 
increased Mow of saliva and dribbling from the mouth ; at other times the gum 
becomes tense and shining, while the mouth is hot, and the child restless and 
feverish ; the position of the new tooth may be seen by the prominence of the 
gum over it ; often there are small ulcerations on the tongue, gums, or inside 
the lips. The child may be fretful and cry out as if in pain, and it may sleep 
badly at night, and perhaps have a convulsion. In yet more severe cases, in- 
flammation of the gum may occur, attended by considerable fever and disturb- 
ance of the digestive functions. Small unhealthy ulcerations may occur on 
the gum just where the tooth has pierced, and these give much pain to the 
child ; such cases, however, are very rare, and in general terms it may be said 
that, with due care to diet, the process of dentition is very simple, attended 
with but very slight consti:utional effects, and very seldom fatal in its result. 
It was formerly a common but a barbarous custom to lance a child's gum 
frequently, under the erroneous idea that the convulsions, or the fever, or any 
other derangement that might be present, arose from the mechanical pressure 
of the tooth in its effort to pierce the gum. Undoubtedly there are times when 
the gum is much swollen and red, and the child is evidently in pain about the 
mouth ; then lancing the gum at the affected spot will give relief; but such cases 
only rarely occur. Prominence of the gum over the place where the tooth is 
about to come, attended with a paleness of the part, is quite a natural appear- 



DEN 149 DEN 

ance, and not one to call for any operative interference. When a child has a 
convulsion from teething, then "lancing " is useful. As a rule, medical inter- 
ference is rarely wanted during dentition. The diet must be carefully regulated, 
and the mouth may be moistened with barley-water, if it is hot and painful ; 
if any ulcerations are present, a lotion containing chlorate of potash is very 
useful. For the same purpose borax and water are useful ; many use borax and 
honey, but the latter is sweet, and apt to become sour and undergo fermentation, 
and when this takes place it only aggravates the ulceration. If the child be 
suckling it may be kept at the breast, and no other diet need be given if the 
mother has sufficient milk ; if, however, the baby has been weaned, more care 
will be required, as it will not digest its ordinary food ; thin arrowroot with a 
third of milk may be given, or milk and water sweetened according to taste ; 
once a day a little chicken broth or veal broth may be given. The bowels are 
frequently disordered in these cases, and at the outset a rhubarb powder may 
be given with a little soda and £ray powder ; one dose will be enough, and it 
need not be continued. Should there be much vomiting and inability to retain 
food on the stomach, lime-water may be mixed with the food, in the proportion 
of one part of lime-water to four parts of milk and water. It allays vomiting 
and diarrhoea by neutralizing any acidity in the stomach, which is apt to be 
superabundant at these times. Solid food should not be given. In addition 
to the local ulceration and affection of the gums in teething, and besides the 
derangement of the digestive functions, convulsions may be added as a not un- 
common occurrence, and they seem to occur in consequence of the greater 
susceptibility to any irritant cause of the infant's nervous system ; indigestion 
and diarrhoea would help to bring about a similar state of things; careful dieting 
and a warm bath during the fit are the best measures. A slight purgative may 
be given if required, and now and then lancing the gums may be necessary. 
During dentition the temperature of the body may suddenly rise several degrees, 
and this usually occurs at bed-time, while in the morning the fever may be much 
less, or perhaps absent ; the very suddenness of the rise of temperature would 
negative the idea of any fever coming on, and point to some reflex source of 
irritation. Lastly, there are some skin disorders which are liable to appear 
during the process of teething ; just as sometimes occurs after vaccination, 
eczema may appear on the skin from the constitutional irritation, so during 
teething, from a similar cause, eczema and impetigo may occur. The former 
may appear in scabs on the scalp or behind the ears, and in the flexures of joints ; 
when the scabs come off, a moist red surface is left, which will soon again be- 
come encrusted. Impetigo appears on the chin and cheeks generally as angry, 
red spots, with a little pustule in the centre about as large as a pin's point ; 
these rapidly spread by scratching, and give great annoyance to the child. (See 
Eczema and Impetigo.) It is not always wise to cure these rashes at the 
time of dentition, as serious symptoms have resulted ; the local mischief may 
be kept in check, and during the intervals of dentition the skin disease may be 
cured. The second dentition consists in the replacement of the "milk" or 
" deciduous " teeth by others which succeed them ; this important change takes 
place in childhood, and commences about the seventh or eighth year of life ; 
some time before this, however, the germs of the new teeth begin to develop. 
Each " milk " tooth has a corresponding permanent tooth ; but the three per- 
manent molars on either side of each jaw do not replace temporary teeth, but 
are new ones added. The sixteen teeth in each jaw are arranged as follows : — 
3 molars, 2 bicuspids, 1 canine, 1 lateral incisor, 2 middle incisors, 
1 lateral incisor, 1 canine, 2 bicuspids, 8 molars. 



DEO 150 DEO 

Jn the replacement of the "milk " teeth, the development takes place with con- 
siderable regularity. First the middle incisors fall out and are renewed ; and 
then a similar process takes place with the lateral incisors; the anterior tempo- 
rary molars are followed by the anterior bicuspid teeth ; then the posterior 
temporary molars are replaced in a like way by the posterior bicuspid teeth ; 
this latter change occurs about a year later than the former ; the canine teeth 
are the last to be exchanged ; finally, in the succeeding year, the second pair 
of true molars appear, while the third pair, or the " wisdom teeth " may not 
appear for three or four years, or even longer ; now and then the}' cause con- 
siderable pain and distress during their development. Since these changes 
occur at well-known periods, the second dentition has been proposed as a test 
of the age of children. The Factory Laws of England do not allow a child to 
work under nine years of age, and up to thirteen years of age the time of labor 
is limited to nine hours a day. From the poverty of the parents, or from a 
desire on their part to increase their earnings, children are often sent to work 
at too early an age ; a standard of height has been adopted by the Legislature, 
but this is fallacious, as often the tallest children are the weakly ones A better 
test is the appearance of the teeth, and in the majority of cases it may be looked 
upon as a sufficiently accurate guide. From some local or constitutional causes 
the development of the teeth m;iy be retarded ; but as these causes would operate 
in delieate and weakly children, the only error would be that the child's age 
would be under-estimated, and no harm would ensue. The following table 
shows the age at which the different permanent teeth appear: — 

Central incisors developed at 8 years. 

Lateral incisors " " 9 " 

First bicuspid " " 10 " 

Second bicuspid " " 11" 

Canines " " 1 2 to 12^ years. 

Second molars " " 12^ to 14 " 

A third dentition occasionally takes place in very old people, but its occurrence 
must be regarded rather as a curiosity than as a circumstance of any practical 
value ; their appearance gives rise to no symptoms, and the teeth themselves 
are not well developed. At that time also the jaw has undergone changes in 
shape consequent on old age, and the nourishment of the teeth is so impaired 
as 10 prevent their arriving at maturity. 

Deobstruents. A class of medicines supposed to remove obstructions 
from any part of the body, especially chronic enlargements, tumors, etc. 
Plasters, iodine, turpentine, and other local stimulants are thus called, and also 
the stimulus of friction either with a brush or the hand, when applied to the skin. 

Deodorants are substances which purify the air and remove noxious 
vapors or gases which may be injurious to human life ; they also check the 
growth of fungoid or infusorial organisms. In the large centres of population 
chemical agents are required to destroy the various poisonous elements which 
would otherwise accumulate to a dangerous extent. Carbonic acid, ammonia, 
sulphuretted hydrogen, and various organic substances, some odorous, others 
not, are the chief impurities met with. Air purifiers or deodorants may be in 
the form of solids or liquids, and absorb the substances from the air; or they 
may be gaseous, and, passing into the atmosphere, act on the various im- 
purities. (1.) Solid deodorants. Charcoal is the most effectual, and has the 
remarkable power of separating gases and vapors from the atmosphere, and 
oxidizes rapidly a great variety of substances. Animal charcoal is better 
than any other variety. It should be exposed to the air iu bags or saucers ; 



DEO 151 DEO 

its effect is very marked with sewage gases ; it absorbs sulphuretted hydrogen 
and purines the air from the organic emanations of disease. Quicklime 
absorbs carbonic acid, and may be employed for that purpose ; the carbolates 
of lime and magnesia and a mixture of lime and coal tar are useful, but not so 
effectual nor so easy to obtain as charcoal. (2.) Liquid deodorants. Solutions 
of potassium permanganate (Condy's red fluid), zinc chloride, and lead nitrate 
are often used ; they should be exposed in thin layers in flat dishes, or cloths 
may be dipped in the solution and hung about the room. Not being volatile, 
they act only on the air which comes in contact with them, but even then they 
may do a great deal of good. Chlorides of lime and soda and solutions of 
sulphurous acid act chiefly by the gases which they evolve. (3.) Gaseous 
deodorants. These air purifiers act as a powerful means of freeing the air 
from impurities. The principal are ozone, chlorine, iodine, nitrous and sul- 
phuric acids, carbolic acid, tar fumes, acetic acid, and ammonia. Ozone is 
supposed to be a modified form of oxygen, and may be produced by the action 
of electricity ; it is found in the air in increased quantity after any electric 
phenomena ; it may be evolved by partially immersing a stick of phosphorus 
in water in a wide-mouthed bottle, or by heating a platinum wire by an elec- 
tric current. It destroys organic matter, and acts as an oxidizing agent. 
Chlorine, when given off in large quantities, is very irritating to the air- 
passages, but in small quantities it is very valuable. Chloride of lime or soda 
may be moistened with water and placed about the room in shallow vessels ; 
the gas is then slowly given off; if a quicker effect is desired, a little weak 
sulphuric acid may be added, which will liberate the chlorine more rapidly. 
Chlorine decomposes sulphuretted hydrogen and sulphide of ammonium very 
soon ; it no doubt destroys organic matter in the air, and its powerful effect 
may be seen by its property of bleaching organic colors and destroying odors ; 
it abstracts hydrogen from the compound and indirectly oxidizes it. This gas 
has an unpleasaut odor, although its action is very effectual. Nitrous acid is 
made by placing clean copper in nitric acid water ; a colorless gas (nitrogen 
dioxide) is given off, and this, combining with the air, forms the red fumes of 
nitrous acid. It is a powerful agent for oxidizing organic matter. It rapidly 
removes the smell of the dead-house, but is extremely irritating and offensive ; 
hence the room should be cleared of people while the deodorizing process is 
going on. Sulphurous acid is easily made by burning sulphur ; it decomposes 
sulphuretted hydrogen, and acts powerfully on organic matter. This gas is 
extremely useful ; a small quantity burned in the morning, in a hall or on a 
staircase, will purify a house very readily, and no disagreeable smell will 
remain ; it is thus useful in a children's hospital or in a nursery, wherever 
there is close air. Ourbolic acid has been much used of late for deodorizing 
air ; when weak, its smell is rather pleasant. It is prepared from coal tar. 
The solid acid may be placed in saucers about the room, or, still better, some 
of the solution may be sprinkled about. It conceals all odor and arrests putre- 
factive changes, and seems to have the power of stopping the growth of fungi. 
Tar fumes, vinegar, or acetic acid and ammonia are old remedies for a similar 
purpose, but they are not very effectual. It is, however, most important to 
remember that none of these agents, valuable as they are, can take the place 
of ventilation and free currents of air. In a sick-room a small fire should be 
kept up, and the door or window opened for a short time three or four times 
a day, but not so as to place the patient in a draught ; it is important to have 
the air thoroughly renewed. Charcoal should be placed about the room, or 
some carbolic acid should be sprinkled about. Deodorants are not only of 



DER 152 DEW 

much service in purifying the air in the above-mentioned cases, but they are 
equally valuable in destroying the noxious emanations from sewage ; for this 
purpose numerous measures have been suggested. Charcoal may be employed, 
but it is not so useful here as in purifying the air. The A. B. C. deodorant is 
a mixture of animal charcoal, blood, clay, and alum refuse, and bids fair to 
become an important agent in deodorizing sewage. Dry earth has a good effect ; 
it is used in earth-closets, and has been found very valuable in large institu- 
tions and in camps ; the excreta are at once covered over, and no effluvia 
escapes ; in this way diarrhoea and typhoid fever appear to have been pre- 
vented. Quicklime and water may be added to the sewage until a deposit 
occurs. The lime forms insoluble salts, and decomposes the sulphuretted 
hydrogen ; it delays, but does not prevent, the decomposition of animal and 
vegetable matters. The salts of alumina mixed with charcoal are very useful, 
and are important ingredients of the A. B. C. deodorant. Perchloride of iron 
is also useful ; it decomposes sulphuretted hydrogen and carbonate of ammonia, 
Which is so often met with in sewage. A solution of chloride of zinc (half a 
pound to a gallon of water) may be used ; it will destroy ammoniacal com- 
pounds and organic matter ; it dela\ T s decomposition for some time. Perman- 
ganate of potash must be used in very large quantities to have much effect on 
sewage ; it is useful in deodorizing excreta, and may be poured on the stools 
of patients suffering from cholera or typhoid fever. The preparations from 
coal tar. as creasote, carbolic acid, and cresylic acid, are very valuable agents 
m purifying sewage ; they may be obtained as powders, or crystals, or liquids ; 
the latter are the most useful, as they mix readily with sewage ; one part of 
the liquid carbolic acid, if good, may be mixed with eighty or one hundred 
parts of water, and poured into a cesspool or on a dnng-heap, or used in a 
water-closet. It does not follow that because air smells badly it is therefore 
impure in proportion : gas works or tan works may be disagreeable, but they 
are not injurious; again, a cesspool or drain may not smell much, but the 
exhalations may be most dangerous. A noxious smell is like a Davy lamp to 
a miner, a warning of danger, but it is not itself the danger. By keeping in 
mind the evils arising from impure air, close rooms, noxious emanations, and 
sewage contaminations, and by using every means to procure ventilation and 
to remove the impurities by chemical means, a vast deal of good must result, 
and many diseases may be prevented. 

Derbyshire Neck, called also goitre, signifies a swelling in the neck, 
owing to enlargement of the thyroid body. It is commonly met with in Eng- 
land in several" of the midland counties, and is a common disease in some of 
the cantons of Switzerland, especially the Tyrol and valley of the Rhone. 
(See Cretins.) America suffers but little from it. Its cause is somewhat 
obscure, being assigned usually (in Switzerland) to the use of snow water, and 
confinement in damp, close valleys, inactivity, and want of occupation; it is 
frequently associated with idiocy. 

Determination of Blood is a phrase erroneously applied to the feeling 
of a rush of blood to the head in those' who are liable to apoplexy and some 
other nervous diseases. 

Devonshire Colic is another term sometimes used for painter's colic. 
See Lkad Poisoning. 

Dew-point is the point at which the mercury stands in the thermometer 
when aqueous vapor is deposited from the atmosphere on a cold object in the 
shape of minute globules of water. The atmosphere always contains aqueous 
vapor in greater or less quantity, and when a cold substance is brought into a 



153 




DEX 155 DIA 

warm room this vapor is deposited on the cold object in the shape of minute 
globules of water. And a similar process takes place on the earth's surface. 
During the day the earth is warmed by the sun's rays ; at night this heat is 
given off by radiation, but not equally from all objects ; thus metals have very 
little radiating power, especially when polished, while plants, grass, sand, and 
the ground readily radiate their heat ; they thus become much cooler than the 
surrounding atmosphere ; in consequence the aqueous vapor in the air is con- 
densed on their surfaces in the shape of dew or minute globules of water. 
The state of the sky also exercises a marked influence on the dew-point. If 
the sky is cloudless, the earth radiates heat very considerably, and therefore, 
becoming very much chilled, there is an abundant deposit of dew. But if 
there are clouds, these radiate towards the earth, and so, as less chilling 
occurs, there is only a slight deposit of dew. Wind also affects the quantity 
of vapor deposited. If feeble, it increases it, because it renews the air ; if 
strong, it diminishes it, because it heats the bodies by contact. The formation 
of dew is greater in proportion to the moisture present in the air. Instru- 
ments used for finding out the amount of aqueous vapor in the air at any 
given time are called hygrometers. The atmosphere is never thoroughly 
saturated with moisture, nor is it ever absolutely dry in its natural state. 
Substances like chloride of calcium absorb water very easily, and soon liquefy 
when exposed to the air in a saucer ; liquids like glycerine and strong oil of 
vitriol also readily absorb water from the air and increase in bulk; such 
bodies as have this property are called hygrometrics. 

Dextrine is a compound of carbon, hydrogen, and oxygen, and is one of 
that series of bodies which is called the dextrine series. When the seeds of a 
plant germinate, the starch they contain is converted into sugar. This is well 
seen in the process of malting, in which the grain is made to germinate, 
and when the sugar is formed the process of growth is arrested by roasting, 
and malt is formed. The sugar of the malt is then fermented and made into 
beer. If the process of germination is arrested after the starch has begun to 
change, and before the sugar is formed, dextrine is obtained. Dextrine differs 
from starch in that it is soluble in water and not colored blue by iodine, and 
from sugar in the absence of sweetness and the capability of fermentation. 
Its name is given by the property it possesses of producing right-handed 
rotation upon a ray of polarized light. It has some of the properties of gum, 
such as forming an adhesive liquid with water, and is used for gumming the 
backs of stamps, and other purposes. British gum, which is dextrine, is ob- 
tained by heating starch at a temperature of 400°. It is also obtained by heating 
an infusion of ground malt in water to 165°, and then adding starch, and 
rapidly heating the liquid to 212°, and boiling till the liquid is syrupy. Dex- 
trine is used for making moulds, and has been employed as a splint in surgery. 
It is valueless as an article of diet. Gum may be said to be stereotyped 
dextrine. Licorice, or Spanish juice, is a kind of dextrine; so also is pec- 
tine. It is, in fact, because a number of. substances closely resemble dex- 
trine, of which starch stands below, sugar at the top, and dextrine in the 
middle, that they have been called the dextrine series. To these belong 
lichenin,or lichen starch, — the starch of sea-weeds and lichens, — manna, and 
various kinds of sugar, none of which are of any value as articles of diet, only 
as they can be converted into sugar, dissolved in water, and taken up into the 
blood. 

Diabetes is a disease in which a very large quantity of saccharine water 
daily by the patient, accompanied by great thirst and general debil- 



DIA 156 DIA 

ity. It may attack people :it any age. but it is far more fatal, and runs a 
much more rapid course in children and young people than in adults, or in 
those of advanced age ; amongst the latter, a small quantity of sugar in the 
urine may be present at one time and absent at another, and these cases 
seldom need cause much anxiety. The sugar which is passed is called grape 
sugar. It is widely spread over the vegetable kindom ; nearly all fruits con- 
tain it ; all the cereals and substances which contain starch produce grape 
sugar if treated chemically. An example of this may be taken from ordinary 
articles of diet; bread, potatoes, and rice all contain starch, which, when mas- 
ticated and well mixed with the saliva, is changed into grape sugar. This, 
when absorbed into the blood, passes into the liver, and there undergoes 
various changes not yet thoroughly understood; on passing through the lungs 
part of the sugar is burnt off as carbonic acid ; sugar, being a hydrocarbon, 
helps to form fat, and so those who do not wish to become stout should avoid 
any substances, as beer, porter, bread, rice, and potatoes, from which sugar 
may be obtained. It is, at present, a moot question whether the liver or the 
blood is at fault in this disease, nor is it yet settled what part the nervous sys- 
tem may play in this affection, but it is an ascertained fact that irritation in 
certain parts of the brain will produce sugar in the urine. The kidneys are 
not the seat of mischief ; they merely allow the sugary urine to pass, and in doing 
so suffer more or less in the process. Symptoms: Great thirst, dryness of 
skin, and passing of immense quantity of urine are the most marked features 
in this disease. The thirst is so great that the patient will commonly drink 
from two to three gallons of water a day. Since so much urine is passed, 
the other tissues of the. body are drier than usual; the skin feels dry and 
harsh, and an eczencatous eruption is liable to break out, and sometimes boils 
form; the nails are dry, and frequently chip in consequence. The bowels are 
confined, and the motions are generally firm and dry. The urine is light in 
color, but much heavier than usual, from the great quantity of sugar present 
in it ; the usual sp. g. of urine varies from 1015 to 1020 ; in this disease it 
may rise to 1030 or 1040. Sugar may be detected in the urine in several 
ways: (1.) Take equal amounts of urine and liquor potassae in a test-tube 
and boil ; the solution will become first yellow, then orange, and finally of 
a deep horse-chestnut color. (2.) On adding to the urine a drop or two of a 
strong solution of sulphate of copper (blue vitriol) and then three or four 
drops of liquor potassre, the precipitate first formed will dissolve, and the solu- 
tion will have a dirty bluish-green color ; then boil, and an orange precipitate 
will come down. (3.) To a large test-tube full of the urine add a little yeast ; 
invert the test-tube in a dish which also contains urine, and let it stand in a 
warm place for twenty-four hours : gas will then have formed in the upper 
part of the tube, which will be found to be due to the carbonic acid evolved, 
for fermentation has taken place, and the sugar has been converted into 
alcohol and carbonic acid gas. (4.) A more delicate test is obtained by allow- 
ing a ray of polarized light to pass through the urine : when sugar is present, 
the vny is turned to the right. The appetite is generally good, and even ex- 
cessive in some cases ; the tongue is often dry and red, and the temperature 
rather lower than usual ; the patient sleeps well, and the general health may 
go on for a long time without being seriously impaired. In the course of 
time, there is more or less wasting of the body, and a liability to disease of the 
lungs. Cataract is, also, by no means an uncommon complication. In young 
people and children the disease often runs a very rapid course, and may cause 
a fatal result in six weeks from the commencement of the symptoms ; much 



DIA 157 DIA 

more commonly it lasts for two or three years, and in old people sugar may 
occasionally appear without any harm resulting. Death often takes place by 
suppression of urine, followed by stupor, coma, and, perhaps, convulsions ; or 
it may occur through general exhaustion, or from disease of the lungs. Treat- 
ment: The treatment of diabetes generally consists in placing the patient upon 
a diet from which all starchy or saccharine articles of food are, as far as pos- 
sible, excluded. Brown bread, bran-biscuits, meat, green vegetables, and milk, 
etc., may be allowed, but ordinary bread, sugar, rice, potatoes, etc., are prohib- 
ited. (See Diet.) Since there is so much thirst, a large allowance of water 
must be given, — as much, in fact, as the patient likes. Raw meat has been 
found to be beneficial in some cases. Various preparations, as diabetic-bread 
and diabetic-biscuit, have been recommended, but few can continue their, use 
long, as they eventually tire of keeping to a restricted diet. There are certain 
cases in which persons pass a very large quantity of water without having any 
sugar in the urine ; they are then said to be suffering from polyuria; this dis- 
ease is of much less importance. 

Diachylon is the name given to adhesive plaster, both spread and un- 
spread; though in the Pharmacopoeia the name is confined to the litharge 
plaster (Emplastrum phcmbi). 

Diaphoretics. A class of medicines which exercise an almost exclusive 
action on the skin, producing perspiration and thereby reducing fever. Such 
drugs as ipecacuanha, antimony, squills, camphor, and opium are of this sort. 

Diaphragm. The diaphragm is the chief muscle of inspiration; it divides 
the chest from the abdominal cavity, and is perforated in several places so as 
to allow of the passage of various vessels and nerves. During inspiration it 
descends, so as to increase the cavity of the chest and to give the lungs room 
to expand, while it ascends during expiration. When there is any distension 
of the abdomen, as from the presence of a large tumor, pregnancy, ascites, or 
flatulence, the action of the diaphragm is impaired and respiration is made 
more difficult. 

Diarrhoea is characterized by frequent loose evacuations from the bowels, 
due to functional or organic derangement of the small intestines, and produced 
either by local or constitutional causes. The evacuations vary in consistence 
and quality as well as in quantity and frequency ; they may be fluid or semi- 
fluid ; sometimes they are watery and serous ; at other times they are mixed 
with mucus and occasionally a little blood. In children diarrhoea is readily 
produced, and is often very troublesome to cure ; it may be acute or chronic, 
and in both forms is dangerous to life. Under five years of age the mortality 
from this cause is greater than at any other period of life, and the greatest 
liability is shown during the period of teething, from six mouths to eighteen 
months or two years of age. In hot climates diarrhoea is more common than 
in cold. As regards the time of year, diarrhoea is far more prevalent in the 
summer and autumn than in spring or winter. 

Causes: The causes may be divided into the'local and general. Amongst 
the former may be classed indigestible food, bad air and water, parasites in 
the bowels, and any irritating matters poured into the intestines. Amongst 
the latter may be enumerated several diseases which produce cachexia, and 
induce a diminution of the vital powers. Consumption, diseases of the liver 
and kidneys, and many cases of blood-poisoning are accompanied by diarrhoea ; 
it is also associated with many fevers at their onset, and it is a prominent 
symptom in typhoid or enteric fever. Diarrhoea may be beneficial and clue to 
an effort of the irritated bowel to throw off its noxious contents, as in cases 



DIA 158 DIA 

where bad meat or putrid fish or unripe fruit is taken ; in other cases it aids 
to bring about a fatal result by exhausting the patient. Hence, properly to 
treat a patient, it is important to make out thoroughly the cause ; this is some- 
times difficult, as two or three causes may be conspiring to produce the same 
effect. (1.) In America and Europe summer diarrhoea prevails epidemically 
during the hot months ; it is never absent during that time of year, but varies 
very much in its spread ; it has been noticed to be far more common before 
the advent of cholera. According to the report of the Board of Health, in the 
five years ending 1848, the deaths in London from diarrhoea were 7850. while 
in the preceding live years they were only 2828 in number. When genuine 
summer diarrhoea is very severe, it is commonly called choleraic diarrhoea, but 
it is advisable not to use such terms, as they lead to the impression that it is 
either related to cholera, or a mild form of it, whereas there is no proof at all 
of the connection. In hot climates, this disease does not always appear at the 
hottest times of the year : probably impure air, malaria, and bad food and 
water all combine to cause it. (2.) Impure air is a common cause ; its in- 
fluence may be seen in large standing camps, where, after a few days' res- 
idence, unless hygienic regulations are carefully carried out. looseness of the 
bowels is very prevalent. Those who are engaged in any occupation which 
exposes them to the influence of decaying animal or vegetable matter, decom- 
posing manure, or emanations from drains or sewers are very liable to this 
complaint. A leaky waste-pipe from a wiiter-closet may allow the foul air to 
enter into a house and cause diarrhoea among all the inmates. (3.) Indigesti- 
ble food will cause diarrhoea. It may do so by the direct irritation on the 
bowel, or by producing a vitiated state of health.. Prisoners in jails and all 
large collections of people suffer sometimes in this way. The excessive mortal- 
ity of infants is often due to this cause. In children brought up by hand, and 
in those in foundling hospitals, this disease is often met with. Improper diet 
causes numerous deaths amongst the children of the poorer classes. Bad 
food, as well as insufficient food, will cause diarrhoea, and the latter cause 
alone will do it, although the quality be fair. An instance of this occurred at 
the Mill bank (England) Penitentiary in 1823. '• The prisoners confined in 
this establishment, who had previously received an allowance of from thirty- 
one to thirty-three ounces of dry nutriment daily, had this allowance sud- 
denly reduced to twenty-one ounces, animal food being almost entirely excluded 
from the diet scale. They were at the same time subjected to a low grade of 
temperature and to considerable exertion, and were confined within the walls 
of a prison situated in the midst of a marsh, which is below the level of the 
adjoining river. The prison had been previously considered healthy ; but in 
the course of a few months the health of a large proportion of the inmates 
began to give way. The first symptoms were loss of color and diminution of 
flesh and strength ; subsequently diarrhoea, dysentery, and scurvy : and, lastly, 
adynamic fevers, or headache, vertigo, convulsions, maniacal delirium, apo- 
plexy, etc. Out of 880 prisoners no fewer than 437, or about fifty per cent., 
were thus affected. The influence of concurrent conditions, especially of pre- 
vious confinement, was here remarkably shown ; for those were found most 
liable to disease who had been in prison the longest." Starvation frequently 
causes diarrhoea, and in the chronic wasting which attends many lingering 
diseases the badly nourished tissues supply the blood with materials which 
rapidly decompose and cause colliquative diarrhoea. (4.) Impure water is 
another common cause of this complaint. Spring water, which contains much 
saline matter, will cause a looseness of the bowels, especially in those who are 



DIA 159 DIA 

not used to it. Any water which contains decomposing animal matter or 
sewage is a fruitful source of diarrhoea, and it may cause it either by direct 
irritation of the bowels, or by introducing poisonous matter into the blood. 
(5.) Any irritants introduced into the stomach may produce diarrhoea ; eating 
a large quantity of unripe fruit will frequently bring on purging, vomiting, and 
griping pains in the stomach. Fruit is by many parents forbidden to their 
children during the summer months ; this is a mistake in the opposite direc- 
tion ; a moderate quantity of ripe fruit is most beneficial to health, and when 
cooked and made into puddings or tarts it will do no harm. Fish which is 
not perfectly fresh may cause considerable distress, with sickness and purging ; 
so also will mussels and periwinkles sometimes; in some people oysters have 
a similar effect. Tainted meat, and the preserved meat which turns sour on 
keeping the cans open too long in which it is put up, may produce this com- 
plaint. Purgative medicines, the mineral acids and caustic alkalies, many com- 
mon berries which grow by our roadsides, etc., will cause diarrhoea by irritation 
of the mucous lining of the alimentary canal. (6.) Malaria, or the damp, faint- 
smelling emanations from a marshy district, are very injurious ; in summer- 
time, on walking along the banks of a river, where the stream is sluggish and 
rank vegetation abundant, it may be often noticed that, as evening comes on, 
a faint, damp smell is present, which is very injurious to those subjected to it. 
(7.) Bad dwellings and cold clamp houses, especially those which are situated 
low and badly drained, will cause this disease ; and so also insufficient cloth- 
ing will aid it. 

Symptoms : In simple irritative diarrhoea, the patient will feel, a few hours 
after a meal, some flatulence and pain in the bowels, followed by loose evacu- 
ations ; this purging may and generally does' relieve the pain ; the motions are 
feculent, and consist of a brown fluid containing small lumps of solid feces ; 
if the purging continues, the motions become more liquid, and contain mucus. 
Generally the diarrhoea will cease of itself as the noxious cause is removed 
by the purging. If the cause should be diseased or putrid food or water, then 
the diarrhoea will be more severe and exhausting; there will be considerable 
constitutional disturbance ; the pulse may become feeble, and the surface of 
the body is colder than usual. In children, simple irritative diarrhoea is very 
common in the summer and autumn months. If the attack comes on in previ- 
ously healthy children, it is generally attended with vomiting of the contents of 
the stomach ; at first the excreta are natural, then they either assume a yellow 
color, which changes to green on exposure to the air, or they are slimy and 
mixed with mucus ; sometimes white particles of undigested milk are found in 
the discharges. As the child returns to health the fgeces become less watery, 
and resume their yellow color, or they may remain for some time green and 
slimy; the disorder usually goes away in four or five days. Such cases are 
not accompanied by fever or much constitutional disturbance in the majority 
of cases. The tongue is moist, but not much coated, while the papillas may ap- 
pear more prominent than usual ; there is very little pain or tenderness over 
the abdomen, and if there is any it is relieved by the purging. Great loss of 
flesh rapidly ensues, and in two or three days a fat, healthy child will lose 
greatly in weight, and its flesh become loose and flabby ; the face is pale, and 
the eyes appear sunken, while the child sleeps badly and is fretful and languid. 
In the diarrhoea produced by teething the symptoms do not come on so sud- 
denly, and they are slower in their course, while they generally disappear 
when the tooth is cut. In whooping-cough, and after recovery from measles 
and other febrile disorders, diarrhoea may come on and assume a chronic form, 



DIA 160 DIA 

which may kill the child by exhausting its strength. Diarrhoea is very obsti- 
nate in some children just after they are weaned, and is due to the altered diet. 
Sometimes this simple diarrhoea passes gradually into an inflammatory form, 
in which there is much more constitutional disturbance ; vomiting and purg- 
ing come on with great frequency ; the stools are like green water, and consist 
chiefly of mucus from the bowel mixed with some feculent matter ; at times a 
little blood passes, and often there is " prolapsus ani," or a protrusion of the 
lower part of the bowel. The skin is dry and hot, the pulse quick, the child 
heavy and peevish; at first restless, it soon passes into a half drowsy state, 
and likes to lie quietly on its mother's lap; very little suffering occurs, al- 
though there is generally a little abdominal pain before each evacuation; the 
tongue becomes red, and the child is very thirsty ; there is loss of appetite, 
and the stomach rejects what is given ; great loss of flesh ensues, and in a few 
hours a plump child may become emaciated. Yet a fatal result is not very 
common, and a marked improvement generally takes place in two or three 
days; a danger exists that these cases may become chronic, as they are liable 
to do, and wear the child out in the course of a few weeks. Parasites in the 
bowels will bring on diarrhoea in children and adults. In such cases the worms 
may be passed, and the nature of the case is then clear ; in other cases the 
breath is fetid, the abdomen larger than usual, the appetite increased and 
difficult to satisfy, and there is often grinding of the teeth at night and pick- 
ing of the nose ; the round worms and the thread-worms are most likely to 
cause this complaint. Inflammatory diarrhoea may occur in the adult as well 
as in the child, and will produce much the same symptoms. Summer diarrhoea 
sets in suddenly ; there is copious vomiting and purging, and the stools are 
copious and liquid ; generally there is much pain and cramp of the abdominal 
muscles or of the muscles of the calf of the leg. The tongue is dry. and the 
patient thirsty ; great exhaustion will supervene, and in very severe cases the 
pulse will become feeble, the voice not raised above a whisper, and the gen- 
eral surface of the body lowered in temperature. These symptoms much re- 
semble Asiatic cholera, and hence the name English cholera has been applied 
to the fatal cases. The majority of cases are amenable to treatment, and are 
well in two or three days ; the mortality is very small. Diarrhoea appears in 
the course of typhoid fever, and many chronic wasting disorders. Chronic 
diarrhoea, or the white flux, is not uncommon in India. There are at first no 
very marked symptoms, besides the looseness of the bowels: the evacuations 
may be copious and fluid, or pale and pultaceous, and about three or four in 
number in the twenty-four hours ; as the disease advances they become more 
frequent, while the stools are paler and look like chalk and water. Then 
dyspeptic symptoms may arise, and the patient will suffer in general health. 
The diarrhoea in most cases causes very little pain, but it is emaciating and 
exhausting ; the skin becomes hard and dry, and sallow in tint ; the temper is 
irritable, and great ancemia ensues. Dropsical symptoms may come on in the 
advanced stages, and ulcerations of the cornea and scorbutic patches : death 
may take place by coma or syncope. There seems to be some connection be- 
tween this "white flux" which occurs in the plains and the "hill diarrhoea," 
which occurs in some parts of India ; it seems to be caused by atmospheric 
influences conjoined with malaria. The symptoms are very similar to those 
just described, but in this form there is more derangement of the functions of 
the liver. It is generally relieved by change of residence iuto the plains. 
When once established, it may last for years, and cause anaemia and exhaus- 
tion; in most cases, there is always a strong tendency to relapse. 



DIA 161 DIA 

Treatment : The treatment of diarrhoea must vary with the cause. In many- 
cases it is not advisable to check the purging, especially where there is some 
irritant present in the bowel, which is keeping up the flux. Often a change 
of diet, which is light and nourishing, is of great benefit ; and any food that is 
taken should be given in small quantities at a time. If the purging be due 
to unripe fruit or indigestible food, a dose of castor-oil at bed-time, followed 
by greater care in the diet, will suffice for a cure ; but if the purging continue, 
and should prove at all exhausting to the patient, then it should be stopped. 
In the case of infants who have been recently weaned, and are suffering from 
this complaint, cold milk and water should be given, with a little broth or beef- 
tea, while solid food should be avoided ; no opium should be given, as it is a very 
dangerous remedy at that age ; an aromatic mixture of chalk, flavored with 
peppermint or anise, will be useful to keep the purging in check ; if it depend 
on teething, it will probably cease as soon as the tooth has been cut, and a 
simple diet, with saline medicine, will promote a cure. Summer diarrhoea is 
generally curable in two or three days, without the use of medicine ; but if it 
persist, and the tongue be clean, a mixture of chlorodyne with camphor-water 
and tincture of ginger will check it ; should the tongue be much coated, and 
the abdomen distended and painful, a gentle purgative should be first given. 
If the symptoms are severe, and there is collapse and cramp in the legs, then 
medical aid should at once be called in ; in the mean time, iced water or milk 
may be given, and mustard-plasters applied to the calves of the legs. If im- 
pure air is the cause, removal to another place is naturally the most efficient 
remedy. Should it break out in a camp, the troops should change their posi- 
tion. If it occur from the bad air of a drain or sewer, means should be taken 
at once to flush the pipe, see that there is nothing blocking it up, and take care 
that the foul air should be carried out into the open, and not enter the house. 
The waste-pipe should communicate directly with the open air, so as to pre- 
vent the stagnation of the noxious air in the pipe, and each closet should be 
provided with a small cistern of water immediately above it, so that the pipe 
may at once be flushed ; again, no waste pipe should enter directly into the 
sewer, but it should communicate first with a box or chamber which is open to 
the atmosphere, and then the excreta, etc., can enter the sewer. The reason 
for this is obvious : after a heavy rain the sewer becomes unduly full, and the 
gases are driven by the flow of water back into the waste-pipes of the differ- 
ent houses supplied, and the pressure is enough to drive the gas back, and 
force it through the water in the siphon portion of the tube ; but if a box or 
chamber be provided open to the air, it prevents this, because as soon as any 
increased pres-ure occurs in the sewer the gases at once escape into the at- 
mosphere, and cannot reenter the house ; it is useful to place some charcoal in 
the box, which will purify the gases, and the charcoal can be changed every 
fortnight or three weeks. Should the cause be indigestible food, or if the 
latter be insufficient in quantity as well as in quality, a more generous diet 
will afford relief. Any food which has been found to disagree with a person 
should be avoided ; the meals should be taken at regular intervals, and not too 
much at a time. If impure water is causing diarrhoea, the remedy clearly is 
to improve the supply ; the cisterns supplying a house should be examined, 
to see if they are clean and sweet ; no cistern supplying a privy or water- 
closet should also supply the drinking water. If a well receive any surface 
drainage, it must be condemned at once, and no one should be allowed to use 
it. No stagnant water should ever be drunk, and every care should be taken 
that the source of the water should be kept free from decomposing animal or 
11 



DIA 162 DIA 

vegetable matter. If the purging follow any irritant food, as putrid fish or 
meat or poisonous berries, a mild purgative may be given, so as to remove 
the cause speedily; and this should be followed by a light and simple diet 
until recovery takes place. Malarious influences must he avoided if they cause 
this complaint, and frequently change of residence is the only cure; this is the 
case in India, and a journey abroad is often the only chance of saving life. In 
short, to cure diarrhoea, the food, the water, and the air should be looked 
to, and every means taken to insure their purity ; and as towns increase in 
size, unless careful sanitary means are taken, the danger to human life will be 
continually on the increase. 

A few general rules may here be mentioned for the treatment of diarrhoea, 
and they may be adopted in addition to removing the cause. (1.) Diet: This 
should not consist of too much farinaceous food, as arrowroot, tapioca, etc. 
Iced milk is most refreshing, and can be readily borne when nothing else can 
be retained on the stomach ; where necessary, a little brandy may be added. 
Beef-tea and broth carefully made are very good ; but the latter should con- 
tain no vegetables, and the former must be made by stewing the meat first 
and then raising it to the boiling point ; in this way the most nourishment is 
gained, while much is lost if the meat be first put into boiling water. An egg 
may be beaten up in the milk or in tea, and prove beneficial ; but hard boiled 
eggs must be avoided. Sago, rice, and such like foods often produce flatu- 
lence ; the lean of a mutton chop or a piece of well-boiled mutton may be 
given, but potatoes and most vegetables are inadmissible. Chicken and veal 
are good; but pork, bacon, and salt beef are too indigestible. In the case of 
children, lime-water mixed with milk proves of great service. If the patient 
be very thirsty, the mouth may be moistened frequently with iced drinks. 
Cooked fruit may be given, and the pulp of grapes or ripe orange juice ; un- 
ripe fruit must be carefully avoided. (2.) Residence and clothing- A damp, 
low situation is injurious, and removal from malarious influences is essential. 
Flannel should be worn next the skin. (3.) Change of climate : Change is 
of great benefit to Americans and Europeans in the tropics who suffer from 
this complaint; but the place selected must vary with the nature of the case 
and the state of the patient. A long journey must not be recommended un- 
less the invalid is strong enough to bear it. (4.) Medicines: In malarious 
cases quinine is of great value, or dilute nitric acid may be given, with infusion 
of gentian or columba ; in addition, iron, strychnia, and salicine may be useful. 
In "the hill diarrhoea; the bowels should be opened with blue pill and castor oil, 
followed by laudanum and astringent medicines. Opiates are rarely, if ever, 
called for in the case of children. They are chiefly of use in the inflamma- 
tory forms of this complaint in the adult, and they may often be given com- 
bined with a purgative, so that the bowel is soothed, while the astringent action 
is counteracted. Astringents may be given when the diarrhoea is not due to 
an irritant, or, when arising from that cause, the purging has gone on without 
being checked. Chalk mixed with mucilage is commonly given, and to this 
may be added some tincture of catechu and peppermint-water ; in some long- 
standing cases, tannin, gallic acid, and kino arc beneficial ; in others the sul- 
phates of iron or copper are resorted to ; ipecacuanha in certain cases is re- 
sorted to with benefit. Where simple remedies fail, medical advice must be 
sought. Rest in bed or on a sofa is advisable in all cases of diarrhoea. When 
a patient has been suffering from diarrhoea in a chronic form, he is very liable 
to relapses, and any error of diet or exposure to an exciting cause may be most 
deleterious. In all cases, therefore, care should be taken both during conva- 
lescence and for some time after it. 



DIA 163 DIB 

Diastole signifies the dilatation of the cavities of the heart, which follows 
immediately after their contraction. See Heart. 

Diathesis implies a peculiar state or constitution of the individual, which 
renders him more liable to a disease or group of diseases than another ; in this 
country there are well-marked diatheses, as the gouty, the nervous, the tuber- 
culous, the bilious, etc. 

Diet. Men require more food per day than women, and those engaged in 
hard, manual exercise require more than those employed in sedentary work. 
Different periods of life make a difference in the quantity as well as in the 
quality of the food taken, so that this subject naturally divides itself into the 
diet required 'for (1) adults, (2) children, and (3) infants. But in the first place 
must be given a short account of the different kinds of food. Physiologists have 
for a long time divided food into five classes, namely, the starchy or saccharine, 
the oleaginous or fatty, the mineral or saline, the albuminous, and the aqueous. 
(1.) The starchy or saccharine food forms a large element in the composition 
of wheaten bread, rice, arrowroot, potatoes, sago, etc. Starch is a complex 
chemical compound of carbon, hydrogen, and oxygen, and such bodies are 
termed hydrocarbons ; when burnt off in the human economy, they form 
water and carbonic acid by entering into combination with oxygen ; the fat or 
adipose. tissue in each individual is stored up in consequence of the amount of 
starchy food taken ; infants are much fatter than adults in proportion, because 
they are accustomed to live on so much farinaceous food, and such a diet con- 
tains a great deal of starch. Starch becomes converted into sugar when it 
mixes with the saliva. The sugar so formed is chemically the same as that 
present in ripe fruits, etc. ; it has the property of being fermented by yeast, and 
thus of being converted into alcohol and carbonic acid. A familiar example of 
this change is seen in the case of the manufacture of beer, for in this process 
the starch present in barley is converted by malting into sugar by mean-s of a 
body called disastase ; this sugar, when dissolved with other bodies in boiling 
water, forms sweet wort, and finally, when acted upon by yeast, carbonic acid 
is given off, as shown by the effervescence which occurs, and alcohol is left in 
the beer, which gives to it its intoxicating properties ; the strength of the beer 
depends, therefore, on the amount of malt or saccharine matter put into it. 
(2.) The oleaginous or fatty kind of food is commonly known ; all butter, 
lard, suet, the fat part of meat, and rich, greasy foods consist of this variety. 
Like the last kind, they consist of carbon, hydrogen, and oxygen, and form, 
when used up in the human economy, water and carbonic acid ; they differ in 
not being acted upon by the saliva or pancreatic juice, but they are made into 
an emulsion by the secretion from- the liver, and thus, being divided into ex- 
tremely minute particles or globules, they are in a fit state for absorption by 
the lacteals, which are so numerous in the small intestine. This kind of diet 
tends to make persons fat, and a common example is seen in the t case of those 
who take cod-liver oil ; those who naturally are too corpulent should avoid 
taking saccharine or fatty substances as far as possible. (3.) The mineral or 
saline variety of food is found in nearly every article of diet ; common salt is 
a familiar example ; in ordinary drinking water, in milk, in bread, and in fact 
in every animal and vegetable product, there is more or less saline matter ; it 
is one of the most important constituents for the formation of tissues, and dur- 
ing foetal life the child is nourished by a fluid which contains a good deal of 
common salt. Wherever vital changes go on rapidly saline matters are essen- 
tial ; without them the health fails, and many diseases have arisen from the 
want of salt during long sieges, (i.) The albuminous foods : these consist 



DIE 164 DIB 

of hydrogen, nitrogen, carbon, and oxygen, and are also called azotized sub- 
stances, from their containing azote or nitrogen. The lean of all kinds of meat, 
the white of an egg, the caseine of milk, the gluten of bread, are common ex- 
amples of this kind of food. They help to build up muscular tissues, and 
hence are much required by those who lead active lives, and who undergo 
much exertion. (5.) The aqueous or watery portion of our food is too well 
known to require notice ; no substances that we eat are so absolutely dry as to 
contain no water. Finally, there are certain condiments, as mustard, pepper, 
pickles, etc., which are not essential as foods, but which tickle the_ palate and 
cause an increased secretion of saliva and gastric juice, and by doing so help 
to promote digestion. From this brief survey it will be seen how valuable 
milk is during the growth of children, for it contains in a liquid and soluble 
form all the elements necessary for the growth of the body ; the cream con- 
tains oily matter, while the remaining liquid portion consists chiefly of water, 
holding in solution saline, saccharine, and alhuminous matters. Bread again, 
is a valuable article of diet, inasmuch as it contains water, salt, starchy and 
albuminous materials. An ordinary joint of meat contains albuminous matter, 
as shown by the amount of lean, associated with more or less of fat and aque- 
ous material, and in addition a small quantity of salt. An egg is a good ex- 
ample of a mixture of the different kinds of food ; the yolk contains much 
fatty matter, while the white of an egg is made up chiefly of albumen, water, 
and salt. Beer contains saline and saccharine matter in combination with al- 
cohol and water ; the hops onlv aid in giving a bitter flavor, and promoting 
the appetite. Tea, coffee, and cocoa contain chiefly water when taken as bev- 
erages, and, in addition, sedative and tonic properties ; cocoa contains a good 
deal of fatty and saccharine matter, and is very nourishing. With this brief 
survey, rules will now be laid down which may be employed in the diet of 
infants, children, and adults. 

Diet of Infants. Too much care cannot be taken in the bringing up of 
children : a great many of their complaints are due to errors in feeding, and 
a large mortality annually results from this cause. Attention to_ the follow- 
ing simple rules,' drawn up by a committee of the Obstetrical Society, will be 
found of the greatest benefit. 

Suckling. Nature provides breast- milk as the proper food for infants, and 
suckling is by far the best wav of feeding a child. Provided the mother or 
wet-nurse has plenty of milk," and is in good health, the child requires and 
should have no other food but the breast-milk until about the sixth month. 
The milk itself, for the first few days, acts as a laxative, and no other aperient 
is necessary. Should the formation of the milk be delayed, a little cow's milk, 
diluted with an equal quantity of warm water, and slightly sweetened, may be 
given until the mother is ready to nurse. The child should, for the first six 
weeks, be put to the breast at 'regular intervals of two hours during the day. 
During the night it requires to be fed less often. As the child gets older, it 
does not require to be fed so frequently. A child soon learns regular habits 
as to feeding. It is a great mistake, and bad both for the mother and child, 
to give the breast whenever the child cries, or to let it be always sucking, 
especially at night. This is a common cause of wind, colics, and indigestion. 
How a nursing mother or wet nurse should be fed. A nursing woman ought 
to live generously and well, but not grossly. She may take porter or ale in 
moderation with' her meals. It is a common mistake for wet nurses to live 
too well, and this often causes deranged digestion in the child. Should a nurs- 
ing woman suffer from dizziness, dimness of sight, much palpitation and short- 



DIB 165 DIB 

ness of breath, or frequent night-sweats, it is a sign that suckling disagrees 
with her, and that she should cease to nurse. 

Mixed feeding, when the mother has not enough milk. When the mother has 
not enough milk to nourish the child, other food may be given, especially dur- 
ing the night. This should consist of the best milk, with one-third the quan- 
tity of warm water added. This plan of combining breast-feeding with bottle- 
feeding is better than bringing up the child by hand alone. 

Weaning. The child should not be weaned suddenly, but by degrees, and, 
as a rule, it should not be allowed to have the breast after the ninth month. 
After the child has cut its front teeth it should have one or two meals a day 
of some light food, such as bread and milk or nursery biscuits, and these may 
be gradually increased until the child is weaned. When the child is about 
from seven to ten months old, according to its strength, it may have one meal 
a day of broth or beef-tea, with crumbs of bread soaked in it„ or it may have 
the yolk of an egg lightly boiled. When it is about a year and a half old it 
may have one meal a day of finely minced meat ; but even then milk should 
form a large proportion of its diet. 

The food of grown-up people had for children. Meat, potatoes, and food 
such as grown-up people eat are often given to young infants. This kind of 
food and all stimulants are entirely unsuitable, and are common causes of 
diarrhoea and other troubles. 

Hand-feeding. If the child must be brought up by hand, the food should 
resemble as closely as possible the milk provided for it by nature. Milk, and 
milk only, should be used for this purpose. Cow's milk is generally used, but 
ass's or goat's milk is good. Two-thirds pure and fresh milk, with one-third 
the quantity of hot water added to it, the whole being slightly sweetened, 
should be used. A tablespoonful of lime-water may often, with great advan- 
tage, be added to the milk, instead of an equal quantity of the warm water. 
The milk should be given from a feeding-bottle, which should be emptied and 
rinsed out after every meal, and the tube and cork or teats kept in water when 
not in use. Perfect cleanliness is most important ; otherwise the milk may 
turn sour and disagree with the child. The child should be fed regularly. 
The milk diet should, as a rule, be given only until the child begins to cut its 
teeth, when other food may be gradually commenced. 

Diet of Children. To make this subject clear, the following tables are 
given as a guide for parents : — 

(1.) From eighteen months to two years old. — Breakfast at 7.30 a.m. 
A large cup of new milk, with a good slice of stale bread, or half a pint of 
hot bread and milk. Dinner should be taken about 1.80 p. m. It may con- 
sist of some good beef-tea or broth, in which some bread crumbs or a well- 
mashed potato may be mixed. A cup of milk and water may also be given. 
At 6 p. m. a large cup of good milk may be given, with a slice of bread and 
butter. No other meal need be given, as the child, when healthy, ought to 
sleep all night, and it is bad to accustom it to wake in the night and cry for 
food. Yet, if it should do so, a little milk and water may be given. Fari- 
naceous food should not be given at an early age to any extent, as the stom- 
ach is overloaded by that means, and fails to digest it properly. 

(2.) From two to three years old. — Breakfast at 7.30 a. m. A large cup- 
ful of milk, with a slice of bread and butter, and now and then the lightly 
boiled yolk of an egg. At 11 A. m. a cup of milk may be given. For dinner, 
a large cup of beef-tea or broth, or a little finely-cut-up roast mutton, or three 
or four tablespoonfuls of gravy, in which bread crumbs or a mashed potato 



DIE 166 DIE 

may be mixed ; a small quantity of rice pudding, with plenty of milk, or a piece 
of custard pudding. At G p. m. some milk may be given, or a little tea with 
plenty of milk in it, together with some bread and butter or toast and butter. 
Now and then a little stewed fruit may be given, or occasionally a little jam. 

(3.) From three to ten years of age. — The amount of food given will vary 
with the age and appetite of the child. Breakfast at 7.80 a. m. A basin of 
bread and milk, with some thick slices of bread and butter. Occasionally 
a lightly boiled egg may be given. At 11a. m., a small slice of bread and 
butter may be given, if required, with a little water or milk and water. Din- 
ner at 1.30 p. m. Some lightly boiled mutton, or a slice of roast beef or 
mutton with plenty of gravy ; bread should be eaten with it, or a mashed po- 
tato. A light pudding may be given, as rice, custard, ground rice, etc. At 
times a fruit pudding, well cooked, may be tried, or well-stewed fruit is bene- 
ficial. Considerable variety may be adopted at this age, provided that too 
much is not given, and that it is digested well. Broth or soup may be substi- 
tuted once or twice a week for the meat. Boiled salt beef, pork, and veal are 
not so easily digested as fresh beef and mutton. Cheese is not advisable. 
Prunes, figs, almonds, and raisins, and such like fruits may be given now and 
then with advantage ; but any excess should be avoided carefully. Biscuits, 
nuts, preserved foreign fruit, walnuts, and dates are less digestible. A roasted 
apple, well sugared, or stewed pears are very nice, and suitable for children ; 
and occasionally some jam, as raspberry or strawberry, or currant preserve, 
may be given with bread at tea-time. At 6 P. M. milk and water, or tea with 
plenty of milk, may be given, also bread and butter. Plain seed cake, or a 
slice of an ordinary home-made plum cake, may occasionally be substituted, or 
a sponge cake. 

(4.) From ten to fifteen years old. — The same diet as No. 3, only now 
more may be given in proportion to the age ; boys, too, often require more 
than girls, as they undergo more active exercise. A good meat meal should 
be given at midday, but it is not required oftener. For breakfast^ cocoa and 
milk is very nutritious, or a basin of oatmeal porridge with fresh milk may be 
substituted for the bread and milk. These diets presuppose that the child is 
in good health, and that active exercise is taken ; but if disease be present 
some modification may be required, and for this medical advice should be 
sought. In the treatment of children's diseases more than half the success is 
due to the careful arrangement of the diet. 

Diet of Adults. It is difficult to lay down any strict rule as to the 
amount of food to be taken in twenty-four hours for grown-up people : men 
require more animal food than women, and those engaged in active exercise 
require much more than those who live a sedentary life. Navvies and labor- 
ers can get through much more work in a day when well fed than when living 
on a moderate diet. The different kinds of food should be well apportioned ; 
it is equally bad to live on a purely farinaceous diet as it would be to take 
only fat or meat ; what is required for a state of health is to take a fair pro- 
portion of each. It is important also that meals should be taken with regular- 
ity, as it is a very bad plan to allow intervals of varying length between meals. 
It has been estimated that the food required every twenty-four hours by a 
man in full health, and taking free exercise, is, of meat 1G oz., bread 19 oz., 
fat 3£ oz., and of water 52 fluid ounces ; that is, about 2\ lb. of solid food and 
about" 3 pints of fluid. The fluid here includes any liquid taken : a man can 
drink from three-quarters of a pint to a pint of tea, coffee, or cocoa at break- 
fast, and a woman takes about one-third less ; if he has dinner at midday, a 



DIB 167 DIE 

pint or a pint and a half of something is drunk ; at tea-time, half a pint of tea 
is swallowed ; while at supper-time a glass of heer is often taken ; in addition, 
there is the liquid portion of the solid food, which must count for something. 
It seems probable that 1£ pint or 2 pints of beer are quite enough for a man 
during the twenty-four hours, and about 1 pint for a woman in the same inter- 
val ; any increase in this quantity does not add to the working qualities of the 
individual. For those who do not take beer, a glass of sherry or claret at 
luncheon, and two or three glasses at dinner, will furnish a full equivalent. 
Wines, of course, vary very much in the amount of alcohol they contain, some 
containing only 5 per cent., others as much as 25 per cent. ; good table beer 
is light, and contains from 2 to 3 per cent. ; strong beer or stout may range 
up to 7 or even 8 per cent, of alcohol. The amount of solid food has been 
stated to be about 2\ lb., but this is often exceeded ; the French take much 
less animal food than we do ; 16 oz. of meat a day is a large proportion, and 
in Europe can be afforded only by the wealthier classes, who take animal food 
at breakfast, lunch, and dinner. The poorer classes in Europe manage to 
subsist on a very small proportion of meat ; frequently they have this kind 
of food only once a week ; and as they live chiefly on bread, broth, tea, and 
now and then bacon, their physical stamina is not very high. For any one 
who is at all engaged in hard work, whether mental or physical, 3 oz. or 4 oz. 
of meat a day seem to be essential. Of the different kinds of meat, mutton 
and roast beef are the most digestible ; salt beef, bacon, pork, and veal would 
rank next in order ; some sorts of fish are digestible, as soles and eels, but 
there is not so much nutriment in them as in a corresponding quantity of meat. 
Bread is taken at most meals, and it forms an important element of diet ; 
not only is it cheap, but it contains four .out of the five kinds of food ; life 
can be sustained for a long time on bread and water. Pastry is heavy, 
greasy, and indigestible. Fruits or preserves made into puddings or tarts are 
very excellent articles of diet, and so are light puddings made of rice, arrow- 
root, tapioca, etc. Salt should be taken with food, and generally it is present, 
in a greater or less degree, in most kinds of food. Sugar seems necessary in 
early life, but the desire for it is lessened as we grow older. Both the sac- 
charine and fatty foods should be avoided by those who are too corpulent, as ' 
they both help to build up fatty tissues. The system of Banting rested on 
this principle, and' there is no manner of doubt that fat people can become 
greatly reduced in weight, and keep themselves down, by attending to this 
rule ; the change should not be made too suddenly, but no danger need be 
feared on that score. The following substances should be avoided by a fat 
man, or at least taken only in moderation : fat of meat, bacon, pork, etc. ; 
white bread, potatoes ; starchy food, as tapioca, rice, arrowroot, sugar, beer, 
and heavy wines or spirits. The following articles may be taken without fear 
of forming too much fat : brown bread, toast, biscuits, rusks ; lean of any 
kind of meat; fish, fowl, or game; green vegetables, as cauliflower, asparagus, 
lettuce, and celery; fruit, either cooked or fresh; jams in moderation, and light 
wines. For people who are thin a converse plan may be in part adopted. 
Climate makes a great difference in the appetite, as lias been shown by the 
large amount eaten by sailors who have served in Arctic expeditions. See 
Composition of Body, Food. 

Dietaries, Public. The construction of public dietaries is a matter of 
great importance, and is constantly the source of disease or health on a large 
scale, according to the knowledge displayed in the combination of the right 
kinds of food. In the construction of public dietaries it should always be rec- 
ollected that there are four forms of food that should be represented at every 



DI3 



168 



DIE 



meal. These are: (1.) Flesh-forming materials, which consist of the nitrog- 
enous substances known as albumen, flbrine, and caseine. (2.) Heat or force- 
giving substances, such as starch, sugar, and fats and oils of all kinds. It 
should be recollected that carbon is the principal substance that acts on the 
system in this group of food. (3.) Mineral substances : these are the saline 
matters found in all kinds of organic bodies, and are as much required for the 
nutrition of the body as the flesh-formers, which occupy more bulk. The fol- 
lowing are examples of public dietaries for different classes of persons, in 
which the quantity of flesh-forming matters is calculated from the known 
quantities of these substances contained in the different articles of food sup- 
plied. The carbon, which represents the force or heat-giving material of the 
food, is calculated in ihe same way. (1.) The English soldier. The average 
result of the diet tables issued for the army in England and in India gives 
daily 5 ounces of flesh formers and 10 ounces of carbon. (2.) The English 
sailor, from tables drawn up for the navy, has 6 ounces of flesh-formers and 
12 ounces of carbon. The quantity here is probably larger than in other 
classes, as the food, consisting largely of salt beef and hard biscuits, is less 
digestible than the food of other classes. (3.) The Dutch soldier in war gets 5 
ounces of flesh-formers and 10 J, of carbon, but during peace he has 3J ounces 
of flesh-formers and 10 of carbon. (4.) The French soldier consumes 4£ ounces 
of flesh-formers and 12 ounces of carbon. (5.) Greenwich pensioners had 3^ 
ounces of flesh-formers and 10 ounces of carbon. (6.) Old men in Gillespie's 
Hospital, Edinburgh, take 3 ounces of flesh-formers and 10 ounces of carbon. 
(7.) Boys at the Royal Naval School at Greenwich, 2h ounces of flesh-formers 
and 7£ ounces of carbon. (8.) Boys at Christ's Hospital, 2\ ounces of flesh- 
formers and 7 ounces of carbon. (9.) Pauper dietaries. The average of 
all the workhouses in England gives 3£ ounces of flesh-formers and 8^ of 
carbon. (10.) Prison dietaries. The average of a number of these gives 4 
ounces of flesh-formers and 10 ounces of carbon for their first-class diet ; the 
second, third, and fourth class diets are much lower. In the Irish prisons the 
short-term dietaries are not more than 2\ ounces of flesh-formers and 5 ounces 
of carbon. (11.) The average dietary of American families, including children, 
is found to be 4 ounces of flesh-formers and 1 1 ounces of carbon. The differ- 
ent kinds of food taken in a day to give this result are as follows : fibrine, 3 
ounces, albumen, 300 grains, caseine in cheese, 137 grains ; making altogether 
4 ounces. The carbon in these would be about 1| ounce, whilst the rest of 
the carbon would be found in starch, 12 ounces, fat and butter, 5 ounces, sugar, 
2 ounces. These things, with about one ounce of mineral matter, including 
salt, are dissolved in from seventy to ninety ounces of water, and taken daily. 
Iu the construction of public dietaries, it should always be recollected that dif- 
ferent kinds of food contain varying proportions of flesh-formers, heat-givers, 
and water. This will be seen from the following tables : — 

VEGETABLE. ANIMAL. 



Names. 


Water. 


Heat- 
Giving. 


Flesh- 
Giving. 


Ashes, 
etc. 


Names. 


Water. 


neat- 
Giving. 


i'iesh- 
Giviug. 


Ashes, 

etc. 




Oz. 


Oz. 


Oz. 


Oz. 




Oz. 


Oz. 


Oz. 


Oz. 


Wheat . . . 


2 


11 


n 


1 


Veal. . . 


10 


H 


24 


1 


Oats .... 


2 


8 


3 


3 


Beef. . . 


8 


u 


'2k 


1 


Maize . . . 


2A 


10 


2 . 


H 


Mutton . . 


7 


6 


2 


1 


Rice .... 


2 


Hi 


1 


H 


Pork . . 


6 


8 


H 


k 


Beans and Peas 


2 


6 


6 


2 


Eggs . . 


12 


H 


2+ 




l'otatoes . . 


12 


H 


1 


1 


Milk. . . 
Fish . . . 


13| 

12 


1^ 


1 


J, 

4 
t 



DIG 169 DIG 

In the preparation of public dietaries, not only should the quantity of the 
principal constituents be regarded, but the quality and properties of the food. 
In the first place variety is of importance. The same amount of the primary 
constituents will go much further when varied from day to clay than when 
the same things are given every day. Salt meat is not so healthful as fresh 
meat. A variety of vegetables, and, if possible, of bread and biscuits, should 
be secured. Fat, in butter or lard, should be given in at least the proportion 
of from two to five ounces a day. Saline substances are also necessary in food. 
These may be omitted in cooking. Salt should be always served, free. The 
water in which vegetables and meat are boiled contains the mineral substances, 
and may be employed in making soup. Uncooked vegetables, as salads and 
fruit, also supply mineral substances. Food should be also served with condi- 
ments ; they exercise a digesting influence in the stomach. In the same man- 
ner, alcohol acts as a stimulant in old and delicate persons. Sick dietaries must 
of course be ordered at the time. All food may be spoiled in the cooking, and 
no attention to the quantity and quality of the food will make up for bad cook- 
ing. Food should not only be cooked well, but served hot. Hot food is half 
the battle of life, for weak and impoverished systems. Then comes the ques- 
tion of the times of meals. Strong and healthy adults require three meals a 
day. Children and old people require four. 

Digestion. The alimentary canal is the great channel whereby new ma- 
terial is introduced into the blood, and in it the important function of digestion 
takes place. A man swallows daily a certain amount of meat, bread, butter, 
water, vegetables, etc., and it has been computed that the amount of chemically 
dried solid matter taken daily by a man of average size and weight amounts to 
about 8000 grains ; he also absorbs by his lungs about 10,000 grains of oxy- 
gen every twenty-four hours, making a total of 18,000 grains (or nearly two 
pounds and three-quarters avoirdupois) of daily gain of dry solid and gaseous 
matter. Of this quantity about 800 grains, or one-tenth part of solid matter, 
leaves the body daily as excreta, leaving about 7200 grains of solid matter to 
pass out of the body in gaseous or liquid secretions, supposing the man to keep 
the same weight. The urine, the perspiration, and the expired air from the 
lungs carry off nearly all this quantity in their secretions. All the substances 
used as food may be classed under four heads: (1.) Proteids, or albuminous 
compounds, — bodies which are made of carbon, hydrogen, oxygen, and nitro- 
gen, and sometimes a little sulphur and phosphorus. In this class must be 
placed such substances as the white of an egg, the gluten of flour, the fibrine of 
the blood, the lean of meat, the caseine of cheese, and other allied prepara- 
tions. (2.) Fats, or fatty and greasy compounds, which contain no nitrogen, 
but are made of carbon, hydrogen, and oxygen. Butter, lard, fat, all oils, and 
animal and vegetable fatty matters come under this head. (3.) Amyloids, 
or starchy compounds, made also of carbon, hydrogen, and oxygen, and like 
the last group containing no nitrogen. Starch is an important member of this 
group, and is met witli in all cereals and farinaceous bodies, as wdieat, barley, 
arrowroot, rice, and potatoes. Sugar also belongs to this division, and is 
intimately allied to starch in chemical composition ; the latter body is con- 
verted into sugar by the process of digestion before it is absorbed into the blood. 
Gum and dextrine are also members of the group. These are all derived at 
present from the animal and vegetable kingdoms, and are produced by the 
agency of living beings. (4.) Minerals are produced from the inorganic or 
non-living world ; common salt is the chief member of the group, and is taken 
daily in our food; nearly all the various foods above mentioned contain more 



DIG 170 DIG 

or less salt of some kind. Finally, water is taken in varying quantity, so as to 
dissolve these solid materials, and prepare them for absorption into the sys- 
tem. When these different foods are swallowed, various changes take place. 
Starchy compounds are very insoluble, but the saliva converts these during 
mastication into sugar, and this passing down into the stomach is easily solu- 
ble ; hence arises the necessity for well masticating bread, biscuits, potatoes, 
toast, rice, arrowroot, etc. Albuminous compounds, such as the lean of meat, 
etc., should be well masticated, so as to tear up each portion into minute pieces, 
and enable it to be easily acted upon by the gastric juice when it gets into the 
stomach. This important secretion, poured out from the walls of the stom- 
ach in great quantity dining digestion, renders soluble all the proteids or albu- 
minous compounds, and the more finely divided these bodies are the easier 
does the process go on. Thus, in the course of three or four hours after a meal, 
the stomach contains all the proteids, amyloids, and minerals in a state of 
solution ; only the fatty matters as yet are unaffected. Passing down into 
the small intestine the food is now called chyme, but it does not go far when it 
meets with the bile and the pancreatic juice, which, acting on the fatty mat- 
ters, form an emulsion, whereby the oily particles are so minutely divided as 
to render them capable of being absorbed by the lacteals and vessels of the 
small intestines. In this way the blood is supplied after every meal with a 
fresh stock of food to make up for the losses which are continually going on in 
other parts of the body. There is, however, always a residue of indigestible 
matters in the food, so that all the chyme is not absorbed, but the remainder 
is excreted daily, and known as freces. As the coat of the intestines is in part 
made of muscle, it is constantly contracting in waves, and gently pushing the 
chyme forward so as to bring it in contact with difEerent parts of the canal, and 
finally to expel the indigestible remainder. If this process'from any cause go 
on too rapidly, then diarrhoea will result, and if it continue the patient will lose 
flesh, because those substances escape which ought to be absorbed by the blood ; 
or again, if there be disease of the mesenteric glands or walls of the intestines, 
as in some cases of wasting disease in children, in cancer of the bowels, etc., 
then absorption will not go on properly, and emaciation will be the conse- 
quence. By bearing in mind the importance of mastication and digestion in 
early life, much suffering may be avoided in after years, and many of those 
who are confirmed invalids and martyrs to indigestion might have been free 
from disease had they paid more attention to diet. See Diet and Food. 

Digitalis, or Foxglove {Digitalis purpurea), though a common plant, is 
one of our most valuable remedies. The leaves of the plant are used, and from 
them may be extracted an active principle, not an alkaloid, called digitaline. 
Its two officinal preparations are an infusion and a tincture. The leaves are 
taken when about two-thirds of the flowers are expanded. Digitalis acts as 
a sedative on certain important organs, especially on the heart, and that, too, 
through one special nerve called the pneumogastric or vagus. This nerve 
serves as a kind of fly-wheel to the heart. Stimulation of it in any shape 
diminishes the rapidity, whilst it increases the force, of the heart's action. 
Paralysis of it, on the other hand, increases the rapidity, leaving the force pan 
passu. Now digitalis stimulates this nerve, and therefore steadies the heart. 
Under its influence the heart no longer, beats frequently, and imperfectly ex- 
pels its contents ; it acts more slowly and more perfectly. When digitalis has 
been too frequently given there is considerable danger of paralysis of the 
heart — it may stop, and so death ensue. This is most likely to be the case 
if the patient attempts any unusual exertion or even sits up in bed. It is, 



DIL 171 DIP 

however, to be noted that in patients the subjects of heart disease this remedy 
may be given for months with only good effects. It is chiefly used as a rem- 
edy in heart disease, where it is most valuable if the proper cases are selected. 
It lias also been used in delirium tremens in large doses, but this treatment has 
not been generally accepted. It is a more valuable application, perhaps, in the 
treatment of acute mania. Digitaline is sometimes used in the same malady, 
being injected under the skin if there is any difficulty in getting the maniac to 
take it. At all times digitalis should be used with caution, and is one of those 
remedies which in appropriate cases do much good, but in badly selected cases 
may kill. The infusion of it is probably the best preparation. 

Dilatation occurs in various organs of the body. (1.) In the heart, in 
many cases in which there is disease of the valves, or where the wall of that 
organ is fatty and weak. (2.) In the air-cells of the lung, forming the condi- 
tion known as emphysema. (3.) In the bronchial tubes, in persons who have 
long been subject to winter cough. (4.) In the bladder, when the patient has 
suffered from stricture for some time. (5.) In the kidney, if the ureter be 
blocked up by a stone, so that this organ may be distended into a large cyst 
and become quite useless. (6.) In the ventricles of the brain, as in some cases 
of meningitis. The treatment will consist in removing the cause of the dilata- 
tion, if possible, as little or nothing can be done for the organ when it has once 
been well dilated. 

Dill is the fruit of Anethum graveolens, a plant belonging to the hemlock 
family. It is cultivated in England, and contains an oil which may be distilled 
from it. To this oil it owes its property, and from it, or from the fruit, is pre- 
pared dill water, the form in which the substance is commonly used. It is 
almost entirely employed in the maladies of children, accompanied by flatu- 
lences. It is much used as a domestic remedy, and is the more to be com- 
mended for this, inasmuch as though useful it is harmless. A teaspoonful of 
the water may be given for a dose, or a drop of the oil let fall on sugar. 

Diluents A class of remedies made use of to quench thirst, or to make 
the blood heated and thickened by fever thinner and cooler. Toast and water, 
barley-water, lemonade, and such like beverages, are of this class. 

Diphtheria is a specific contagious disease, occurring generally in an epi- 
demic form, and characterized by a peculiar inflammation of the mucous or 
lining membrane of the fauces, pharynx, and upper part of the air-passages ; 
sometimes the disease spreads to other parts of the mucous membranes ; there 
is also generally some affection of the spleen and kidneys, together with much 
general prostration. This disease' seems to have been known for the last two 
thousand years, and under various names it has prevailed with great severity 
in different countries. It has often been confounded with croup and scarlet 
fever, and it was not until quite recent epidemics that the disease was clearly 
and generally recognized. In the four years 1859-62, the number of deaths 
registered from diphtheria was 24,219. Of these 11,229 were males, and 
12,990 were females, showing that in the latter sex it is more fatal than in 
the former. Half of these deaths occurred in the first five years of childhood ; 
children and young people are more exposed to it than adults, and more girls 
suffer from it than boys ; in like manner women are more liable than men, 
and the weakly of either sex are more prone to the disease than the strong 
and healthy. Climate and season do not seem to exercise any influence on 
the disorder ; it occurs with equal severity in the winter as in the summer 
months, and in its symptoms and mortality it is the same in hot as in cold 
countries ; yet various epidemics differ in severity and in extent. The French 



DIP 172 DIP 

called this disease dipktherite, and in 1859 the name diphtheria was applied 
to it by English and American authorities, and has now become a well-known 
and established designation. It is quite clear that this complaint is conta- 
gious, but in what way is not so manifest. The infectious matter is capable of 
being diffused into the air and carried to a distance, but it is more common for 
people who inhale the patient's breath or who come in close contact with the 
sufferer to be attacked. No atmospheric condition is known which tends to 
favor the spread or check the progress of the disease ; it is very doubtful if 
the disease can be taken from one house to another by an unaffected person, 
but the presence of one sick person in a house is sufficient for its communica- 
tion to another, although the two may be kept as separate as possible. As in 
most epidemics the mortality is greatest at the outset, and this is probably due 
to the most weakly and most susceptible being attacked first. Although every 
care be taken to cleanse and purify an apartment in which a patient has suf- 
fered from this disorder, yet the infection will sometimes cling to it with re- 
markable tenacity. " In a country house in Scotland a visitor suffered from 
this disease while occupying a chamber in which a case of diphtheria had oc- 
curred eleven months before." The time between exposure to the disease and 
the first appearance of the disorder varies very much ; in some cases the period 
has been only thirty hours, in others several days elapse. Two children were 
taken from an infected house and removed to a village where no similar case 
had appeared ; one child had symptoms of the disease on the third day, being 
apparently quite well in the interval, and another person going from that vil- 
lage to nurse her sister in the infected house fell ill four days afterwards. In 
another house a servant was taken ill with this disease, and remained there a 
month until she was quite well ; the house was then well cleansed and venti- 
lated, and remained empty for ten days ; at the end of that time the family 
returned, and three weeks afterwards the baby was attacked, and then the 
other inmates in turn. The infection may be disseminated for some time after 
convalescence has been established. There seems to be a predisposition on the 
part of some people to take this disease more readily than others ; those who 
are highly nervous or have undergone much mental activity, and those who 
have suffered from exhaustion or bodily fatigue, are more liable than others. 
The disease seems to attack indifferently all classes of society. 

Symptoms: The onset of an attack is marked by lassitude and prostration, 
aching in the back and legs, pallor of the skin, and pain in the throat , in 
children there may be diarrhoea, headache, giddiness, and a stupid condition. 
The pulse becomes quick, and may beat 120 or 140 times a minute, but the 
respirations are not particularly increased. The tongue is moist, and slightly 
coated; the appetite is impaired, and there is more or less thirst. The urine 
is pale, and generally contains a little albumen. The throat is sore, and it is 
difficult and even painful to swallow, and this pain extends often to the ears, 
and there is a feeling of stiffness in the muscles of the neck. On looking in- 
side the mouth there will be found some swelling and redness of the soft palate 
and tonsils and the back part of the throat ; if the inflammation exteud up- 
ward into the nasal passages there may be a glairy discharge from the nose, 
or, if it spread downward into the larynx, symptoms similar to those met with 
in croup will appear. There will then be hoarseness and weakness of the 
voice, with cough and crowing inspiration, and, if the obstruction be great, 
imperfect expansion of the chest, pallor of the face, and lividity of the lips. 
AVIien the inflammation extends into the larynx, the mortality, especially in 
children, is very great, and it has been estimated that one-half of the fatal 



DIP 173 DIP 

cases die from this cause. Sometimes the mischief is confined entirely to the 
larynx, but more generally the fauces will be found affected also. The most 
characteristic appearance in diphtheria is the presence of a membrane which 
covers more or less the parts about the upper and back part of the mouth ; 
this membrane is soft and of an ashy gray color, and when removed leaves 
behind a red and raw surface, and then it rapidly re-forms again. This mem- 
brane, too, may appear on any abraded surface, on a mucous membrane, or on 
the skin ; if there be an open wound anywhere, the surface will cease to heal 
and become covered with this unhealthy membrane. Haemorrhage occasionally 
takes place on attempting to remove the deposit from any affected surface, so 
that much care must be taken whenever this is attempted. The inability to 
swallow is sometimes very great, and when fluids are taken they are often apt 
to come back through the nose ; at the same time there is a loss of sensibility 
in the fauces and soft palate ; complete inability to swallow seldom comes on 
before the third or fourth week of the disease, and it arises from paralysis of 
the muscles of deglutition ; this condition is a very serious one, and adds much 
to the danger of the case ; the pulse may become weak and slow, and death 
may occur suddenly from fainting on any undue exertion. The paralysis may 
extend to other parts of the body, and these become affected at a later period ; 
in this way the legs or arms become useless for a time, and the muscles of the 
neck may be so paralyzed that the patient is unable to move his head. Loss 
of power and irregular action of the muscles of the pharynx is the earliest and 
most common form of nervous affection in this disease, and it may disappear 
rapidly and leave no mischief behind, but sometimes it lasts for many weeks 
or months, and retards convalescence. The patient is often unable to articulate 
clearly from imperfect movement of the tongue, and tingling sensations are 
often felt in the tongue and lips. Every case of diphtheria is attended with 
considerable danger ; any extension of the deposit in the fauces, the onset of 
a hoarse voice or croupy breathing, and the occurrence of haemorrhages are 
serious symptoms. The mortality varies in different epidemics, but the aver- 
age of deaths ranges from one in three at the height of the epidemic to one in 
seven or ten at its close. 

Treatment : This consists in general means and local measures. There is 
no drug which can be looked upon as a specific, nor are there any means in 
our power to eliminate the disease when once it has attacked an individual; 
yet a great deal may be done at the onset if the disease is recognized suffi- 
ciently early. As a local remedy a solution of nitrate of silver should be 
thoroughly applied to the diseased surface of the throat, but not forcibly, so as 
to rub off' the membrane and cause bleeding to follow. Hydrochloric acid and 
honey have been used for a similar purpose. The patient must be put in a 
well-ventilated room, but free from draughts, and if the weather be cold there 
should be a fire in the room ; the air should be between 60° and 65° Fahr., 
and it may be kept moist by boiling water in a kettle on the fire and letting 
the steam pass into the room occasionally. Complete rest must be obtained, 
as there is always great prostration, and any exercise or movement on the part 
of the patient should be avoided, so as to store up all his strength. Milk may 
be given to the extent of three or four pints a day, and brandy can be mixed 
with it, if it is necessary. Beef-tea, chicken-broth, and eggs may also be 
given ; it is of no use giving solid food, as the patient will not care for it, and 
it will create pain in swallowing. The general treatment, in fact, is similar to 
that which has been laid down in the article on Fevers ; in this disease, how- 
ever, great care must be taken that the food is given in small quantities at a 



DIP 174 DIS 

time, and slowly, because, in consequence of the paralysis of the muscles of 
deglutition which often ensues, the act of swallowing is rendered dangerous. 
"Where there is much obstruction in the larynx the operation of tracheotomy 
may be resorted to, but this proceeding is attended with a very small amount 
of success, and is nearly always followed by a fatal result in very young chil- 
dren. When convalescence begins, the return to solid diet must be slow and 
gradual ; for many weeks the nutriment should be light and wholesome, and not 
too much should he taken at a time. As soon as the patient can be removed 
with safety, and without carrying infection to others, removal to country air 
or the sea-side is most beneficial. Cold bathing, tonic medicines, moderate 
exercise, even a sea voyage, are very valuable aids in restoring the health. 
Although this disease is not so communicable by the clothes as scarlet fever 
and some other disorders, yet it is always advisable that any articles of cloth- 
ing should be thoroughly disinfected before being worn again, and for this 
purpose they may be placed in an oven and exposed to a high temperature ; 
a similar remark will apply to the bedding, curtains, sheets, etc., of the room 
in which the patient has lain. When possible, the house in which the disease 
has broken out should be well cleansed and fumigated ; it may be kept empty 
for this purpose for a week or ten days, and chloride of lime may be sprinkled 
about the rooms on the floors. The great danger in diphtheria seems to be 
from inhaling the breath of an affected person ; therefore communication with 
other people should be avoided as far as possible, and this is most important 
in the case of children, who are very susceptible to this complaint. 

Dipsomania is the name given to that horrid craving for drink which is 
either developed or is innate in some men — more rarely in women. What- 
ever be its cause, whether brought on by a man's own doings, or, as some 
would have us believe, hereditary, the man who becomes the subject of dipso- 
mania is no longer a free agent, and he ought to be dealt with as such. It is 
terrible to see a man who has been brought up well, and whom you have 
known as a true gentleman, become from whatever cause a dipsomaniac. The 
man who was once the 'soul of honor becomes a liar, whose word you cannot 
for a moment trust. He was honorable in his dealings ; he becomes every- 
thing that is the reverse, and will not hesitate to steal to gratify his horrid 
appetite. This, indeed, is a consummation much to be desired, for if he does 
he can be locked up and cured ; if he is not locked up he will not be cured. 
If you take his money from him he will pawn his clothes; if you search the 
house every night, his cunning will defy you; he will get drink unless you lock 
him 11 p. and if you do so you do it at your peril. An action for false im- 
prisonment would lie, and you might be mulcted in ruinous damages. Yet, 
while you talk to them and are with them, these people are manageable ; it is 
only when they escape from your sight that they straightway go wrong. It 
would be possible to persuade some of them to give up their liberty for a time 
on the cliance of recovering, for they know their weakness ; meantime the 
law does not allow this, and without absolute control over such individuals 
any attempts at reformation are useless. 

Disinfectants are substances which are used to purify the air of those 
noxious products which emanate from persons in certain states of disease. It 
is supposed that when persons are suffering from various contagious disorders, 
as small-pox, scarlet fever, measles, typhus fever, diphtheria, certain particles 
emanate from them, and, passing into the air, carry the disease to other people. 
These germs which are floating about in the atmosphere may be easily carried 
to other localities, and set up fresh centres of disease. It is therefore very 



DIS 175 DIS 

important to use such measures as may be possible to destroy these germs, 
and so diminish the propagation of the disorder. In small-pox and the above- 
mentioned fevers it seems likely that the morbid products ;ire given off from 
the skin or in the expired air, while in cholera and typhoid fever the evacua- 
tions from the bowels are looked upon as the chief source of danger. Patients, 
as a rule, are more dangerous to others when the malady is subsiding, or dur- 
ing the convalescent period ; thus in scarlet fever, when a child's skin is peel- 
ing the disease is very liable to be propagated. Chlorine is one of the best 
disinfectants, and if the air of the room could be thoroughly charged with this 
gas all the poisonous particles would most likely be destroyed ; this cannot be 
well done because the gas is so irritating, and the same remark will apply to 
the use of nitrous and sulphurous acids ; nevertheless, when the room is empty 
and requires fumigating well, these gases can be used freely and with great 
benefit. In any case of fever, chloride of lime can be laid in saucers or shal- 
low dishes about the room, and then enough chlorine will be given off to pro- 
duce a faint smell of the gas in the apartment. Carbolic acid is perhaps as 
effectual, and not so disagreeable ; solutions of it diluted with water may be 
sprinkled about the room, or cloths dipped in the fluid may be hung up ; in 
other cases the powdered carbolate of lime may be placed near the patient. 
All these -disinfectants should be also placed outside the apartment, in the hall 
or on the staircase, and the hands of the attendants should be washed in weak 
carbolic acid (one part to two hundred of water) before they leave the sick- I 
room. In the case of cholera or typhoid fever, where the evacuations are 
looked upon as sources of disease, let the stools be at once disinfected by pour- 
ing a solution of carbolic acid over them (three large tablespoonfuls of the 
liquid carbolic acid to a gallon of water will suffice), and removed from the 
room. When a person is taken ill with any fever, he should be put to bed in 
a room with a fair amount of light, and furnished with proper means of ven- 
tilation ; let all the window-curtains, bed-curtains, and articles of ornament be 
removed, so as to lessen the danger of subsequent infection. A plain iron 
bedstead, with a rather hard mattress, or, if necessary, a water bed, is the best 
thing. The floor may be then sprinkled with carbolic acid, or saucers may be 
placed about containing it or chloride of lime. The stools, after being disin- 
fected, should be buried in dry earth, but not near a well, or anywhere where 
there is a chance of water becoming impregnated with the poison, and after- 
wards drunk by other people. The clothes should be thoroughly disinfected, 
as well as the bed linen, and for this purpose they should be exposed to a dry 
heat in an oven for some hours at a temperature of from 250° to 300° Fahr., 
and they may at the same time be fumigated by burning a little sulphur in 
the oven, so as to produce sulphurous acid. If this cannot be clone, let the 
clothes be hung out in an open space after being fumigated in a room ; or bed 
linen, etc., may be soaked in boiling water, having been previously dipped in 
a solution of chloride of lime (one gallon of strong solution of chloride of lime 
to about twenty-five or thirty gallons of water). See Fevers. 

Dislocation. By this term is usually meant displpcement of one or more 
bones and a separation, either partial or wide and complete, of those surfaces 
which are covered by cartilage or gristle, and in their natural condition re- 
main in close contact, forming a joint or articulation : thus, when the shoulder 
or elbow is said to have been ' k put out," there is a dislocation or separation of 
the upper extremity of the humerus from the shoulder-blade, and of the bones 
of the fore-arm from the lower end of the humerus or long single bone of the 
arm. Dislocation, or luxation, as it is technically called, is in most instances 



DIS 176 DIS 

caused by external violence, generally a fall. Now and then a joint which 
had previously been severely injured undergoes what is called spontaneous 
dislocation, the bones being 'suddenly displaced by rapid or excessive use of 
their muscles. This form of dislocation is occasionally met with in the shoulder 
and lower jaw. In some persons there is a tendency for the jaw to glide for- 
wards from its natural situation, whenever the mouth is widely opened, as with 
gaping and immoderate laughter. In most cases of dislocation caused by ex- 
ternal violence, the ligaments or sinews which fasten together the ends of bones 
forming joints are torn and stretched, and in many instances the skin is bruised 
and the soft parts about the joint are swollen and very painful. The most 
severe form of injury is that called by surgeons a compound dislocation ; here 
a deep wound is present, which extends from the surface of the injured region 
to the dislocated bone and leads directly into the joint. Simple dislocation at 
one of the joints of the arm or leg, when promjjtly and properly treated, is by 
no means so serious an accident as fracture in a similar situation, but when 
overlooked, and not reduced shortly after the accident, becomes a source of 
great and long-continued annoyance to the patient. The difficulty and pain 
attending the reduction of a dislocation bears a direct proportion to the dura- 
tion of the injury. In the great majority of cases of dislocation at a large 
joint, it is impossible after an interval of twelve hours to replace the separated 
bones without administering some anaesthetic. Dislocation is by no means so 
frequent an accident as fracture. The joint which is most prone to dislocation 
is the shoulder ; next in frequency are the hip, elbow, and ankle. Like all 
other injuries from great external violence, dislocation more frequently occurs 
with men than with women. It is occasionally complicated by fracture of one 
or more bones very close to the joint. This compound injury generally ren- 
ders the treatment of the dislocation very difficult, as the surgeon cannot apply 
any extension to the short terminal fragment. In children and young persons 
a peculiar injury is sometimes met with near a joint, which may be readily 
mistaken for a dislocation ; this is the injury called by surgeons " separation of 
epiphyses." Up to the age of sixteen or eighteen years, and in some instances 
beyond this, the long bones of the extremities are not single masses composed 
entirely of osseous tissue, but the joint ends are separated from the shafts by 
layers of a tough gristly structure, which as the individual approaches to adult 
age graduallv disappear, leaving the terminal portions and the intervening 
shaft to be 'converted into one long cylindrical bone. These remote and 
articular portions, before their fusion with the rest of the bone, are called 
epiphyses, and whilst in this condition may through external violence be de- 
tached from the shaft and displaced, thus producing the symptoms of disloca- 
tion or fracture. 

The symptoms indicative of a recent dislocation are : inability to move that 
part of the limb immediately below the seat of injury, the displaced extremity 
of the bone being fixed in its unnatural position ; pain in the. injured joint, 
which varies in intensity in different cases ; sometimes the displaced bone 
presses upon one or more large nerves, and then causes much suffering. Some 
swellings of the surrounding soft parts and bruising of the skin are generally 
present. Finally, but more important than any other sign, there is deformity 
in the joint ; this' can usually be recognized at the first glance : sometimes there 
is flattening, as in dislocation at the shoulder, and at other times well-marked 
unnatural prominence of one or more bones, as in the elbow and ankle. It 
should be borne in mind that all these symptoms are common to dislocation 
and to fracture near the joint-end of a bone ; but in fracture the segment of 



177 




Fig. xsxiv. 



Fig. xxxm 



PLATE VI. 



DIS 179 DIS 

bone below the injury is commonly very movable, and one may generally de- 
tect, on moving the broken parts, a peculiar grating noise, called by surgeons 
crepitus, which is felt rather than heard both by patient and medical attendant. 
In pure dislocation, this crepitus is absent. Another distinction between dis- 
location and fracture consists in this : when once the deformity attending the 
former injury has been removed by surgical manipulation, or setting of the 
joint as it is called, it does not return, as the head of the displaced bone when 
brought back into its socket remains there ; with fracture, on the other hand, 
there is a constant tendency for the fragments of bone to become displaced, 
until they are joined together by young bone in the course of the treatment. 
If the dislocation has been left unreduced for a week or ten days, it becomes 
necessary to place the patient thoroughly under the influence of an anaesthetic, 
for the purpose of relaxing the tense muscles which prevent the return of the 
displaced bone. In dislocation of six weeks' or two months' standing, the 
chances of a reduction will depend upon the situation of the injury. If the 
shoulder be affected, well-directed attempts under the influence of an anaesthetic 
will probably replace the head of the bone. With the hip, however, the 
chances of recovery are not so good at the end of a month after the receipt of 
the injury. After an interval of six months the case is generally hopeless ; 
the limb, however, does not remain immovable and quite useless: the head of 
the dislocated bone by it's pressure forms for itself a fresh socket in that por- 
tion of the adjacent bone on which it was thrown at the time of the accident ; 
fresh sinews are formed, the muscles adapt themselves to the altered state of 
things, and a new joint is formed which allows the patient considerable, though 
far from perfect, use of his arm or leg. This favorable process is carried on 
only in strong and healthy individuals. The surgical treatment of dislocation 
consists: in pulling at the part below the injured joint — extension; in keep- 
ing the parts immediately above the joint fixed — counter-extension ; and in 
endeavoring with the hand to elevate or replace the dislocated bone — manip- 
ulation. In recent cases of dislocation of the shoulder and elbow and of most 
smaller joints, a sufficient amount of extension may be obtained by the unaided 
efforts of the surgeon and one or two assistants ; but in recent displacement of 
the upper extremity of the thigh bone, and in most old dislocations of other 
joints, the pulleys are required. Counter-extension is generally kept up by 
means of a napkin, jack-towel, or folded table-cloth. The reduction of the 
bone is indicated by a sudden snap; the form of the joint and its functions are 
at once restored, and the pain is very much relieved ;* the whole limb also re- 
covers its natural length and position in relation to the rest of the body. The 
subsequent treatment consists in confining the limb for a period varying with 
the size and situation of the injured joint. In dislocation of the shoulder, the 
arm is bandaged to the side of the body for about two weeks, and in dislocation 
of the hip it is necessary for the patient to remain in bed for some time. The 
muscular power and general tone of the limb are restored by shampooing and 
friction, affusion of cold water, and the use of liniments. Recovery can never 
be complete, as the dislocated joint always remains weaker than any of the 
other sound joints. In a healthy and young or middle-aged subject, whose in- 
jury has been properly treated, this difference is scarcely appreciable, but in 
old people and those who are rheumatic or gouty the joint remains more or 
less stiff and painful, and is much affected during climatic changes and after 
exposure to cold and wet. In the following paragraphs a short sketch will be 
given of the symptoms and management of the most common forms of dislo- 
cation. 



DIS 180 DIS 

Dislocations of the Upper Extremity. Lower jaw. This bone when dislo- 
cated is carried forwards, and its front part is depressed so that the lower row 
of teeth projects beyond the middle teeth of the jaw above. The jaw is fixed 
in this position, and the mouth can not be closed, the cheeks are flattened, the 
tongue is slightly protruded, and the saliva flows over the lower lip and chin. 
There is generally severe pain below the ears. This dislocation may be pro- 
duced by opening the mouth very widely, as in yawning or attempting to masti- 
cate large pieces of food, or by a blow or fall upon the chin when the mouth 
is open. So long as the jaw is in this unnatural position the patient is unable 
to speak plainly or to swallow. Sometimes only one head of the bone is put 
out of place, and then the teeth are displaced laterally away from the seat of 
dislocation. AVhen surgical aid cannot be obtained, an attempt may be made to 
reduce this dislocation by placing the thumbs, protected by pieces of linen, over 
the last teeth on either side of the lower jaw, and, whilst depressing these teeth 
by raising the chin with the fingers, the jaw will then probably return with a 
sudden snap. When the dislocation occurs only on one side, one thumb only is 
to be placed on the corresponding molar teeth ; the jaw should then be kept in 
its place by a handkerchief or bandage, and the patient must for many weeks 
restrict as far as possible the movements of the bone, for the sake of avoiding 
a recurrence of the dislocation. 

Shoulder-joint. Dislocation occurs more frequently in this than in any 
other joint of the body. The usual causes of dislocation in this region are 
blows upon the shoulder or falls upon the elbow or hand. The head of the 
displaced arm-bone is most frequently forced downwards into the arm-pit, but 
may be carried inwards, forwards, or backwards. The following are the signs 
of a downward dislocation of the arm-bone: pain and loss of motion in the 
joint, slight elongation of the upper extremity, and tilting outwards of the el- 
bow ; the hollow of the arm-pit is occupied by a hard swelling, which moves 
with the rest of the arm, and can be felt distinctly to be the displaced extremity 
of the bone. In the absence of surgical aid, an attempt may be made to re- 
duce this dislocation by raising the injured arm from the side of the body, the 
patient being seated in a chair, and placing the knee in the arm-pit. and then 
gently depressing the arm over this, which should serve as a fulcrum. An- 
other method, which, however, is not so safe, is to place the heel, the boot hav- 
ing been removed, in the arm-pit, and to pull down the whole arm, the grasp 
being taken either at the wrist or just above the elbow. The patient must lie 
full length on a mattress. ' If any grating should be felt or heard on moving 
at the injured limb, these attempts ought not to be continued. Care should be 
taken to confine the injured arm in bandages for some weeks after the reduction. 

Elbow. Dislocations at this joint are common in children. The most fre- 
quent form is the displacement of the bones of the fore-arm backwards ; they 
are sometimes displaced to one or the other side, and, in some rare instances, 
forwards. The backward dislocation is usually caused by a fall on the palm 
of the hand. The following are the symptoms of this injury : The whole of 
the upper extremity appears to be shorter than its fellow ; the fore-arm is 
half bent and the thumb and outer surface of the wrist turned forwards ; at 
the back of the elbow there is a considerable hard projection formed by the dis- 
located upper extremity of the cubit; in front of the elbow the lower extrem- 
ity of the arm-bone is unnaturally prominent. Every attempt to bend or 
straighten the fore-arm causes acute pain. In lateral dislocation, which is al- 
ways partial, the nature of the injury is indicated by increased width of the el- 
bow, particularly in front, and by unnatural prominence of one or other of the 



DIS 181 DIS 

lateral projections at the lower extremity of the arm-bone. The lateral dislo- 
cation more frequently occurs outwards. The reduction of a recent disloca- 
tion at the elbow can generally be effected without much difficulty : the pa- 
tient having been placed in a chair, the surgeon, resting his foot on the seat, 
applies his knee to the front of the elbow; he then grasps the wrist and bends 
the fore-arm round his knee, taking care at the same time to press backwards 
the upper extremities of the bones of the fore-arm, in order to free them from 
the lower part of the single bone of the arm. If this method should not suc- 
ceed, an attempt may be made to reduce the bones by forcibly extending the 
fore-arm, whilst an assistant keeps up counter-extension by grasping the arm 
firmly above the elbow. 

Thumb. The first or metacarpal bone, which extends from the wrist towards 
the web of the digits, is sometimes dislocated either backwards or forwards at it 
upper extremity ; this, however, is a rare accident. The second and third bones 
are frequently dislocated backwards over the heads of the bones above, in 
consequence of falls upon the end or contracted surface of the thumb. Forward 
dislocations also occur, though very rarely. In dislocation of the second from 
the head of the first bone, the reduction in many instances may be readily per- 
formed, either by pulling out the end of the thumb, or by forcibly betiding the 
displaced portion backwards, and passing forwards the dislocated extremity of 
the second bone. When the injured thumb is short, or a firm grasp of it can- 
not be obtained for the fingers, a finger bandage or piece of broad tape may 
be tied round the thumb in a clove-hitch, and extension made with this. In 
some cases of the above dislocation, and in almost all cases of dislocation of 
the third bone of the thumb, reduction is extremely difficult, and before it can 
be effected it is often necessary to administer anaesthetics, and even to perform 
a cutting operation. Dislocations of the fingers are not so frequent as those of 
the thumb, which they resemble in their direction and indications for treatment. 

Dislocations of the Lower Extremity. Hip-joint. Dislocation occurs more 
frequently at this than at any other joint of the extremity. There are several 
varieties of dislocation at the hip-joint. The most common form is displacement 
of the head of the thigh-bone backwards and upwards upon the back of the 
large hip-bone. This injury is usually caused by the individual falling while 
bearing on his shoulders a heavy load, or by a fall of some large and heavy 
mass upon his shoulders whilst the body is bent forwards. The following are 
the symptoms : the injured limb is shortened to the extent of one inch and 
a half or two inches ; the knee is turned inwards and bent forwards ; the foot 
also is inverted, and the toes rest upon the upper surface of the sound foot ; the 
head of the thigh-bone forms an unnatural projection above and behind the 
situation of the hip-joint, and the natural roundness of this joint has disappeared. 
There are two methods of restoring the head of the thigh-bone to its socket, — 
by forcible traction, or by what is called manipulation. If the former method 
is to be tried, the patient is laid on his back upon a mattress, and a jack-towel 
is passed between the dislocated hip and the perineum, and fixed behind the 
patient's head, either to a bed-post or to a hook firmly screwed into the wall ; 
whilst counter-extension is kept up by this, traction is made on the thigh-bone 
by cords and pulleys fixed at one end to a staple in the wall in front of the 
patient, and at the other to a padded leather belt or long towel fastened around 
the lower part of the thigh, the knee being turned inwards and the whole thigh 
brought over the opposite limb. The surgeon sometimes endeavors to raise 
the displaced head of' the thigh-bone by means of a second jack-towel passed un- 
der the upper part of the thigh, and around the back of his neck and shoulders. 



DIS 182 DIS 

In reduction by manipulation, no pulleys or apparatus of any kind are required. 
The patient having been. put under the influence of an anaesthetic, the surgeon 
bends the knee and hip of the injured extremity to the utmost extent, then rolls 
the thigh-bone outwards, and finally abducts the thigh or forces it directly out- 
wards and away from the median line. In cases where reduction has not been 
effected, the range of movement becomes much increased, owing to the forma- 
tion of a new joint. The limb is of course shortened, and the patient must 
always limp, but with the aid of a thick sole to the boot worn on the injured 
side this inconvenience may be very much diminished. In dislocation for- 
wards and downwards the limb is lengthened to the extent of two inches or 
more ; the knee is bent'forwards and the whole limb is widely separated from its 
fellow; the body is bent forwards and slightly directed to the injured side; the 
foot is pointed forwards and downwards. This dislocation may be reduced by 
the pulleys, counter-extension being made as in the former injury by a jack- 
towel passed around the crutch. Extension of the limb having been made 
downwards and outwards, .the head of the bone should be pulled outwards by 
means of a towel applied round the upper part of the thigh. Dislocation for- 
wards and upwards happens when a person wdiile walking puts his foot into 
some unexpected hollow on the ground ; and his body being at the moment 
bent backwards, the head of the bone is thrown forwards upon the pubic bone. 
In this injury the foot is turned outwards and the whole limb separated from 
its fellow, rolled outwards, and shortened. In the groin can be felt a large 
hard mass, which is the displaced head of the thigh-bone. In the reduction of 
this dislocation the surgeon makes extension of the limb downwards and in a 
line behind the axis of the body, so that the thigh-bone may be dragged back- 
wards ; to effect this the surgeon places the patient near the edge of the bed 
or couch, so that the injured limb can hang down. 

Knee-joint. The leg may be displaced forwards, backwards, or to either side. 
The dislocation is nearly always partial, as might be expected from the extent 
of the opposed surfaces of the thigh-bone and the tibia, or larger bone of the 
leg. In lateral displacement the nature of the injury is apparent at first sight, 
in consequence of the unnatural projection of the inner or outer condyle of the 
thigh-bone. The leg is generally twisted upon its axis. These injuries are 
usually caused by violent and sudden twists of the knee, or by heavy blows. 
In the backward dislocation, the hollow at the back of the joint is occupied by 
the displaced head of the leg-bone. The dislocation forwards is associated with 
rupture of all the important ligaments of the knee and of some of the ham-string 
tendons. Reduction may be effected by extending the leg whilst the thigh is 
fixed by counter-extension. After reduction, cold should be applied to the 
injured knee, and the patient be kept in bed for about three weeks. 

Knee-cap. This bone may be displaced inwards, outwards, or upwards. In 
some cases, it is half twisted upon its axis, so that its outer or inner edge rests 
upon the front of the lower extremity of the thigh-bone. The most frequent 
injury is dislocation outwards : this, like the other varieties of dislocation, is 
generally caused either by a blow on the side of the knee, or by a sudden lateral 
movement of the body, made by the patient in order to avoid being knocked 
down by any passing object, or being run over. The bone may be either par- 
tially or completely displaced. In the dislocation edgeways, the knee-cap forms 
a very distinct unnatural prominence in front of the knee ; and its sharp edge, 
in most cases the outer one, can be felt immediately under the tense skin. A 
laterally displaced knee-cap may generally be restored to its proper position 
without difficulty by raising the limb high above the level of the body, and then 



DIS 183 DIS 

depressing the prominent edge of the dislocated bone. Sometimes the bone 
may be taken between the thumb and finger, and lifted into its proper place. 
A twisted knee-cap cannot be replaced so easily, and sometimes remains im- 
movably fixed. Reduction of this form of dislocation may be produced by 
bending the knee forcibly and suddenly ; or, if this does not succeed, by making 
the whole limb straight, and then pressing down the prominent edge of the bone. 
The subsequent pain and inflammation in the joint should be treated by keeping 
the knee at rest, and by applying ice or frequently renewed cold compresses. 
A person whilst walking sometimes strikes the everted foot against some hard 
projecting object, and immediately feels an acute pain in the knee, which pre- 
vents him from walking. After the accident the knee begins to swell. In 
cases of this kind, there is dislocation of the semilunar cartilages, two flat 
gristly structures of a horse-shoe shape, which are fixed to the margins of the 
upper surface of the leg-bone. Reduction may be readily effected by first 
extending the leg upon the thigh, and then suddenly bending it backwards until 
the heel touches the corresponding buttock ; the other hand of the surgeon being 
placed at the same time upon the front of the knee. This dislocation is very 
apt to return, and for this reason the patient should, when he takes exercise, 
wear a bandage or tight knee-cap. 

Ankle-joint.. Dislocation at this joint is generally associated with the fracture 
of one or both bones of the leg. The uncomplicated dislocations are those in 
which the foot is moved forwards, or its upper part driven upwards, between 
the two bones of the leg. Both these injuries are extremely rare. In those 
dislocations which are complicated with fracture, the foot may be dislocated 
outwards, inwards, or backwards. In the first and third class of cases, the. 
slender outer bone of the leg is generally broken, and in the second class both 
bones across their lower ends. In simple dislocation of the foot forwards or 
upwards, an attempt may be made to bring about reduction by grasping the 
instep of the injured foot with one hand and the heel with the other, and making 
extension, whilst the leg is kept steady by an assistant. In the complicated 
dislocations, the chief object of treatment will be to reduce the fracture, and to 
retain the foot in its proper position by splints until the bones are set. The 
astragalus, an irregularly shaped bone which articulates with the lower surfaces 
of the bones of the leg, is sometimes thrown forwards upon the upper surface 
of the foot, and forms there a hard prominent tumor. This, if it cannot be 
reduced by forcibly extending the foot whilst the patient is anaesthetized, may 
give rise to much local mischief, and the formation of abscesses, which will ne- 
cessitate its removal by a surgical operation. 

Dispensaries are institutions founded and kept up by charitable people in 
New York, and other large towns, for the relief of the poor. They differ from 
hospitals in not having beds for in-patients, and in the fact that out-patients are 
visited at their homes by the physicians and surgeons, or by the resident medical 
officer. Out-patients attend also for advice at the dispensary at certain fixed 
times, and for this they must, in the first place, obtain permission from the 
proper authority. In some parts of the country efforts have been made of late 
years to establish " provident dispensaries," where the patients, instead of be- 
ing seen free, pay a small sum for medical attendance, but as yet they have 
not come into general use. 

Dissection Wounds. Under this heading we may conveniently class not 
only such poisoned wounds as are encountered by those professionally engaged 
in the examination of dead bodies, but such as are frequently met with in indi- 
viduals who may be in any way exposed to contact with decaying or putrescent 



DIS 184 DIS 

animal matter introduced into the system by some local wound or abrasion. 
During the decomposition of animal matter, substances are formed which liave 
a most deleterious effect if introduced into the blood of a living animal. When 
the patient suffers from the effects of inhalation of such poison only, he ex- 
hibits symptoms of sickness, diarrhoea, or dyspepsia, and the poison is quickly 
eliminated by change of air, stimulants, or aperients. Where the poison is 
inoculated, the symptoms are severe, and the result is frequently fatal, owing 
to lymphatic inflammation, with diffuse cellular inflammation, followed by 
pyaemia. The most dangerous cases are those in which the subject dissected 
has died recently of erysipelas, puerperal fever, or pyaemia. In dissecting- 
rooms, after a puncture or scratch, there is rarely any great danger of more 
than a local sore, unless the operator is in a low state of general health. It is 
not usually the severe wound which infects, but it is from some insidious scratch 
or abrasion, which has existed perhaps some time, and has been so small as to 
pass unheeded. The symptoms manifest themselves perhaps six or eighteen 
hours after, when the patient begins to feel unwell, depressed, sick, shivery, 
with severe headache and a sharp, rapid pulse. Supposing a finger to be the 
seat of inoculation, pain and tenderness in the shoulder perhaps at first directs 
his attention to his case; afterwards there is severe pain and swelling in the 
aim-pit. and upon examination there will be seen red, regular lines along the 
fore and upper arms, proceeding from the seat of inoculation towards the arm- 
pit, indicating the course of the lymphatics. Abscess forms after a while, per- 
haps, accompanied with diffuse suppuration of the surrounding areolar tissue. 
There is always intense constitutional disturbance. Sometimes the influence 
of the morbid poison is so virulent that the patient dies of the precursory fever 
before sufficient time has elapsed for any local disease to appear ; sometimes 
diffused cellular abscesses occur in remote parts, such as the knee or hip ; some- 
times diffused inflammation commences at the seat of injury and extends up the 
arm, accompanied by cutaneous erysipelas. With regard to the treatment, 
diaphoretics and diuretics should be maintained till elimination of the poison 
seems to be complete; afterwards tonics, fresh air, and exercise. In more ur- 
gent cases, calomel and opium are frequently beneficial ; after suppuration has 
been freely established, iron, bark and ammonia are indicated; all abscesses 
should be opened at once. Thirst should be quenched by effervescent drinks ; 
beef-tea, wine, or brandy should be given to support the pulse. In very severe 
cases doses of quinine and mineral acids are of great service; locally, hot 
fomentations, poultices to the inflamed and swollen axilla or elbow, and free 
incision as soon as any decided swelling with softening be detected. 

Distilled Spirits are made by distilling alcohol from some of the various 
forms of fermented liquor in which it exists. Distilled spirit is not, however, 
pure alcohol, but contains varying quantities of water. A spirit having a 
density of 920, water being 1000, is called proof spirit in this country, and 
when distilled spirits contain more or less alcohol than this they are said to 
be under or above proof. The most common forms of distilled spirits which 
are used in this country are brandy, gin, rum, and whisky. Brandy is dis- 
tilled from wine, and its peculiar flavor is produced by the addition of peach 
kernels to the liquid whilst distilling. It also contains oenanthic and acetic 
ethers. Gin is obtained from fermented grain, to which the berries of the 
juniper are added to give a flavor. Other flavoring substances are used, such 
as ciunamon, cloves, etc. Rum is procured from fermented sugar and mo- 
lasses in the West Indies. Whisky is principally distilled from fermented 
grain. Many other distilled spirits are drunk in various parts of the world. 



DIS 185 DRA 

Arrack is made in the East from rice or from betel nuts, or the sap of various 
species of palm. Liqueurs are also alcohol distilled with various substances to 
give it a flavor, and large quantities of sugar are also added. The favorite 
liquor of the French is absinthe, which is a spirit distilled from wormwood. 
Spirits are made from all fruits containing sugar, as apples, oranges, pears, 
artichokes, maize, and other things. Honey is capable of vinous fermentation, 
and a beverage called mead is made from it. Proof spirit is used for making 
tinctures. Sometimes vegetable substances are added to proof spirit and then 
distilled. Such preparations are called spirits in the Pharmacopoeias. 

Distilled Water. See Water. 

Diuresis implies an excessive flow of urine. 

Diuretics are medicines which increase the flow of urine, whether directly 
or indirectly. The flow of urine may be increased in various ways : thus, in 
disease of the heart, by strengthening the action of that organ, as is done by 
digitalis. But there are certain substances which seem to act directly on the 
kidney, and to stimulate it in such a way as to give rise to a free flow of urine. 
Such are cantharides and turpentine. Juniper, too, acts in this way. We may 
also foster the flow of urine by introducing certain salts into the system, such 
as citrate and acetate of potass, cream of tartar, etc. One of the most efficient 
and most readily obtainable diuretics is broom. The tops are boiled and the 
fluid used. This, combined with cream of tartar and juniper or gin, willoften 
be found to be -an efficient and harmless remedy in cases of dropsy depending 
on heart disease. Alcohol itself is diuretic, and a glass of beer will often pro- 
duce a copious flow of urine. 

Dizziness. See Vertigo. 

Donovan's Solution. This title was given to a valuable combination of 
arsenic, iodine, and mercury. It was found to be of special value in the treat- 
ment of skin diseases connected with syphilis, but not limited to these. It has 
fallen greatly out of practice, and it is not now contained in the Pharmaco- 
poeia. Ten to twenty drops were given for a dose. 

Douche signifies a stream of hot or cold water which is poured over the 
body ; it is used in the ordinary process of shampooing, and sometimes it is 
ordered as a remedial agent, as in cases of chorea and hysteria. 

Dover's Powder, known in the Pharmacopoeia as Compound Ipecacuanha 
Powder, contains ipecacuanha, opium, and sulphate of potass, a grain of each 
of the two former in every ten. Ten grains is the usual full dose. It is a 
powerful diaphoretic. It does not agree with everybody, and at all times it is 
advisable to take precautions against cold after its use. In the feverish stage 
of a common cold, this remedy is particularly valuable, and frequently cuts 
short the malady. When the patient is cold and shivery, but the skin hot and 
the nose stuffed, ten grains of the powder at bed-time, putting the feet in hot 
water at the same time, and promptly getting covered over with the bed-clothes 
will commonly induce a profuse sweat, and will probably greatly benefit the 
patient. A cold sponge is advisable next morning, and the bowels must be 
seen to if confined. 

Dracunculus, or Guinea Worm, is an animal parasite which burrows in 
the skin of the legs or feet in Guinea and other parts of Africa. See Ectozoa. 

Dragon's Blood. The common name of an Indian plant (Pterocarpus 
draco), from which exudes a red-colored resin, once used in medicine as an 
astringent, but now only employed to color tooth-powder, or by French pol- 
ishers to give a deep color to their wood. 

Drainage Tube. This is an india-rubber tube about one-sixth of an inch 



DRA 186 DRO 

in diameter, perforated at frequent intervals. This is introduced iuto a sinus 
or abscess, so as to allow of the matter passing through these openings into the 
tube continuously. The tube should be introduced on an eyed probe, by tying 
it to it with a piece of thread. A counter-opening in the abscess is generally 
made, and the tube passed through both. 

Drain Fever. See Typhoid Fever. 

Drastics. This name is given to purgatives whose action is somewhat 
violent; such are elaterium, gamboge, jalap, scammony, and the like. They 
should never be used except by medical advice. To do good in consumption, 
these remedies should be as gentle as is consistent with the fulfillment of their 
object. 

Dress. See Clothing. 

Dropped Wrist is an affection met with amongst painters, and others who 
work much with lead : it consists in paralysis and wasting of the muscles of 
the arm ; the result of which is that the patient cannot raise the hand when 
the palm is looking downwards. See Lead Poisoning. 

Dropsy is a term applied to any accumulation or effusion of fluid under the 
skin or in a cavity of the body, occurring in diseases of the heart, liver, lungs, 
or kidneys. Sometimes the legs only are swollen ; at other times the abdomen 
becomes swollen to a very great size, and when the breathing becomes im- 
paired the operation of tapping and drawing off the fluid may be had recourse 
to. Dropsy affects the most dependent parts, and hence the legs are more 
swollen at night after walking about. When the dropsy is all over the body 
it is called Anasarca ; when limited to one part, it is spoken of as (Edema of 
that part ; when in the abdominal cavity it is called Ascites ; in the cavity of 
the chest, Hydroihorax; when in the cranial cavity the name Hydrocephalus 
is applied. Under these headings a more detailed account will be given. 

Drowning. This is a frequent form of violent death. In a case of pure 
drowning the individual at first sinks to a certain depth and then ascends to 
the surface of the water, where, if he be not a good swimmer, he struggles to 
clear his lungs and mouth, and to obtain fresh air. As water is generally 
taken in with the inspired air the patient sinks again for a short distance, and 
then by his exertions again succeeds in reaching the surface. These strug- 
gles are repeated until the lungs and stomach are filled with water, and the 
general specific gravity of the body is thereby increased. The body then 
sinks to the bottom. The duration of this contest for life will vary accord- 
ing to the sex, age, strength, and general condition of the individual. Fat 
persons float more readily than those who have large bones without any un- 
usual amount of adipose tissue. Women and children float longer than adult 
males, their skeletons being smaller and the fat more abundant. After the 
final submersion the dying individual still endeavors to breathe, and the re- 
maining portion of air is forced out from the lungs by the entrance of more 
water, and rises in bubbles. Death is preceded by convulsive movements of 
the extremities, the patient having by this time become unconscious and insen- 
sible. According to Dv. Taylor, who accidentally experienced all the phe- 
nomena of drowning up to this point, " there is not the least sensation of pain, 
and as in other cases of asphyxia, if the individual recover, there is a total un- 
consciousness of suffering during the period when the access of air was cut off 
from the lungs." The cause of death in cases like the above is apnoea or suf- 
focation. When the air no longer enters the lungs, the venous blood which 
passes through these organs is not fitted, in the absence of oxygen which alters 
dark and venous into bright red and arterial blood, to keep up the nutrition of 



DRO 187 DRO 

the various organs of the body. This arrest in nutrition is indicated by un- 
consciousness and convulsions, by palsy of the muscles, including those of 
respiration, cessation of the action of the lungs, and, finally, stoppage of the 
heart's movement. In cases of drowning, however, death is not always due 
to simple apnoea. Strong individuals, who struggle much at the surface of the 
water, and make violent muscular efforts to save themselves, die as much from 
exhaustion as from suffocation. Weak and delicate individuals, on the other 
hand, may die from syncope, shock, or sheer fright. Again, in diseased or 
aged people, cold and intense mental excitement may cause apoplexy or ar- 
rest of the action of a disordered heart. In consequence of the body falling 
upon some hard mass before it reaches the water, apnoea may be complicated 
by concussion or compression of the brain, or severe injury of some other im- 
portant organ. The question as to how long a human being may be sub- 
merged, and yet be recoverable, has not yet been clearly settled. According 
to the officers of the Humane Society, persons who have been under water for 
more than four or five minutes do not generally recover. But on the other 
hand cases have been reported in which recovery took place after submeision 
lasting for fourteen minutes, and even half an hour. According to Dr. Taylor, 
however, the recorded cases of restoration after submersion of half an hour 
and upwards are to be regarded as " extravagant fables." The following are 
the appearances generally presented by a body which has been recovered 
shortly after death by drowning : The surface of the body cold and of a 
white color, mottled here and there by large patches of lividity ; the face also 
pallid; the jaws closed and the lips and nostrils covered by a frothy foam; 
the tongue swollen, but not protruded ; the eyes half open and the upper lids 
livid and somewhat swollen ; the knees and elbows bent ; the hands clenched, 
and mud or sand, and sometimes portions of weed, found included in their 
grasp ; the skin of the fingers is sometimes excoriated, and mud or sand is 
found underneath the nails. The stomach and air-passages and sometimes the 
lungs contain much water. The vessels of the lungs are engorged with black 
fluid blood. All the important internal organs are much congested. The right 
side of the heart contains much more blood than the left side. In a body 
that has been in the water for a long time, general putrefaction has taken place. 
The skin where not covered by clothes is of green or blue color, and the face 
much swollen and distorted. The gases formed by putrefaction and decom- 
position of the tissues collect and render the body lighter than its bulk of 
water, so that it rises to the surface and floats there. The period at which the 
drowned body rises varies according to the depth of the water, the character 
of the water, whether it be salt or fresh, and its temperature. In inquiries 
as to how a body found in water came to its death, — whether in the first place 
it was due or not to drowning, and next whether in the former case the drown- 
ing was accidental, suicidal, or homicidal, — great importance is attached to the 
presence or absence of the following post-mortem appearances : excoriations 
of the fingers ; sand or mud under the nails ; portions of water-plants or mud 
grasped in the hand; a rough and contracted skin — the so-called goose-skin ; 
water in the stomach, especially when this contains plants, duckweed, and 
other substances resembling those which exist in the water from which the 
body has been taken ; froth on the mouth and nostrils ; mucous froth contain- 
ing mud or sand in the air-passages ; water in the lungs. The circumstances 
attending the death cannot very readily be determined, and the questions as to 
whether it was accidental or intentional, and whether it was the result of sui- 
cide or homicide, are extremely difficult to answer. When there are no marks 



DRO 188 DRO 

of violence upon the surface of the body, this point cannot be considered by a 
medical man, and must be decided upon other evidence. When marks of in- 
jury are present, it has to be considered whether these might not have been 
caused by the fall of the individual against some hard substance at the time of 
immersion, or by the rubbing of the body against sharp and hard obstacles 
after death, or, if the marks be such as to indicate intentional infliction before 
immersion, whether these were such as would be inflicted by one intending 
suicide. 

Treatment of the Apparently Droicned. The following very useful direc- 
tions have been published by the National Lifeboat Institution : — 

" I. Send immediately for medical assistance, blankets, and dry clothing, 
but proceed to treat the patient instantly on the spot, in the open air, with the 
face downward, whether on shore or afloat, exposing the face, neck, and chest 
to the wind, except in severe weather, and removing all tight clothing from 
the neck and chest, especially the braces. The points to be aimed at are, 
first and immediately, the restoration of breathing ; and secondly, after breath- 
ing is restored, the promotion of warmth and circulation. 

" II. To restore Breathing. To clear the Throat. Place the patient on the 
floor or ground with the face downwards, and one of the arms under the fore- 
head, in which position all fluids will more readily escape by the mouth, and 
the tongue itself will fall forward, leaving the entrance into the windpipe free. 
Assist this operation by wiping and cleansing the mouth. If satisfactory 
breathing commences, use the treatment described below to promote warmth. 
If there be only slight breathing, or no breathing, or if the breathing fail, 
then turn the patient well and instantly on the side, supporting the head, and 
excite the nostrils with snuff, hartshorn, and smelling-salts, or tickle the throat 
with a feather, etc., if the)' are at hand. Rub the chest and face warm, and 
dash cold water, or cold and hot water alternately, on them. If there be no 
success, lose not a moment, but instantly imitate breathing. To imitate breath- 
ing, replace the patient on the face, raising and supporting the chest well on 
a folded coat or other article of dress. Turn the body very gently on the side 
and a little beyond, and then briskly on the face, back again, repeating these 
measures cautiously, efficiently, and perseveringly, about fifteen times in the 
minute, or once every four or five seconds, occasionally varying the side. (By 
placing the patient on the chest, the ivcig/it of the body forces the air out ; when 
turned on the side this pressure is removed, and air enters the chest.) On each 
occasion that the body is replaced on its face make uniform but efficient press- 
ure with brisk movement on the back between and below the shoulder-blades 
or bones on each side, removing the pressure immediately before turning the 
body on the side. During the whole of the operations let one person attend 
solely to the movements of the head and of the arm placed under it. The 
result is respiration or natural breathing, and if not too late, life. Whilst the 
above operations are being proceeded with, dry the hands and feet, aud as 
soon as dry blankets or clothing can be procured strip the body, and cover or 
gradually reclothe it, but taking care not to interfere with the efforts to restore 
breathing. 

" III. Should these efforts not prove successful in the course of from two to 
five minutes, proceed to imitate breathing by Dr. Silvester's method, as fol- 
lows : Place the head on the back on a flat surface inclined a little upwards 
from the feet; raise and support the head and shoulders on a small firm cush- 
ion or folded article of dress placed under the shoulder-blades. Draw forward 
the patient's tongue, and keep it projecting beyond the lips, — an elastic band 



DRO 189 DRU 

over tlie tongue and under the chin will answer the purpose, or a piece of 
string or tape may he tied around them, or by raising the lower jaw the teeth 
may be made to retain the tongue in that position, — and remove all tight 
clothing from about the neck and chest, especially the braces. To imitate the 
movements of breathing : Standing at the patient's head, grasp the arms just 
above the elbows, and draw the arms gently and steadily upwards above the 
head, and keep them stretched upwards for two seconds. (By this means air is 
drawn into the lungs.) Then turn down the patient's arms, and press them 
gently and firmly for two seconds against the sides of the chest. (By this 
means air is pressed out of the lungs.) Repeat these measures alternate]}', 
deliberately, and perseveringly, about fifteen times in a minute, until a spon- 
taneous effort to respire is perceived, immediately upon which cease to imitate 
the movements of breathing, and proceed to induce circulation and ivarmth. 

" IV. Treatment after Natural Breathing has been Restored. To promote 
warmth and circulation, commence rubbing the limbs upwards, with firm grasp- 
ing pressure and energy, using handkerchiefs, flannels, etc. (By this measure 
the blood is propelled along the veins towards the heart ) The friction must 
be continued under the blanket or over the dry clothing. Promote the 
warmth of the body by the application of hot flannels, bottles or bladders of 
hot water, heated bricks, etc., to the pit of the stomach, the arm-pits, between 
the thighs, and to the soles of the feet. On the restoration of life, a tea- 
spoonful of warm water should be given, and then, if the power of swallow- 
ing have returned, small quantities of wine, warm brandy and water, or coffee 
should be administered. The patient should be kept in bed, and a disposition 
to sleep encouraged. 

" General Observations. The above treatment should be persevered in 
for some hours, as it is an erroneous opinion that persons are irrecoverable 
because life does not soon make its appearance, persons having been restored 
after persevering for many hours. 

" Cautions. Prevent unnecessary crowding of persons round the body, 
especially if in an apartment. Avoid rough usage, and do not allow the body 
to remain on the back unless the tongue is secured. Under no circumstance 
hold the body up by the feet. On no account place the body in a warm bath 
unless under medical direction, and even then it should only be employed as a 
momentary excitant." 

Drowsiness is a symptom which naturally precedes sleep ; it is often the 
forerunner of serious mischief in those who are the subjects of Bright's dis- 
ease. It occurs also as a result of living in an overcrowded or badly venti- 
lated room, in consequence of an accumulation of carbonic acid gas ; it pre- 
cedes the fatal stupor of those who are frozen to death in the snow. 

Drunkenness. Alcohol, when swallowed, is speedily absorbed by the 
veins of the stomach and mixed with the blood, and then, by its poisonous 
action on the brain, spinal cord, and nerve trunks, produces the symptoms of 
acute alcoholism or drunkenness. In mild cases, the pulse becomes rapid, the 
face hot and flushed, and the eyes bloodshot ; if more drink be taken, there is 
confusion of intellect and partial paralysis of the voluntary muscles, and the 
drinker feels giddy, reels, and experiences more or less difficulty in articulat- 
ing properly, as the muscles of the tongue become paralyzed ; he becomes 
maudlin and afterwards noisy and delirious, and finally sinks gradually into a 
state of deep stupor. On the following day there is general prostration, with 
nausea and occasional vomiting. In fatal cases of poisoning by alcohol, the 
state of stupor passes into one of true coma ; the drinker becomes quite un- 



DRU 190 DRU 

conscious and insensible, and cannot move ; respiration ceases, and finally the 
action of the heart is arrested. In cases of death from large quantities of al- 
cohol, the patient speedily passes into a state of marked coma, which is some- 
times accompanied with convulsions. The intensity and character of the 
symptoms of alcoholic poisoning, and the rapidity with which thejr come on, 
vary much in different persons, even when about the same quantity of alcohol 
has been taken by each. The more concentrated the spirit, the more rapidly 
is drunkenness produced. The speedy absorption of alcohol into the blood is 
favored by an absence of food from the stomach. When much alcohol is 
taken on a full stomach, the ordinary symptoms of drunkenness are associated 
with excessive vomiting. The mental symptoms, such as noisy talk, senti- 
mental and maudlin utterances, and delirium, vary according to the character 
of the individual. "When excessive drinking is combined with the consumption 
of strong tobacco or cigars, drunkenness comes on quickly, and is indicated by 
much reeling, much mental confusion, and vomiting. During the state of 
drunkenness, alcohol is present in the urine and sweat, and the odor of the 
spirit or wine which has been taken is very perceptible in the breath. The 
action of alcohol on the nervous system is indicated by the double vision, the 
difficulty of articulation, the partial palsy of the muscles of the lower ex- 
tremities, and the mental condition of the individual. Drunkenness may be 
produced by inspiring the concentrated vapor of alcohol. Persons employed 
in large wine-cellars, and who have been occupied for many hours in bottling 
spirits, and also anatomists, who have been engaged in the dissection of speci- 
mens preserved in strong alcohol, may be readily intoxicated by the spirituous 
Vapor. Consideration of the predisposing causes of alcoholism will render 
evident the hopelessness of all attempts by mild or ordinary legislative means 
to reduce the consumption of stimulants so widely prevalent in this country. 
General education and increased wages to the laboring classes, with an amel- 
ioration in their moral and hygienic conditions, will no doubt produce vast 
improvement in this portion of the community, in respect to the diminution of 
drunkenness ; but still the occupations, both mental and bodily, of those who 
are the typical representatives of a highly civilized and commercial nation, 
necessitating, as they do, excessive energy and intense mental excitement aud 
mental tension, which are invariably followed by nervous exhaustion and de- 
pression, must induce, in many instances, a craving for stimulants. Excessive 
indulgence in alcohol prevails amongst those persons whose occupation ex- 
poses them to constant temptation, and also amongst those who follow fatigu- 
ing occupations, and are exposed to cold and wet and the inclemencies of 
weather : amongst brewers' draymen, potmen, cab-drivers, watermen, and 
fishermen cases of drunkenness are very frequent. Poverty, serious disap- 
pointments in life, and pecuniary embarrassments are all predisposing causes 
of alcoholism. Monotony of occupation is also another frequent predisposing 
cause. Finally, we meet with those unfortunate persons whose tendency to 
indulge in alcohol has been caused by an inherited morbid condition of the 
nervous system. The diagnosis of advanced alcoholic intoxication is a ques- 
tion of great difficulty and importance, and has been much discussed of late 
in consequence of the increasing number of those unfortunate instances in 
which persons have been confined in police-cells whilst in a state of insensi- 
bility due to other and perhaps fatal conditions, such as cerebral apoplexy, 
concussion from an injury to the head,. compression of the brain from fracture 
of cranium or traumatic intracranial haemorrhage, opium-poisoning, or uraemic 
poisoning from disease of the kidney. A medical man, when asked to give 



DRY 191 DYS 

an opinion on a case of this kind, has to pass over in his mind the character- 
istic symptoms of each of the above affections. If the face be flushed, and 
the conjunctivae red and swollen, if the breath smell strongly of liquor, and 
if the man, when aroused, supposing it is possible to do so, talks maudlin 
or sentimental nonsense, the case is clearly one of drunkenness. If the face 
be pale, the surface of the body cold, the pupils contracted, and if the patient, 
when aroused, speaks but a few words, and then relapses into a state of un- 
consciousness, the case is considered to be one of concussion. If the breath- 
ing be stertorous, the face drawn on one side, the pupils dilated, one or more 
limbs paralyzed, and the patient in a state of confirmed coma, perfectly uu- 
conscious and insensible, the case will probably be regarded as one of cere- 
bral compression, due either to apoplexy or to injury. In a doubtful case, 
the medical man would endeavor to draw off some urine from the bladder by 
means of a catheter, and then if he found, on boiling this urine, or on adding 
to it a few drops of strong nitric acid, that there was a dense white and cloudy 
deposit, he would probably assume, in the absence of any other cause for the 
state of insensibility, that the patient was suffering from the effects of uraemic 
poisoning. It should be remembered, however, that although the insensible 
person may have been drinking freely, and that a strong odor of alcohol in 
the breath is most unmistakable, the insensibility may not be the direct effect 
of the drunkenness. He may have had a fall and injured his head ; fatal in- 
juries to the brain may occur without any external signs, save a slight graze 
or bruise of the scalp. Apoplexy may have occurred whilst the man was in a 
state of intoxication. Again, a person not very intoxicated may be rendered 
insensible by exposure to cold and wet. And finally, it must be remembered 
that the symptoms of cerebral concussion or compression may be marked by 
the peculiar symptoms of alcoholic intoxication. 

Dry Cupping. See Cupping. 

Dulcamara, better known perhaps by its English name, which is synony- 
mous with that just given, bitter-sweet (Solanum dulcamara), is a remedy 
of very doubtful value. It has been commended for certain forms of skin dis- 
ease, especially those of a scaly nature, but most probably it has no real in- 
fluence over them. 

Dulcamarine is an extract, not a true proximate principle, obtained from 
the twigs of bitter-sweet. 

Dumb Ague. See Intermittent Fevetc. 

Dumbness is usually associated with deafness, and but few instances are 
met with where it is not so. Occasionally, however, there is some congenital 
malformation of the organs of speech, which prevents the power of articula- 
tion, and in rare instances it is recorded as arising from the entire neglect in 
childhood of exercising the function. There has recently been a system intro- 
duced by which the dumbness consequent on deafness is overcome, and the 
deaf person is made to articulate sounds by aid of sight. 

Dura Mater, a thick fibrous membrane, which lines the skull and spinal 
column, and forms a covering for the brain and spinal cord. 

Dysentery — which is an inflammatory affection of the great gut, giving 
rise to ulceration, mucous and blood stools, straining, and much pain — is well 
known and very fatal. It generally appears among soldiers after long ex- 
posure to wet in low districts with insufficient food. It always tends to make 
its appearance in marshy districts where malaria prevails. It generally begins 
with some uneasiness and griping pains in the abdomen, and there is much 
desire to go to stool. At first this gives relief, but by and by no relief fol- 



DYS 192 DYS 

lows, so then the patient seems to desire to sit on the stool constantly. What 
comes away consists at first of badly-formed motions, but by and by they be- 
come more scanty, then mucous and even bloody, sometimes mixed up with 
small hard masses called scybalce. The desire continues to increase ; the at- 
tempt to gratify the desire increases the pain ; the stools alter more and more, 
becoming bloody, fetid, and with shreds of membrane in them ; sometimes, 
too, there is purulent matter. The urine is frequently voided, and is generally 
high-colored and scalding. There is at the same time more or less fever, and 
there is great restlessness and sometimes cramps. The tongue is furred and 
dry ; the pulse small and quick ; great thirst and complete loss of appetite. Per- 
haps these gradually abate, the purging and straining become less frequent, and 
the rest in the intervals is more complete ; gradually the patient gets better, but 
his bowels remain in a troubled state for a long time to come. Sometimes, on 
the other hand, and this is especially the case where the malady is epidemic, 
the patient gets worse, the bowels become inflated and the abdomen tender, 
the tongue becomes dry and glazed, or aphthae form on it and the insides of 
the cheeks. The evacuations are exceedingly offensive and passed under the 
patient; the whole body has a corpse-like odor, coma conies on, and death 
soon follows. Very frequently in warm countries, or in epidemics, dysentery 
is complicated by ulcers of the liver. Sometimes the ulcerations perforate the 
gut and set up peritonitis, or the gut may mortify. In warm countries, too, the 
disease may become chronic, and the nutrition of the body is so sadly inter- 
fered with that the patient wastes away. The bowels continue during this time 
very irregular, and the discharges most offensive. Very much may be done by 
treatment, especially when the disease is not epidemic. The diet should be 
scanty but nutritious, hot poultices or cold compresses applied to the abdomen, 
and strict rest enjoined. It is desirable to remove all hardened fasces which 
may set up irritation, and for this purpose nothing suits so well, or gives the 
bowels so much relief, as copious injections of warm and very thin gruel. 
These having been removed, a totally different plan must be adopted : no more 
copious injections, but enemata of an ounce or two of starch, containing thirty 
drops of the liquid extract of opium. This may be repeated if necessary. At 
the same time it is desirable to give internally lull doses of ipecacuanha, con- 
sisting of not less than from thirty to sixty grains, in any form which may be 
deemed desirable. It may be repeated in six hours if necessary. If the pa- 
tient gets over this, another kind of treatment must begin. Tonics must be 
given carefully, the bowels attended to, and every sign of relapse closely 
watched. The diet must then be nourishing but not bulky. Remedies may 
be given to prevent the contents of the bowels from putrefying, such as sul- 
phate or hyposulphate of soda, or sulphocarbolate of soda, or carbolic acid. 
If dysentery become chronic, change of climate is important, a mild and agree- 
able atmosphere doing great good. 

Dysmenorrhcea, or difficult menstruation, affects more especially women 
who are nervous, or of a rheumatic and gouty tendency. It may occur at any 
time in the child-bearing period of life, and affects both the married and the 
single. The pain is felt in the lower part of the abdomen on each side, just 
above the groin and in the region of the ovaries ; pain is also felt in the back 
and in the womb itself; it is generally most severe a day or two before the 
" period " comes on, and is relieved when the flow takes place. Between the 
different times, the patient may enjoy good health. In some the pain is due 
to neuralgia of the ovaries or uterus, and in such cases, medicines containing 
quinine are useful, and bromide of potassium is a valuable sedative. In others 



DYS 193 DYS 

the pain is due to the vessels of the part being too full of blood, and when the 
congestion is relieved great benefit ensues ; a hot hip bath and leeches applied 
to the neck of the womb, or to the abdomen over the seat of the pain, will give 
relief. During the interval the general health should be looked to ; if able to 
bear it, moderate exercise every day in the open air should be ordered ; if too 
feeble, a carriage drive may be taken. Avoidance of late hours, of over-work 
in close and confined rooms, a generous and wholesome diet, with an occasional 
aperient, will aid in curing this disease. 

Dyspepsia. See Indigestion. 

Dysphagia, or difficulty of swallowing, generally arises from one or other 
of two causes, — obstruction of the gullet (which see), or defect in its innerva- 
tion. It may also be hysterical. If hysterical, the best remedy is the inter- 
rupted galvanic current. 

Dyspnoea, or shortness of breath, is a symptom often met with in many 
diseases. It occurs naturally after running fast, and is due to the altei'ation, 
for the time being, in the quantity of blood passing through the lungs, and the 
amount of air entering the chest. In emphysema, chronic bronchitis, and in 
almost all diseases of the lungs, larynx and trachea, difficulty of breathing oc- 
curs as a symptom ; in many cases of kidney and heart disease it is almost 
always met with. It comes on when the patient makes any exertion, or on 
exposure to cold air, as going out on a raw foggy morning, and sometimes it 
will make the patient wake suddenly from his sleep, and forms then what is 
commonly called an asthmatic attack. Rest in bed, in a room with, moist air, 
of the temperature of 65° to 70° Fahr., is to be recommended when the patient 
is very much troubled in this way ; avoidance of cold air must be insured ; in 
some cases a respirator is advisable. During an attack, much relief may 
ensue from taking an expectorant mixture containing ether and ammonia and 
squills. When there is hydrothorax or oedema of the lung, brought about 
either by kidney or heart disease, less air can enter the lungs, and dyspnoea 
must be more or less present, and the space in the chest is further encroached 
upon by the increased size of the heart usually found in these cases. When 
the dyspnoea comes on in consequence of a foreign body, as a marble or a coin, 
getting into the larynx or windpipe, surgical means must at once be resorted 
to, and when it is due to inflammation of that tube, as in cases of croup or 
diphtheria, special remedies must be used, appropriate to the treatment of 
those diseases. (See Croup, Diphtheiua.) Finally, an aneurism of the 
aorta may cause dyspucea by pressing on the windpipe, or setting up a spasm 
of the epiglottis by pressing on the nerve supplying that part of the windpipe ; 
but little can be done in such cases. Orthopnoea is another term employed 
when the dyspnoea is such as to prevent a patient from lying down in bed. 

Dysuria, a pain or difficulty in passing urine, may arise from a great va- 
riety of causes, some connected with disease of the organs concerned, others 
arising from altered conditions of the fluid itself; stone, stricture, inflamma- 
tion of the bladder and urinary passages, are all important causes, and to 
these the reader is referred. Alterations in the urine giving rise to dysuria 
are commonly excessive acidity or the presence of calculi, either of which ma)' 
give rise to great irritation and a tendency to pass water, without, however, 
bringing any away. Albuminuria also gives rise to something of the same 
kind, the patient frequently emptying his bladder. Sometimes there is a kind 
of neuralgic pain connected with urination, which gives rise to much discom- 
fort. If the pain arises from acidity, alkalies will speedily relieve it ; if due 
to spasms, a pipe of tobacco is perhaps the best remedy. 
13 



EAR 194 BAR 



E. 

Ear, Diseases of. The affections of the organs of hearing may be re- 
ferred to those three chief portions of which it consists, thus: (1.) The af- 
fections of the External Ear, or Auricle. (2.) Those of the Middle Ear, or 
Tympanum. (3.) Those of the Internal Ear, or Labyrinth. 

(1.) Affections of the Auricle. The auricle is subject to severe 
cutaneous affections, the most important being chronic erysipelas and chronic 
eczema. In chronic erysipelas the ear becomes greatly swollen, its skin is dry, 
red, and covered with epithelial scales, with derangement of general health. 
The treatment consists in cleanliness and free exposure to the air. If the in- 
flammation is considerable, poultices are of use, and an astringent lotion should 
be applied. Glycerine is a valuable application. In chronic eczema the auricle 
is considerably swollen, and covered with yellow crusts, exuding fluid. The 
meatus, or passage, must be w. 11 syringed out with warm water, to prevent 
the accumulation of discharge, and the ear itself bathed with some astringent 
solution, or with glycerine. The scabs are to be removed by poulticing. 

Gout affects the external ear, and is a common cause of deafness. The 
treatment is the same as that for gout in other parts of the body. See 
Gout. 

Tumors are frequently met with. For example, enlargement or hyper- 
trophy of the lobes, frequently met with in women who wear heavy ear-rings, 
cystic, fibrous, and malignant tumors, all requiring surgical interference. 

The external meatus, or passage, is liable to accumulation of the cerumen or 
the natural wax, and deafness is frequently due to this condition. When de- 
tected it should be removed by syringing. The water injected should be 
warm. The ear should be plugged with cotton wool after the operation is 
complete, for a day or two. If the wax be very hard and firm, a few drops 
of oil introduced for a few nights will facilitate its dislodgment. In syring- 
ing the ear the nozzle of the syringe should be placed at right angles to the 
side of the head, and pressing the tragus (the eminence over the opening) for- 
wards. Small abscesses or boils often form in the meatus, causing intense 
pain. Hot poultices and fomentations applied to the ear give great relief, and 
in severe cases free purges and leeching may be advisable. The constitutional 
treatment consists in the administration of tonics, of which iron is of the most 
value. This external meatus is very frequently the seat of inflammation, 
which may either be acute or chronic. In acute inflammation there is at first 
a dull aching pain, enlargement of the glands of the neck, and impairment of 
hearing, followed perhaps by a discharge of mucus, or muco-pus, and con- 
siderable derangement of the health. Syringing the passage with warm water 
gives great relief ; hot fomentations and poultices and the internal administra- 
tion of morphia are useful ; all exposure to draughts should be carefully 
avoided, and the general health attended to. The chronic form is generally a 
sequel to the foregoing, and is often caused by prolonged bathing and neglect 
in drying the hair; weak astringent lotions, such as a weak solution of acetate 
of lead or of nitrate of silver, are of great use. In children this complaint is 
invariably associated with derangement of the health, and quinine, cod-liver 
oil, and iron are indicated. 

Polypi. These growths may form anywhere in the passage, and not un- 
frequently on the membrane : one form soft, pulpy, and vascular, and the other 



EAR 195 EAR 

firm and fleshy. They cause deafness, and set up an offensive discharge. The 
treatment consists in their removal. 

Foreign bodies. See Foreign Bodies in Ear. 

(2.) Affections of the Tympanum. The Membrane of the Ear (see 
Hearing) is liable to both injury and disease. Rupture may occur from a 
variety of causes, such as the introduction of foreign bodies, a blow, sudden 
deafening noises, violent syringing, with improper introduction of the syringe 
(vide supra), violent blowing of the nose, vomiting, coughing, etc. The 
symptoms are slight pain, generally a little bleeding, and perhaps impairment 
of hearing, although this condition is not necessary. Inflammation of the* 
membrana tympani may be acute or chronic, a consequence of cold, gout, 
scrofula, or syphilis. The symptoms are pain, itching, and slight deafness. 
Ulceration may take place, and perforation of the membrane ensue. It is to 
be treated with reference to its cause ; beyond this the treatment is the same as 
that for inflammation of the external meatus. Perforation of this membrane 
may occur after ulceration of its substance from internal inflammation ; the 
diagnosis of this perforation is easy. In the first place, it can be detected by 
a speculum ; again, the patient, by closing the mouth and nostrils, can blow 
air (if the Eustachian tube be not obstructed) through it ; and the patient is 
moreover somewhat deaf. If possible, attempts must be made to close the 
orifice by the application, in slight cases, of lunar caustic to the edges of the 
wound, or by the introduction of cotton wool, or by the artificial membrana 
tympani. At first this apparatus should only be worn for an hour or two, and 
always removed on retiring to rest. Occasionally the hearing becomes re- 
established after it has been worn for some time. The Eustachian tube, or 
passage of communication between the middle ear and the pharynx, is liable 
to several forms of disease, obstruction, and a permanently open condition. 
The cavity of the tympanum is liable to severe inflammation, arising from 
cold, scrofula, or a sequence of scarlet fever. Tlie usual symptoms of this 
condition are discomfort in swallowing or blowing the nose, headache, and 
intense pain in the ear, and more or less deafness. The constitutional symp- 
toms are severe, and in adults delirium is present, and convulsions in children. 
These conditions terminate either in resolution, or by the formation of ab- 
scesses. Salines should be given, if due to gout or rheumatism, colchicum, or 
iodide of potass. Locally, steam, poppy-head fomentations, linseed, onion, or 
garlic poultice, and small blisters behind the ear. 

(3.) Affections of the Internal Ear. The function of hearing may 
be impaired, or completely destroyed by the results of the severer diseases of 
the middle ear, when suppuration has followed either of them. The auditory 
nerve, which is found lying within the labyrinth, is subject to functional dis- 
eases, causing what is termed nervous deafness. True neuralgia has been 
described as occurring occasionally. Earache, or otalgia, a neuralgic affec- 
tion, occurring in fits of excruciating pain, darting over the head and face, is 
generally caused by bad teeth. It may be partly relieved by syringing the 
ear out with warm water, to which a little laudanum has been added — say, 
twenty drops to a wineglass of water. Hot fomentations should be applied to 
the ear, or tincture of aconite or belladonna painted behind the auricle. The 
state of the bowels is to be carefully attended to, and free action obtained by 
purgatives. 

Earth Closets are contrivances recently introduced for superseding 
water closets, particularly in country places. In them, instead of pulling the 
handle and allowing a flood of water to sweep away all matter from the pan 



EAU 196 ECT 

into the sewer, the same handle allows, from a hopper, a quantity of dry earth 
to fall and cover the evacuations. The dry earth completely prevents any 
smell arising from them, and apparently prevents all further decomposition. 
After a time the accumulated matters may be removed, and constitute a valu- 
able manure. Only one or two precautions are necessary to make them work 
well. Fluid excretions should, as far as possible, be kept apart from solid 
excreta, and the earth used should be well dried before use. Imperfectly 
burned wood ashes, mixed with ordinary loam dried, makes the best kind of 
earth to use. Sand does not suit well. 

Eau de Cologne is a much-esteemed perfume, which derives its name 
from the city where it is so largely manufactured. It is a distillation in alco- 
hol of various sweet-scented substances, and is most refreshing and grateful as 
an application in cases of headache and exhaustion. 

Ecchymosis. See Bruises. 

Echinococcus is the name given to the parasite found in hydatid cysts, 
and when occurring in man the echinococci are developed from the tape-worm 
of the dog. See Hydatids. 

Eclampsia. See Puerperal Convulsions. 

Ecraseur. This is an instrument that has been devised for the purpose 
of removing tumors by a combined process of crushing and tearing. Its use 
is attended with much less bleeding than that of the surgeon's knife, and for 
this reason it has been applied w.ith success to cancer of the tongue, internal 
piles, and other vascular growths. It consists of a chain mounted upon a 
metallic staff, and arranged above in a loop, which can be tightened by work- 
ing a handle. There are various forms of ecraseur, some large and very for- 
midable, others consisting of a single fine wire. 

Ecstasy, a peculiar form of intense nervous and emotional excitement. 
See Catalepsy. 

Ecthyma is the name given to a skin disease. It consists of large, circu- 
lar, raised pustules, surrounded by a livid purplish zone. They occur gener- 
ally on the extremities, and are always isolated; the fingers and legs are very 
common seats of the eruption. If the pustule is pricked, an unhealthy 
greenish-colored fluid exudes, and a scab forms; then in about three weeks 
this scab falls off, and leaves no ulcer beneath, but simply a red scar. It 
mostly occurs in children, and especially when, from any cause, they are in a 
debilitated condition, as after recovery from measles or scarlet fever, or from 
bad living. Plain but wholesome diet, with fresh air and exercise, will im- 
prove the general condition ; while steel wine taken internally, and zinc oint- 
ment applied to the spots, will generally complete a cure. An occasional 
aperient may be recnured. Care should be taken that the child does not 
knock the pustule or scratch the head off. 

Ectozoa are animal parasites which have their "habitat" on the surface 
of the human body. The following are the most common varieties which are 
met with : — 

(1.) The a car us, or itch-insect. There are two kinds, male and female; 
the latter burrows in the epidermis, and there deposits the ova. They are 
generally found amongst very dirty and poor people, and occur on the front of 
the fore-arm, and very often between the fingers, also on the trunk, but rarely 
above the shoulders or below the knees. The male is about a third smaller 
than the female. He has suckers on two of his hind feet, and possesses on the 
abdominal surface genital organs, all of which characters are absent in the 
female. The female, besides being much larger, is characterized by three 



ECT 197 ECT 

kinds of horny spines which are scattered over the back. By means of the 
suckers, or ambulacra, they have powers of locomotion, while witli their man- 
dibles they are enabled to cut through the epidermis and extract fluid from the 
tissues. The female seldom leaves her burrow except at night ; when dis- 
turbed by scratching, they crawl with great rapidity over the skin, and read- 
ily pass from one person to another, so that the complaint is easily caught. 
Great itching accompanies the presence of these insects. Although the dis- 
ease is extremely troublesome, it is easily cured. An ointment composed of 
sulphur and lard well mixed together should be thoroughly rubbed in every 
night until the skin which is rubbed feels a \yarm glow, and the next morning 
the patient should be well washed in hot water with coarse soap and a flesh- 
brush. This method, if repeated three or four mornings properly, will gen- 
erally effectually cure. Every night the person should be wrapped in an old 
shirt, which can be destroyed as soon as the disease is cured. 

(2.) Pediculi, or lice. Of these there are different kinds. Some are found 
on the hair of the head, and chiefly at the back part ; they are of a pale drab 
color, and much longer than they are broad ; they crawl about in the hair, and 
deposit their ova on the hair by means of a gummy kind of substance. At 
first these ova are close to the root of the hair ; but as the hair grows they 
may be found an inch or two off the skin ; but by that time the ova have es- 
caped, and only left the empty sac in which they lay attached to the hair ; 
these sacs with their contents are commonly called "nits." They give rise to 
great itching. The best treatment is to cut off the hair as close as possible, 
aud rub in every night for three or four nights some white precipitate oint- 
ment; this should be done, however, with care. A solution of carbolic acid 
(one part of the acid to sixty parts of water) will kill all the lice, but not the 
ova. Others are found in the hair of the genitals, to which the names of crab- 
louse and " crabs " have been given. They are much smaller than the former, 
and are nearly square. In other respects they are very similar, and the treat- 
ment is the same. 

(3.) The harvest-bug, which often attacks people when walking through a 
stubble field in the autumn ; it is a small red insect, which causes intolerable 
itching. 

(4.) In the West Indies a most troublesome creature is the chigoe, or Pulex 
penetrans. It penetrates the skin, and there lays its eggs, producing, in con- 
sequence, an irritable sore. See Chigoe. 

(5.) The Filaria medinensis, or Guinea worm, is a long, thin worm, several 
inches in length, which enters the skin of the legs ; it is supposed to enter 
from the waters of the rivers, and is met with in the legs of those who have 
been occupied in boats where water has lain at the bottom, or on the backs of 
those who have been employed in carrying water. The natives extract them by 
twisting one end round a small piece of stick, and the rest of the worm is grad- 
ually coiled out. Care should be taken that the worm is not broken during the 
process. The common flea and the bug both affect man, and live by sucking 
animal juices through the skin ; but as they lay no eggs, and are only tempo- 
rary occupants, they are not generally included under the ectoz^a. 

Ectropion. This name has been given to eversion or turning outwards of 
the eyelid. It may be temporary or permanent. Temporary ectropion is 
most frequently due to acute inflammation, with much thickening of the con- 
junctiva, the smooth, glistening membrane covering the surface of the eyeball, 
and reflected.on to the inner surfaces of the lids. It is generally met with, how- 
ever, as a permanent and progressive affection, when it may have originated 



ECZ 198 ECZ 

in one of the following conditions : slow and prolonged inflammation of the 
eyelid, destruction of the skin of the cheek and eyelid due to ulceration, 
a thick, shrinking scar on the cheek resulting from an ahscess or from dis- 
eased jaw, the presence of scars produced hy burns or scalds. This condition 
is frequently met with in scrofulous children. In these it is generally very ex- 
tensive, and causes much eversion of one or more eyelids. The lower is more 
frequently affected than the upper lid. Ectropion in its severe forms produces 
much disfigurement, and finally, if not relieved, opacity of the cornea and 
blindness. The surface of the eyeball being no longer completely protected 
against dust, etc., there is much irritation and inflammation of the conjunctiva, 
which membrane, especially that part of it which is exposed by the eversion 
and stretching of the affected lid, becomes roughened and of a bright red 
color. In some cases of ectropion from burns, the lid is not only turned out- 
wards, but has been partially destroyed. In cases of chronic inflammation of 
the eyelids the eversion is usually slight. Temporary ectropion, which is 
often met with in the severe purulent ophthalmia of newly-born children, dis- 
appears spontaneously as the inflammation of the eye subsides. Permanent 
eversion is a very difficult affection to deal with, and can be relieved only by 
some surgical operation. In cases of chronic inflammation of the eyelids, and 
during the healing of burns and large ulcers on the cheeks, much may be 
done towards preventing eversion. The eye should be covered by cotton 
wool, and the light kept out ; and, in the latter case, the patient should be 
told to keep his lids closed as far as possible until the ulcer has healed. 

Eczema is a skin eruption of very common occurrence. It is non-conta- 
gious, and is characterized by the presence of minute vesicles hardly seen 
without a lens. These spots may terminate by the fluid in the vesicles being 
reabsorbed, or excoriations may form, which leave a raw red surface, from 
which a watery liquid oozes ; as the liquid dries it forms dirty scabs on the 
affected part, which present a very loathsome appearance. It may be pro- 
duced in a great many ways. Heat may cause it, and then it is called eczema 
solare, or heat spot. Contact with irritating substances will produce it, and 
so it is found among grocers, affecting the hands of those who deal much in 
sugar; potboys are, from a similar cause, very liable to it. It sometimes 
occurs in those engaged in working with quicksilver, or in those who have 
taken an undue amount of mercury. The eruption begins usually on the 
groins and thighs ; it is commonly produced in the flexures or folds of the skin 
in fat and dropsical people. The skin at first is red, and is accompanied by 
heat and tingling ; it is apt to extend very rapidly, but although the surface 
affected may be large, yet the disease does not go below the skin itself. On 
this red, angry-looking skin numbers of minute glittering vesicles soon appear, 
and these vesicles are due to a very small portion of the epidermis being 
raised up by a little serum or watery fluid beneath ; at first they are clear and 
almost pellucid, but the contents become opaque, and under favorable circum- 
stances dry up ; more often these little vesicles burst, and the fluid escapes 
and dries up into gummy masses on the surface ; in doing this it entangles 
any dust or dirt that may be present, and thus forms large, ugly-looking 
scabs ; this takes place when the part is neglected, for with proper care such 
scabs should not be allowed to form. In children it runs a course similar to 
what it does in the adult. Owing to their delicate condition, any disturbance 
of the constitution is liable to cause the appearance of this rash, especially in 
those who are at all strumous. In infants, after birth, a red rash often ap- 
pears, merely from the irritation of the air or clothes on the tender skin : this 



ECZ 199 ECZ 

is well known under the common name of red gum ; it is easily cured by 
washing the surface with warm water and using zinc ointment. After vacci- 
nation eczema often appears, and it is owing to this in a great measure that so 
much prejudice is felt against vaccination ; now, this operation, simple as it is, 
and valuable as it is in its result in preserving humanity from small-pox, can- 
not be done without some slight disturbance of the constitution, and tlien this 
disease often appears ; amongst the ignorant and the filthy the rash soon 
spreads, and forms dirty, fetid scabs, which lead people to imagine that their 
children are suffering from some horrible and dangerous disorder. No popu- 
lar prejudice can be more unfounded, as eczema is in nearly all cases curable 
by a little care and cleanliness, and it is in no degree attended by danger. 
Teething is another cause, and here again the irritation and febrile disturbance 
brought about by that process act in a similar way to the above. Fat chil- 
dren often have this eruption in the folds of the chin, beneath the knees, in 
the bend of the elbow, and very often in the nates or round the buttocks ; this 
is generally due to the irritation caused by the passage of the excretions, and 
to a want of due cleanliness and proper changing of linen. The head in chil- 
dren is a very common seat of eczema ; it begins on the scalp in the usual 
way, and comes behind the ears, leaving angry red places from which oozes 
moisture. This disease often comes on after a child is recovering from measles 
or scarlet fever ; it is met after an attack of chicken-pock, glass-pock, and is 
often due to the child scratching the vesicles and so irritating them. In the 
disease known as itch, eczema appears sometimes, being produced artificially 
by the scratching of the skin. A very common cause of eczema in the head 
of children is the presence of pediculi or lice. 

Treatment: In most cases the following treatment will suffice: Smear on 
the part some simple olive oil, so as to soften the crusts, and then lay on at 
bed-time a hot linseed-meal poultice, so as to cover the part well. In the 
morning most of the scabs will be removed and a great deal of the dirt, while 
a moist red surface will be left, and if the process be not repeated it will soon 
scab over again ; washing with soap is of no use, as it only further irritates 
the skin ; let cleanliness be kept up carefully by oiling and washing. If the 
rash should be in a part where it is difficult to keep on a poultice, it is just as 
good to wash the part with oatmeal and hot water, instead of poulticing. 
When the surface is in this way cleaned, let zinc ointment be applied all over 
the sore. A child in a filthy state, and covered with scabs, may thus in a day 
or two, with care, make great progress. When itch is present, the remedy for 
that must be used; both diseases cause itching, but the itch does not affect the 
head ; it comes on the body and airnis, and between the fingers, and is, more- 
over, very catching. When lice are present, let the head be shaved, or the 
hair cut as close as possible at once ; no head can be cured without, and the 
cure is far more rapid ; then white precipitate ointment should be smeared all 
over, which effectually kills these creatures ; then a poultice may be applied, 
and if this be done every night for a week, a cure will soon result. For 
adults, and especially for old people, this ointment must be used in small quan- 
tities and with caution, as sometimes serious results occur ; in children it is 
borne very well. At the same time, the patient should live on plain, whole- 
some diet, take exercise every day, and the bowels should be opened moder- 
ately. Children are often much benefited by taking steel wine for a few 
.weeks. It is important to know that while the great majority of cases are 
thus easily cured, yet the disease is very liable to recur, and in a few obstinate 
cases seems to defy all treatment. In some scrofulous children the disease will 



EFF 200 EGG 

break out in some part or other, the skin at first looking rough, dry, and shiny, 
as if it were too tight over the part, then it becomes moist and goes through the 
usual stages. Relief may be afforded for a time, and the child may grow out 
of it. but such cases are very troublesome. 

Eczema of the leg is often met with in aged people, and in those who suf- 
fer from varicose veins and ulcers. There are two typical forms of eczema in 
this situation, namely, the acute and the chronic. In the former, the affection 
comes on quickly and is very painful. The skin is of a bright red color and 
very tense. Upon this inflamed portion of skin minute blebs are formed 
which contain a transparent fluid. As the inflammation subsides, these blebs 
either dry up and form thin scales, or their contained fluid increases in amount 
and becomes thick and milky like pus, causing much irritation to the skin, and 
finally drying and forming thick yellow or brown scabs. The severe symp- 
toms of acute eczema subside in the course of five or six days, and then the 
affection either disappears altogether, or, as most frequently happens, it passes 
into the chronic form. Here the skin is less painful and inflamed, and there 
is less " weeping," or discharge, of thin fluid from the affected surface. The 
chronic form of eczema is a troublesome and obstinate affection, and is gener- 
ally attended with much itching. Eczema occasionally attacks the nipples. 
Like other forms of acute eczema, this is attended with much pain. It attacks 
women at all periods of life, most frequently girls who have just reached the 
age of puberty. The chronic form is very troublesome and obstinate. Eczema 
in the lower extremities of persons troubled with varicose veins may be pre- 
vented by the use of bandages or an elastic stocking, cold bathing, and by 
avoiding as far as possible much standing or walking. The treatment of acute 
and severe eczema, whether in the legs or on the nipples, consists in administer- 
ing saline purgatives, and by applying some warmed Goulard water mixed with 
a small quantity of laudanum. For chronic eczema tonic medicine is gener- 
ally indicated, and also warm baths. The inflamed parts should be frequently 
washed with simple water or with bran-water. Soap should not be used. The 
skin around the inflamed patch should also be well washed with weak spirits of 
wine, and then carefully wiped. The following are some of the lotions most 
frequently applied to chronic eczema : bicarbonate of soda dissolved in water; 
nitrate of silver dissolved in water, with the addition of some sweet spirits of 
nitre ; a mixture of tannin and glycerine ; bichloride of mercury, proof spirit, 
and water ; lime-water ; borax and glycerine. 

Effervescing Draughts are often very useful and pleasant in febrile at- 
tacks. They can be made from any of the vegetable acids and an alkali. 
To a tumbler of water the following proportions are sufficient: bicarbonate 
of potash, 2 scruples ; tartaric acid, 25 grains : or, carbonate of soda, ^ 
drachm ; tartaric acid, i- drachm. Add a teaspoonful of capillaire, or any 
syrup, and you have a pleasant draught. 

Effusion is the pouring out of any fluid either into a cavity or the cellular 
tissue of the body. An effusion may be of blood or serum, which is called 
water, Thus, we have in the first case apoplexy, if the effusion be of blood 
on the brain ; or water on the brain, if of serum. Likewise on the chest, effu- 
sion causes either congestion or water, as the case maybe. Effusiou also may 
take place in the joints, or between the skin and muscles. 

Eggs of Birds are very nutritious articles of food ; they contain as much 
oil and flesh-forming matter as butcher's meat. They enter into the composi- 
tion of puddings, cakes, buns, and other forms of diet. They are also eaten 
alone, boiled, or fried, and are most digestible when least done. The egg of 



EGY 201 ELE 

the domestic fowl is usually eaten, but those of other birds are frequently 
used. All birds' eggs may be eaten with impunity. The average weight of a 
hen's egg, shell and all, is about 2 ounces. The following is the composition 
of 100 parts of the white and yolk of hens' eggs : — 

WHITE. TOLK. 

Water 85.0 Water 53.28 

Albumen 12 Albumen 17.47 

Extractive matter 2.7 Oil or fat 28.75 

Salts 0.3 Salts 50 

100 1C0.00 

Eggs are found most useful and nutritious as articles of diet in the sick-room. 
They are used for mixing with castor oil, turpentine, and other strong medi- 
cines, to render them more palatable ; also for making mulled brandy and 
wine. A most nutritious and agreeable drink may be made for invalids, con- 
sisting of sherry or brandy beaten up with raw eggs and sweetened with sugar. 
Eggs may also be given mixed with Liebig's extract of meat. 

Egyptian Ophthalmia. See Ophthalmia. 

Elaterium is the sediment which falls from the expressed juice of the 
squirting gourd, or wild cucumber. This plant grows wild in Southern 
Europe, but is cultivated elsewhere. When ripe it ejects its seeds, hence its 
name. The juice is set aside after expression, and the sediment is allowed to 
strain on a linen cloth, after which it is dried on a porous brick. The drug is 
an exceedingly powerful one, one-eighth of a grain acting as a strong drastic 
purgative, carrying off much fluid. It accordingly requires to be cautiously 
given, and should never be employed if there is a tendency to irritation of the 
bowels. It often causes nausea and sickness, and sometimes gives rise to con- 
siderable pain. Its great value is in dropsical accumulations of fluid, as in 
heart disease, when it is usually combined with a few grains of compound ex- 
tract of colocvnth, causing an immense drain of water. It should, however, 
not be used for too long a period continuously. Belladonna is a good thing 
to give along with it. 

Elaterine or Momordicine is the active principle found in elaterium. 
Its dose is about a quarter that of elaterium. 

Elder Flowers. The water distilled from off these flowers is sometimes 
used as a vehicle for more powerful medicines. The inner bark of the tree 
acts as a hydragogue cathartic, and has been used with success in the treatment 
of dropsies in the form of decoction. 

Electricity or Galvanism is an exceedingly powerful remedial agent, the 
exact value 'of which we are only now beginning to appreciate. There are 
three kinds of electricity in use : first, the so-called static variety, which is 
obtained by rubbing a glass plate or cylinder. This is also called Franklin's 
electricity, from its discoverer, Franklin. The most important variety of elec- 
tricity to us is that called dynamic, or current electricity, and of this there are 
two kinds, namely, that which passes in a continuous current from one pole 
of the battery to the other, and that which is called interrupted, which is 
a kind of to-ancl-fro current ; the last is also called an induced current, and as 
its properties were first investigated by Faraday, it has received his name. It 
would be impossible to enter into full details as to the mode in which these 
forces are developed ; briefly, the main points are these : Suppose a plate of 
copper and a plate of zinc are introduced into a vessel containing diluted oil 
of vitriol ; if now a copper wire be so placed as to touch both of these, active 



ELE 202 ELE 

change will be set up in the fluid, and an electric or galvanic current will he 
set up in the fluid from the zinc to the copper, and out of the fluid by means 
of the wire from the copper to the zinc. This is the continuous current, and 
if the pair of plates be multiplied, so will the force increase. Moreover, if 
two wires are used instead of one, and any portion of the body be introduced 
between the two, the current will pass through the body so as to go from one 
wire to another, and its effects on the body will be made manifest. It is to be 
noted that the effects are only noticeable when the circuit between the metals 
which give rise to the current is complete ; when the circuit is broken there 
is no current. But suppose the current to be made to pass through a piece of 
soft iron, this will be affected like the wires, readily conducting the electricity 
from one wire to another. If now, however, a coil of thin wire be made to 
surround the soft metal, so as not to touch either it or itself, through the coil 
of wire will pass a stream of electric force whenever the circuit is opened or 
shut ; that is to say, whenever either of the wires is made to remove from or 
to touch the iron centre piece. When the wires touch, the circuit is closed, and 
the current passes from the copper to the zinc, as usual, but if removed it can no 
longer pass, and the iron remains unelectrified. The wire coil does not touch 
the centre, and so the current is said to be induced ; it only passes on opening 
and closing the circuit, that is, interrupting the current; hence it is also called 
an interrupted current ; but it is plain these interruptions occur in both the 
original circuit and the induced current, so that in reality both are interrupted, 
though only one is induced. The so-called magneto-electric machines, which 
are turned by hand, are related to the last mode of developing electricity, in- 
asmuch as by them electric currents are induced by a permanent magnet of 
the ordinary horse-shoe form, against which two coils of soft wire are made to 
revolve. Each of these in turn is magnetized as it approaches an extremity 
of the horse-shoe, and in this way a current of an interrupted kind is set up. 
It would not be possible to give in this short space full details of the kind of 
cases in which the several forms of electricity may prove or have proved use- 
ful. In the first place, they may be applied either locally or generally ; that is 
to say, to some one spot or part of the body, or to the whole body. If applied 
to one definite part, the influence would naturally be to a great extent limited 
to that part, but if to the whole body a kind of tonic rather than any distinct 
or specific effect would be anticipated. The mass of force, however gener- 
ated, of many pairs of plates is likely to exceed in certain powers those of at 
most one or two wires, however intensified. Hence it is more powerful in 
overcoming resistance, in reaching parts at a distance from the surface. It 
also possesses the power of causing muscles to contract, on opening and clos- 
ing its circuit, in certain instances when induced electricity altogether fails. 
Above all, it^ possesses much greater chemical and heating power than the 
other, so much so that care must at all times be taken that these are not man- 
ifested at inopportune times and seasons. The induced current is much more 
convenient and manageable ; and briefly we shall point to two most important 
sets of cases where electricity does good. First in neuralgia, especially of the 
face. This most intractable and painful malady sometimes yields in a most 
surprising manner to the use of electricity, and especially to the continuous 
current, though cures sometimes do better with the interrupted one. In facial 
palsy, too. where the muscles are so wasted as to be unable to respond to the 
interrupted current, prompt contraction follows the application of the contin- 
uous one. In ordinary cases of paralysis one great object, at all events, is to 
keep the muscles properly nourished until the nervous system of what has suf- 



ELB 203 EMB 

feral damage has had time to be repaired. One form of loss of voice con- 
nected with hysteria is promptly cured by the interrupted current. In certain 
forms of paralysis connected with syphilis the continuous current is most useful. 
As to instruments, the best continuous and constant current battery is some 
modification of Daniel l's battery ; that in common use in hospitals is such an 
one, invented by Muirhead. Stohrer's continuous current batteries are also 
in use. The interrupted current battery now almost invariably employed in 
England is one by Stohrer, of Dresden. 

Electuaries are certain forms of remedies into which sugar or honey 
largely enters. They are much the same as confections, and two of them at 
least are very valuable remedies. There are confection of sulphur and con- 
fection of senna, both sometimes called electuaries ; both are valuable laxatives, 
the former especially useful to those troubled with piles, the latter as a means 
of administering a good but nauseous remedy to children. 

Elemi is a kind of resin, with properties allied to turpentine, which is im- 
ported from the East. Its ointment is sometimes employed in sluggish sores. 
It is not given internally. 

Elephantiasis is the name given to a condition where limbs swell to 
enormous proportions from no very definite cause, and remain permanently in 
that elephantine condition. In it the skin and subjacent tissues are greatly 
thickened and increased in density, but the muscles are destroyed or altered 
for the worse rather than increased in strength. Most frequently it attacks 
the lower extremities, sometimes the upper, less frequently other parts of the 
body. The skin is the part most affected ; it becomes of a brawny thickness. 
All kinds of remedies have been tried, but success has not been great. In 
India such a growth frequently attacks the scrotum, causing it to assume the 
most portentous proportions. For this, as for the other, removal seems the 
best remedy, and should not be too long deferred, or the health may suffer 
irretrievable damage. 

Elixir is an Arabic word, signifying strength. At one time it was a favorite 
name for medicines supposed to be particularly efficacious, and where the in- 
gredients were almost entirely dissolved in the menstruum, making it thicker 
than a tincture. There were then all sorts of elixirs sold, but at present we 
find in the shops only elixir of vitriol and paregoric elixir, besides a few patent 
medicines called elixirs. 

Elm Bark is a remedy of very uncertain value. It is given in the form 
of decoction as a tonic and alterative. 

Emaciation or loss of flesh occurs in cancer, consumption, starvation, etc., 
and is clue to the tissues not receiving a due supply of nutrition. 

Embalming is the process of preparing any animal body to resist the de- 
cay natural to it. The art of embalming was practiced by the Egyptians in 
perfection, and we have their mummies now to prove their skill. The chief 
ingredient in all embalming preparations is benzoin, a resin existing in Friars' 
balsam. This, combined with naphtha, is freely used, and bandages soaked in 
it are bound round the body, after elaborate preparations of spices and resins 
have been placed within the body itself. At the present day embalming is 
seldom required, even by the rich, for their dead, excepting when a long time 
must necessarily elapse before interment ; and, as in the case of royal per- 
sonages, where lying in state is practiced. 

Embolism is a term applied to a condition in which a piece of fibrin e in 
the heart or in a large vessel has become dislodged and carried by the cur- 
rent of the circulation into some distant part. This occurs in some cases of 



EMB 204 EMB 

heart disease, and more especially after rheumatic fever has caused disease 
of that organ; a clot of fibrine carried into an artery of the extremities will do 
very little harm, but if carried into an artery supplying the brain an attack 
of hemiplegia or paralysis will ensue, and the patient will pass into a state of 
coma or insensibility. An embolon, or plug of fibrine, may be carried from 
a vein into the heart, and cause sudden death by blocking up the pulmonary 
artery. Sucli cases are very rare, but may come on after a confinement. 
Death will take place in an hour or two, or may be still more prolonged ; the 
patient will suffer intense agony and distress from a feeling of impending 
suffocation ; she will toss herself about, calling for air, although there is plenty 
entering the chest, and a fatal result will shortly ensue because the blood can- 
not get to the air to be oxygenated. It is doubtful if recovery ever takes 
place when once the above symptoms have come on. Embolism may occur 
on a smaller scale in many diseases, and small areas of tissue may become 
diseased from the capillaries being plugged, but this condition can here call 
for no further comment. 

Embolon is the term applied to the plug or clot of fibrine which is earned 
by the circulation from one part to another in cases of embolism. See Em- 
bolism. 

Embrocations are forms of remedies intended to be rubbed into a part, 
whereas a liniment is strictly intended only to be smeared on to it. Never- 
theless, the word liniment is now generally used in the widest sense, so as to 
embrace embrocations. See Liniments. 

Embryo is the name given to the earliest appearance of the foetus when it 
begins to be developed in the womb. 

Emetics are medicines or other agents which produce vomiting, the sim- 
plest, and in many cases the most effectual, being a tickling of the back of the 
throat, especially at the part called the soft palate, with a feather. In medi- 
cine several classes of emetics are used ; some cause sickness and faintness ; 
some by irritating the stomach cause it to get rid of its contents without any 
great degree of faintness such as accompanies the other. Vomiting itself is a 
complex act, partly the result of the powerful muscles constituting the wails 
of the belly, partly the result of contraction of the muscular walls of the 
stomach itself, that is to say, of the cavity into which the food is received. Of 
ordinary emetics, ipecacuanha is that most frequently employed ; antimony is 
also used in the form of antimonial wine or tartar emetic, the latter in small 
doses. These remedies cause much sickness and prostration, and consequently 
are used chiefly in cases where it is desirable that such a condition should be 
induced for the arrest or suppression of certain diseases. Thus, in the case of 
children attacked with croup, an emetic of this class is of the greatest possible 
value, especially if accompanied with a warm bath and fostered with lukewarm 
drinks. Then, again, it must never be forgotten that little children, especially 
infants, if attacked with cold, cough, and thereby expel from their lungs the 
matter which has collected there, but this in all probability only reaches the 
air tubes, and gets no farther. They cannot expectorate, and so the tendency 
is to accumulate phlegm in the chest, whence the rattling noises heard when 
they have colds. Now it is of vital importance to get rid of this substance, 
and of all remedies an emetic is the most efficient. Ipecacuanha wine had 
best be used, and that may be given in repeated teaspoonful doses until the 
child is sick and the whole is brought up. This may seem harsh practice, but 
in the end it is safest. In poisoning by whatever agent it is of vital impor- 
tance to get it expelled from the stomach, and for this purpose common salt, 



BME 205 EMI 

mustard, or smelling-salts may be given in the respective doses of a handful of 
salt, a tablespoonful of mustard, or a teaspoonful of smelling-salts, all freely 
diluted with water, and to be followed up by copious draughts of lukewarm 
water. These are especially useful in poisoning with opium or other narcotic 
agent. For this purpose, too, sulphate of zinc (white vitriol) and sulphate of 
copper (blue vitriol) are particularly well adapted,. but as a rule less readily 
attainable. Sulphate of zinc is a very safe emetic, emptying the stomach with- 
out giving rise to much nausea. Perhaps the best is a combination of this 
with ipecacuanha, — fifteen grains of sulphate of zinc and five of ipecacuanha, 
given as usual with much lukewarm water. There are many cases where an 
individual has partaken of indigestible or unsuitable food, in which an emetic, 
by getting rid of it, does great good, as during the process of vomiting the 
liver and gall bladder are compressed, and bile finds its way back into the 
stomach, thence to be expelled by the mouth. An emetic is often one of the 
very best plans for getting rid of an accumulation of bile in the liver or its 
appendages. The process of vomiting also commonly causes a certain amount 
of perspiration. 

Emetine is the active principle of ipecacuanha. It is rarely, if ever, used 
in medicine. 

Emigration is a means of reducing the surplus population of a country, 
but some loss to a nation is incurred by the process, because the young, the 
hearty, and the strong go abroad, leaving the poor and infirm at home; but 
this is somewhat counterbalanced if the children send back to the aged parents 
some of the proceeds of their wealth. Again, the idle man and the pauper do 
not emigrate as a rule, and therefore they are a sort of dead weight in the 
country. The emigrant should, to be successful, be provided with some little 
means for living for a short time on landing in a new country ; agents should 
be appointed to point out the countries where the different kinds of labor are 
most required, so as to avoid a glut in the market ; all grades of laborers 
should be sent out, so that a new colony may be self-supporting as far as pos- 
sible, and the men and women should be pretty equally mixed. The annual 
average emigration from Ireland between 1831 and 1841 was 40,346, and from 
June 30, in the latter year, to the end of 1845, it averaged 61.242 per annum. 
In consequence of the potato blight, famine, and pestilence, the number rose 
to 105,955 in 1846; in 1847 the numbers were more than double those who 
left in the previous year; in 1848 the emigrants amounted to 178,159, but in 
1849 they again rose to 214,425. The emigration reached its maximum in 
1851, when the numbei'S amounted to 249.721, after which they gradually de- 
creased to 150,222 in 1854. From 1841 to 1851 no less than 1,240,737 left 
the country, while the number who emigrated from Irish ports in the decade 
1851-61 was 1,208,350, —namely, 179.507 in 1851 ; 190,322 in 1852; 173,148 
in 1853 ; 140,555 in 1854 ; 91.914 in 1855 ; 90,781 in 1856 ; 95,081 in 1857 ; 
61,337 in 1858; 8599 in 1859; 84,621 in 1860; and 17,485 from January 1 to 
April 7, 1861. From these causes the population of Ireland has diminished to 
about one-half of what it would have been had there been the same ratio of in- 
crease as in other parts of the United Kingdom. The population of Ireland in 
1841 was 8,175,124; in 1851 it should have been 9,018,799; in 1861, 9,887,400; 
and in 1871 it would have been nearly 10£ millions. But from the above 
causes, of which migration has played a great part, the number of people sank 
to 6,574,278 in 1851, to 5,798,967 in 1861, and to 5,402,759 at the census in 
1871 ; the decrease is now less rapid than formerly. Emigration has also gone 
on in other parts of the United Kingdom, but in a much less proportion, and 



EMM 



206 



EMM 



in spite of it there has been a large increase in population. Official returns 
state the number of emigrants who left the United Kingdom during the fifty- 
five years from 1815 to the end of 1869 at 6,756,697. Of this total there 
went 4,276,597 to the United States, 1,356,476 to the British North American 
colonies, 971,358 to the Australian colonies and New Zealand, and 152,266 
to other parts. The numbers include foreigners who embarked from ports in 
the United Kingdom. The following table gives the number and destination 
of emigrants for each of the sixteen years, 1861 to 1876, the last column in- 
cluding all individuals not enumerated under the three great outlets of British 
emigration, namely, the United States, North American, and Australian colo- 
nies. 



Years. 


To North American 


To the United 


To Australia and 






Colonies. 


States. 


New Zealand. 








Of British 




Of British 




Of British 




Of British 






Origin 




Origin 




Origin 




Origin 




12,707 


Only. 


49,764 


Only. 


23,738 


Only. 


91,770 


Only. 


1861 


3,953 


38,160 


20,597 


65,197 


1862 


15,522 


8,328 


58,706 


48,726 


41,843 


38,828 


121 214 


97,763 


1863 


18,083 


9,665 


146,813 


130,528 


53,054 


50,157 


223,758 


192,864 


1864 


12,721 


11,371 


147,042 


130,165 


40,942 


40,073 


208,900 


187,081 


1865 


17,211 


14,425 


147.258 


118,463 


37,: 03 


36,683 


209,801 


174,891 


1866 


13,255 


9,988 


161,000 


131,840 


24,097 


23,682 


204,882 


1 70,053 


1867 


15,503 


12,160 


159,275 


126,051 


14,466 


14,023 


195,953 


156,982 


1868 


21,062 


12,332 


1 55,532 


108,490 


12,809 


12,332 


1 96,325 


138,187 


1869 


33,891 


20,921 


203,001 


146,737 


14,901 


14,457 


258,027 


186,300 


1870 


35,295 


27,168 


196,075 


153,466 


17.065 


16,526 


256,940 


202,511 


1871 


32,671 


24,954 


198,843 


150,788 


12,227 


11,695 


252,435 


192,751 


1872 


32.205 


24,382 


233,747 


161,782 


15,876 


15,248 


295,213 


210,494 


1873 


37,203 


29,045 


233,073 


166,730 


26,428 


25,137 


310,612 


228,345 


1874 


25,450 


20,728 


148,161 


113,774 


53,958 


52,581 


241,014 


197,272 


1875 


- 


12,306 


- 


81,193 


- 


34,750 


- 


140,675 


1876 




9,335 


- 


54,554 


~ 


32,196 


_ 


109,469 



The English Poor Law Act of 1834, and other subsequent Acts, empower the 
application of the poor-rate towards the emigration of poor persons, and enable 
guardians of unions and parishes to promote emigration at the cost of their 
funds, with the order and subject to the regulations of the Local Government 
Board. The general effect of the Acts appears to be that guardians of unions, 
or of separate parishes not in union, may, without the previous consent of the 
vestry meeting, but with the sanction of the Local Government Board, expend 
any sum not exceeding £10 in aid of the emigration of any poor person having 
a settlement in the parish, or in any parish in the union. Poor persons who 
are irremovable by reason of one year's residence or otherwise, if they are 
chargeable, or would, if relieved, become chargeable, may also be assisted to 
emigrate by the guardians, with the sanction of the Local Government Board, 
without reference to the limit of £10. So also the guardians are not limited 
as to the amount to be expended by them in respect of poor persons who are 
actually chargeable upon the common fund of the union, whether settled 
therein or not. 

Emmenagogues are remedies which are supposed to foster the menstrual 
flow. They are a most diversified and unsatisfactory group. Very often de- 
ficiencies or absence of the flow is due to no local cause, but to bad health gen- 



EMO 207 EMP 

erally, especially to the condition known as anaemia. When this is the case it 
is useless to attempt to restore the local functions until the general mischief is 
set right. For this reason salts of iron are among the most useful emmena- 
gogues, especially in large towns, and as in these patients the bowels are usu- 
ally more or less sluggish, especially the lower bowel, it is well to give aloes 
at the same time. Sometimes the arrest or non-appearance of the flow is due 
to mechanical obstruction, in which case operative procedure becomes neces- 
sary. This is comparatively rare. 

Emollients are remedies which, when applied locally, soothe the part 
and diminish irritation. Bathing with warm water ; the application of hot 
poultices, however compounded ; the application of oily or greasy substances, 
so as to keep the skin lissom and supple, all come within the definition. 

Emphysema is a disease of the lungs, which is attended very often by 
shortness of breath, cough, and inability to expand the chest thoroughly. It 
very frequently comes on as a sequel to a winter cough. When a person has 
been suffering every winter with a recurrence of bronchitis, the air-cells of the 
lungs become unduly distended, and cannot so well expel their contents ; it 
thus happens that the lungs become larger and hold more air than usual, but 
as the air is stagnant in the lungs in a great measure, respiration is carried on 
imperfectly, as the products of combustion are not removed fast enough. Such 
people are generally stout, and have too much fat deposited about them ; this 
arises from the fact that they are not able, or are indisposed, to take violent 
exercise, and that the ordinary processes of combustion in the lungs are some- 
what impaired. In old people also emphysema occurs, in consequence of the 
changes which naturally take place in the tissues in old age ; the lungs, like 
other organs in the body, are less nourished then than usual, and so they are 
unable to bear the external pressure o£ the atmosphere ; hence the air-cells 
dilate, and this is most observed in the upper and front parts of the lungs. 
This disease is met with also in children, and appears in some cases to be 
hereditary ; in many cases, however, it follows whooping-cough or some bron- 
chial affection of childhood, and the little patient may be seen with high 
shoulders, prominent chest, quick but shallow expansion of chest, and rather 
congested appearance in the veins of the face. This disease in itself is not 
dangerous, but it is so often accompanied by bronchitis, and in so great meas- 
ure induces that disorder, that grave evils may ensue. Besides shortness of 
breath and inability to take fast exercise, there is often palpitation of the heart 
and pain at the pit of the stomach, because the right side of the heart is full 
and cannot properly force its contents through the altered lungs. Sometimes 
the neck and face are swollen, and even the legs may become so too, and then 
when the finger is pressed on the skin a little pit or clepresssion is formed, and 
the patient is said to be dropsical. But these results do not occur except in 
bad cases, and only when the person has been suffering for some years. Bron- 
chitis is the most common affection which coexists with emphysema, and often 
it is extremely troublesome. When a cold comes on, the breath is shorter 
than before, and there is difficulty in breathing; the patient is wheezy, and 
feels as if there were a weight lying on his chest ; in a day or two. by proper 
treatment, the cough will become looser, and he will find relief by expecto- 
rating a good deal of phlegm from the chest. The cough is generally very 
troublesome the first thing in the morning, because the phlegm has been ac- 
cumulating during the night ; the patient is unable to lie down comfortably, 
and feels better when propped up in bed. By coughing so much, pain is fre- 
quently felt in the lower part of the chest on each side, and this is due to the 



EMP 208 EMP 

muscles there being tired with the violent exertion. At times the eyes may 
be bloodshot and the veins of the neck stand out during the cough, because 
they are congested. Frequently the patient breathes better when he leans for- 
ward, resting on his hands, because then, the shoulders being fixed, expansion 
of the chest takes place more freely. After many attacks the lips, ears, and 
nose are often of a livid or purplish tint, owing to long-continued congestion of 
the vessels of the part. A draught of cold night air or a fog is a thing always 
to be dreaded by any one suffering from this disease. It affects all classes, 
more especially those whose work exposes them to all kinds of weather : cab- 
men, who often have no shelter for hours in cold and wet weather, are very 
liable to it ; draymen and costermongers are also subject to it. A very com- 
mon cause is indulgence in eating and drinking. Women, by leading a more 
domestic life, are less subject to this disease than men. It is far less common 
in warm and sheltered places than in cold and damp parts. 

Treatment : If a person is predisposed to emphysema by one of his parents 
having suffered from it, he should avoid exposure to inclement weather as far 
as possible, and when he has a cold or an attack of bronchitis he should try 
to get it cured as soon as possible. Avoid excess of eating and drinking, if 
at all inclined to obesity; take lean meat rather than fat; do not eat much 
bread, or butter, or pastry, or potatoes, but have dry toast, biscuits or brown 
bread, and green vegetables ; a little claret or sherry is preferable to beer. 
Exercise should be taken every day in fine weather, and night air should^ be 
avoided. Removal to a warmer and equable climate is of the greatest service, 
but this is often beyond the means of most people. As the next best thing, 
those places which are sheltered from chilling and inclement winds are to 
be recommended. When an emphysematous person has taken cold, or has 
an attack of bronchitis, he should at once go to bed, and keep the room at a 
moderate temperature of 65°' or 70° Fahr. ; if too hot, the air is oppresssive; 
the atmosphere should be moistened by boiling water in a kettle, so that the 
steam shall pass into the apartment; moist hot air is what is most giateful 
to the patient. Avoid any draught of cold air into the room. Place on the 
chest hot linseed-meal poultices, but care should be taken that they are really 
hot, and not allowed to lie on until they become a cold damp lump on the 
chest ; or flannels, wrung out of hot water, may be sprinkled over with a tea- 
spoonful of turpentine, and then placed over the chest or back ; a piece of oiled 
calico should be laid over the flannel, — it not only keeps in the heat, but pre- 
vents the clothes becoming wet. The patient should not lie too low in bed, as 
he will breathe freer if propped up by pillows. Careful attention should be 
paid to the diet ; solid food should be avoided at first, and hot milk, or bread 
and milk, may be given, with a lightly boiled egg and beef tea at intervals. 
Beer should not be given, and if any stimulant be needed some port-wine 
negus or a glass of warm whisky and water may be given ; any excess in this 
direction is bad. Anv light farinaceous pudding or some mutton may be tried 
in a few days, when the appetite returns, but the stomach should not be loaded 
with food so as to cause distension. The bowels are often confined, and so 
puro-atives may be given occasionally. Severe cold or foggy weather is a 
great source of fear to the emphysematous. Between the attacks, and during 
the warm summer weather, the object is to improve the general health as far 
as possible by careful diet and tonic medicine. Flannel should be worn next 
the skin, and warm socks and thick boots. A respirator often gives great 
relief, as the inspired air is bv that means warmer, but it is not so pure. Per- 
sons affected in this way should breathe through the nose rather than through 



EMP 209 EMP 

the mouth, and they should not talk when out walking in the night air.*- Great 
relief is afforded by staying in the house all the winter, so as to avoid being 
exposed to cold or wet. 

Emprosthotonos is a technical name given to those convulsive seizures 
in which the body of the patient is thrown violently forwards ; it occurs in 
some cases of tetanus. See Tetanus. 

Empyema is a disease of the pleura associated with the effusion of pus 
into the pleural cavity. In many respects this disease presents symptoms 
closely resembling those met with in pleurisy, but differing in being more in- 
tense, and attended with more danger to the patient ; in simple inflammation 
of the pleura, the products effused have a tendency to become absorbed, and 
to leave only adhesion of the two surfaces of the membrane, while in empy- 
ema adhesions rarely occur, and the matter must be let out by surgical inter- 
ference. Persons who suffer from this disease have generally been in a bad 
state of health previously, and are often of a scrofulous constitution. Scarlet 
fever in children may set up empyema, and it is more common from this cause 
in early life than among adults. In some who have diseased joints or sinuses 
in the limbs, with diseased and bare bone, and after amputation of a limb when 
pyaemia has been set up, secondary deposits in the lungs and empyema are 
very liable to recur. Those also whose lungs are in a diseased state, as in 
cases of phthisis and some forms of pneumonia, are liable to this complaint. 
The bursting of a hydatid cyst into the pleura, the rupture of a tuberculous 
cavity of the lungs, and the extension of a similar disease in the pericardium 
will set up empyema. And, finally, it may come on insidiously without. any 
distinct cause being made out. 

Symptoms : There is at first pain of a sharp and shooting character in the 
affected side, and this is generally confined to one spot; the patient cannot 
cough, or take a deep breath without increasing this pain. In a few days, 
when the fluid is poured out into the pleura, the pain may diminish considera- 
bly ; but there is more or less distress of breathing, because, from the pressure 
of the fluid, air cannot enter the lung on the affected side, and the other lung 
is called upon to do all the work ; hence the patient lies on his back or diag- 
onally towards the diseased side, so as to give the healthy side of the chest all 
the room he can to expand. From the first there are the usual signs of fever, 
— a furred tongue, quick pulse, loss of appetite, and much thirst. The tem- 
perature, too, of the body rises considerably, and is liable to much daily 
variation, being high at night and perhaps two or three degrees lower in the 
morning. When the disease is well established, the diseased side of the chest 
is larger in circumference than the other, and there ■ is bulging of the inter- 
costal spaces ; the veins also are obstructed over the part, and appear as blue 
lines running over the chest. The dyspnoea is great, and increased on exer- 
tion ; each respiration is hurried and shallow ; the countenance is anxious, and 
sometimes pale or livid. Generally the patient is worse at night, and becomes 
hotter and more oppressed ; at times a hectic flush appears on the cheeks, at 
others there is much perspiration over the head and body ; rigors or shivering 
are very usual in the early stages of the disease, but becomes less frequent 
afterwards. 

Treatment: The patient must be kept in bed in a warm and well- ventilated 
room ; the air should be moist, and of a temperature from 60° to 65° Fahr. 
When there is much pain a few leeches will often give great relief, and when 
bleeding has stopped, a hot poultice can be applied, or else flannels wrung out 
of hot water, and covered over with some oiled calico or oiled silk, so as to 
14 



EMU 210 END 

keep in the heat, and prevent the bed-clothes becoming wet. Food of a light 
and nourishing description must be given ; milk, beef-tea, broth, and a moder- 
ate amount of stimulant are best borne ; the diet, in fact, is such as may be 
given in all ca-es of fever, and will be more fully described under the general 
head of fever. (See Fevers.) When there can be no doubt in the mind of 
the medical man that pus is present, it is certainly advisable to open the chest 
by a small incision, so as to let it out ; no good can come by delay, as the pa- 
tient's health will become worse, and no benefit can be expected from leaving 
the case alone. Yet, should any doubt exist as to the nature of the disease, 
an exploratory puncture may be made by means of a fine trocar and canula. 
If pus escape, then there can be no hesitation in tapping the chest, or in per- 
forming the operation which is technically known as "paracentesis thoracis." 
For this purpose an incision, about an inch long, or rather less, is made through 
the skin, about the sixth or seventh intercostal space, and in the line of the 
axilla or arm-pit. A trocar and canula about one-fourth or one-fifth of an inch 
in diameter is then introduced, and when the trocar is withdrawn the pus will 
run through the tube most readily. The wound should not be allowed to close, 
but a piece of tubing of gutta-percha should be kept in, so that any more pus 
that forms may escape at once, and not accumulate again. Even in very 
favorable cases pus continues to be secreted and to flow through the tube for 
days and even weeks after the original puncture. The quantity produced daily 
gradually diminishes until at length it ceases. All this while the patient will 
be easier ; he can breathe more comfortably ; there is less fever and hectic ; 
he will recover his appetite, and rest better at night ; but in all cases that 
recover, convalescence is a slow process, and tonics, generous diet, cod-liver oil, 
a visit to the sea-side or country, are indispensable aids for regaining health. 
If the lung cannot expand after the matter has escaped, the chest-wall of the 
affected side will he pressed in by the external atmosphere, and so be smaller 
than the other, and in this way such patients often have lateral curvature of 
the spine afterwards. In time the healthy lung becomes much increased in 
size, and does, in a great measure, the work of both. The mortality from this 
disease is considerable, and it is nearly always fatal when arising from pyaemia, 
or when the patient's health has been worn down by previous disease. In a 
few cases the pus has made its way through the skin of the chest, and burst 
externally of its own accord ; but it is best to tap the chest before such a pro- 
cess has taken place. 

Emulsion is a soft, smooth liquid, usually prescribed for coughs, though 
purgatives can be made into emulsions, as when castor oil is rubbed down with 
yolk of egg, or milk, or mucilage and syrup. A pleasant cough emulsion is 
made from almonds, gum arabic, sugar, water, and a little tolu, paregoric, aod 
sweet spirits of nitre. 

Encephalitis is a technical term for inflammation of the brain. 

Encephaloid Cancer is one of the varieties of cancer. 

Endemic. Diseases which are peculiar to localities or situations, such 
as ague to Lincolnshire, England, goitre to Switzerland, and yellow fever to 
Havana. Diseases may be endemic and epidemic at the same time. 

Endocarditis means inflammation of the lining membrane of the heart, 
and is common after an attack of rheumatic fever, and in the course of Bright's 
disease ; it generally is met with in the left ventricle, and sets up a serious 
affection of the valves. See Heart. 

Endoscope, an instrument devised to see the interior of the bladder, but 
it is not of any practical use. 



ENB 211 ENT 

Enema. When food or medicine is introduced in a fluid form into the 
lower bowel it is termed an enema ; formerly a clyster. It may be employed 
with advantage in cases of prolonged constipation, when it is better and easier 
to act upon the hardened mass from below than from above. Many substances 
may be employed, but there is none better than plain soap and water. If that 
do not succeed, half an ounce of castor oil and half an ounce of turpentine 
may be beaten up with an egg, and a pint of hot water added. In making use 
of enemata for this purpose, not less than a pint should be used ; for the nor- 
mal stimulus to the bowel to act is distension. If, on the other hand, it is de- 
sired that the enema should be retained instead of being expelled, the smaller 
the quantity used the better. This is the case when from disease of the stom- 
ach it is impossible or unadvisable to give food that way, and small quantities 
of beef-tea, etc., may be thrown up the bowel. Then not more than a couple 
of ounces should be used at a time. This too is the case when opium enemata 
are prescribed, as they sometimes are for disease of the lower bowel or neigh- 
borhood. 

Enervation is a term applied to the weak state met with in cases of 
nervous debility, and in those who suffer from hysteria and allied nervous 
disorders. 

Enteric Fever. See Typhoid Fever. 

Enteritis, or Inflammation of the Small Intestines, is rare as a dis- 
ease arising of its own accord. Usually it is the result of irritants, or is pro- 
duced by scrofula. The inflammation may affect all coats of the intestine or 
only the mucous membrane. When inflamed, the mucous membrane becomes • 
of a deep red color, almost black, and occasionally ulcers form on it. Some- 
times these ulcers eat so deep into the gut that their outer wall is perforated, 
the contents escape, and peritonitis, a much more fatal malady, is set up. If 
the inflammation be only of a subacute character, the bowel maybe thickened. 
This sadly interferes with its function, and gives rise to constantly recurring 
attacks of diarrhoea. The symptoms of enteritis vary exceedingly in gravity. 
If all the coats are affected at once, the symptoms then resemble those of 
strangulation. There is intense pain, a hot skin, quick, hard pulse ; the legs 
are drawn up to relieve the tenseness of the belly, and there is nausea and 
vomiting. The bowels, too," in this form, are obstinately confined, and there 
may be faecal vomiting. The slightest pressure increases the pain, so that the 
patient can hardly bear the bed-clothes. The pulse soon becomes excessively 
small and hard, wiry, and imperceptible. If the mucous membrane alone be 
affected, the symptoms are quite different. There is diarrhoea instead of costive- 
ness, and no fecal vomiting; but there is great fever, thirst, and pain, and the 
bowels swell with flatus. In dealing with such a case we must rely on opium, 
given both by the mouth and bowel. If it cannot be retained, morphia must 
be given in the anus or over the bowels. Small doses frequently repeated are 
best. Hot fomentations or turpentine stupes applied to the abdomen give great 
relief. Ice to such is both grateful and valuable. Strict quiet is to be main- 
tained in bed, and no attempt made to open the bowels until such time as that 
is urgently needed. The food, too, should be given in the smallest possible 
bulk. When it is judged safe to open the bowels, if they do not act of their 
own accord, enemata of soap and water had better be used. With children, 
opium must be given with great caution. Lime-water suits them well. 

Entophyta are vegetable parasites which dwell within the body ; they are 
found in some diseases of the mucous membrane of the mouth and alimentary 
canal. In the complaint called thrush, so common in infants, spores of the 



ENT 212 ENT 

fungus known as Oidium albicans may be found, also in the false membrane 
formed in the throat in cases of diphtheria. In certain cases of enlargement 
and dilatation of the stomach, fungi are found in the vomited matters ; the 
name of Sarcina ventriculi has been given to them ; they form little square 
packets of a greenish-yellow color, and are marked by vertical and transverse 
lines. The yeast plant, or Tortula cerevisia, which is made use of in ferment- 
ing beer or spirituous liquors, is also occasionally found in the stomach and 
bladder. They are probably conveyed into the body from the external atmos- 
phere, and develop wherever they find a convenient nidus. 

Entozoa are animal parasites which are met with or have their "habitat" 
within the human body. They have been divided by biologists into three 
classes : — 

(1.) Coelelmintha, or hollow worms. 

(2.) Sterehnintha, or solid worms. 

(3.) Accidental parasites, or those having the habits, but not referable to 
the class, of entozoa. 

(1.) The following are the most common worms met with in the class 
Coelelmintha: (a.) Ascaris lumbricoides, or round worm, which is met with in 
the small intestine, and often passes upwards into the stomach. The male 
measures from four to six inches long ; the female from ten to fourteen. In 
shape it much resembles the ordinary earth-worm. They are most common 
in children between the ages of three and ten years, (b.) Ascaris or Oxyuris 
vena icularis, commonly known as thread-worms ; they are found in the rectum 
or lower bowel, and are more frequently met with in children than any other 
worm. The male measures one-sixth of an inch in length ; the female is from 
one-third to half an inch long. (See'AsCAEiDES.) (c.) Tricocephalus dispar, 
or the long thread-worm: it is not very* common in this country; the male 
measures an inch and a half in length, the female two inches. It is found in 
the large intestine, (d.) Trichina spiralis, a worm rare in this country, but 
common in Germany. It gets into the system by eating sausages not thor- 
oughly cooked. It is attended by symptoms not unlike those of typhoid fever, 
. income respects. They are met with in the muscles, where they lie coiled up 
in little oval cases, which are just visible to the naked eye. (e.) Filaria 
medinensis, or Guinea worm, found in Guinea and different parts of Africa. 
It attacks the skin and subcutaneous tissues, wriggling its way in the legs 
chiefly. 

(2.) The following are included under the class Sterelmintha : (a.) Tamia 
solium, or tape-worm. Its length is great, varying from six to ten or twenty 
feet or more. It is a flat, ribbon-like worm, of a white color, about one-third 
of an inch broad, and made up of segments about an inch long near the tail 
end, and each fits into the segment preceding. The body is pretty uniform in 
width, but towards the head the neck tapers very much, not exceeding often 
one-eighth of an inch, and the segments also are very much shorter. The 
head is known by four black spots upon it, and these are the suckers by which 
it clings to the walls of the bowels ; the head is about the size of a pin's head, 
and is°rather wider than the neck. On the front part of the head is a small 
proboscis, on which is arranged a double row of hooks in a circle. The worm 
increases in length by fresh segments being produced at the neck, while the 
fully developed segments near the tail drop off ; each fully matured segment 
is called a " proglottis." No good is clone unless the head is expelled, as 
yards may come away, but if the head remain fresh growth will take place. 
This worm is found in the small intestine, {b.) Tcenia mediocanellata is an- 






ENT 213 ENT 

other kind of tape-worm, and the more common of the two. It resembles the 
preceding in every respect, except that there is no proboscis on the head, and 
no hooklets. (c.) Bothriocephalus latas, or broad tape-worm; it is the largest 
of all. and is often twenty or thirty feet in length and an inch in breadth. The 
head is club-shaped; there are no hooklets; the anterior segments are narrow 
at first, but widen gradually, so as to attain their greatest width towards the 
centre of the body; towards the tail end the segments diminish in width, but 
increase in depth, so that the worm is much thicker in the posterior than in 
the anterior part, where it is flattened. The mature segment or "proglottis" 
of these worms contains both male and female organs of reproduction ; when 
one mature segment has become impregnated with another mature segment, 
by contact with it, eggs are formed. These eggs remain in the " proglottis " 
until it escapes from the bowel, when the "proglottis " itself bursts from the 
growth of the eggs within ; when the ova escape in this way, they may be 
eaten by some animals, or even taken into the stomach by their being present 
in drinking water. When the embryo in this way enters into a pig or rab- 
bit, it breaks its shell, and, boring through the intestinal wall, lodges in the 
tissues ; here it forms a cyst, where it may attain a large size, and develops 
an animal consisting only of a head and neck. There are a great many tape- 
worms of different kinds, and many animals, as the dog, cat, and rabbit, are 
liable to them as well as man. We may chance to swallow the ova of the 
tape-worm in the dog by eating water- cresses, or drinking water in which the 
embryo has happened to be ; and if this be done, we shall not suffer from 
tape-worm, but from the intermediate variety, called cysticercus, and thus a 
cyst may form in some organ, and grow so as to cause some inconvenience, 
and even danger to life. These cysts are often called hydatids, and the liver 
is the most common seat ; they rarely heal of themselves, but generally form 
rounded tumors, which cause very little pain or disturbance ; they generally 
contain fluid, and attached to the inner wall of the cyst are those curious 
bodies known as cysticerci, or the worm in the intermediate stage. Tape- 
worm in man is not caused by swallowing the ova, but by eating meat in 
which the cysticerci are lying. Pigs and rabbits provide us with the Tcenia 
solium, while oxen may give us the Tcenia mediocanellata. Bchinococcas 
hominis is the name given to the cysticercus of the Tcenia echi?iococcus, a 
tape-worm which is met with in the clog and wolf. There are some other un- 
important varieties ; the first two are the only common ones in this country ; 
the development of hydatids is very rare. Tape-worm itself is attended with 
much inconvenience, but very little danger. 

(3.) There are a few accidental parasites, as the larva of the gad-fly, and a 
few less well known. These resemble the entozoa in dwelling within the 
body, but they have no anatomical relation to those which form the class 
known under the name of Entozoa. See Parasites. 

Entropion. This condition is the reverse of ectropion, and denotes an 
inversion or turning-in of the eyelid. This, though not a cause of so much 
disfigurement as eversion, is usually more troublesome and painful to the 
patient, by reason of the inward displacement of the eyelashes, which are 
brought into contact with, and constantly rub against, the cornea and the front 
of the eyeball. Permanent entropion is usually the result of slow inflamma- 
tory changes affecting the tissues of the eyelid, chiefly the inner lining of the 
mucous membrane, and causing retraction of these and inward rolling of the 
free margin of the lid. In some instances the eversion is due to persistent 
spasm of the circular muscle which closes the eye. This affection, when 



ENU 214 EPI 

neglected, may result in opacity and ulceration of the cornea, and even general 
disorganization of the eyeball. Entropion, like ectropion, is more frequently 
observed in the lower eyelid. It cannot be relieved by any plan of treatment 
except surgical operation. 

Enuresis, a technical term for incontinence of urine. See Incontinence 
of Urine. 

Ephemera. See Milk Fever. 

Epidemic Diseases are such as are universally prevalent in a district or 
country at the same time, and which, having endured for a period, at last dis- 
appear or. die out. Influenza and cholera are instances of epidemic diseases. 

Epidermis is the name given to the epithelial covering of the skin ; the 
number of layers of epithelial cells or scales varies in different parts of the 
body, being thinnest on the inside of the arms and legs, and on the fingers and 
toes, while it is very thick on the external surfaces of the body, on the palm 
and heel, etc. 

Epiglottis, a valve-like membrane which fits accurately over the glottis or 
upper part of the air-passages, so as to prevent any food going down that 
way. 

Epilepsy is a diseased condition, the exact causation of which is undeter- 
mined, but of which the main features are sudden and total loss of conscious- 
ness and convulsions, lasting a longer or shorter period. These attacks have 
a tendency to recur and ultimately affect the mental powers. Frequently 
these fits are preceded by a kind of warning (see Aura) ; and if this can be 
stopped, the attack may be arrested. The attack begins with a sudden pallor 
of the countenance and a fixed expression of face. Sometimes there is a 
shriek, and the individual falls to the ground violently convulsed (hence the 
name falling sickness). There is usually foaming at the mouth; the tongue 
is thrust forward, and sometimes fearfully lacerated by the teeth. The eyes 
are often fixed, sometimes rolling and quite insensitive. The countenance is 
suffused, sometimes purple, and the breathing is frequeiuly suspended for a 
time. The bowels and bladder may discharge their contents. The convul- 
sions may affect any or all parts of the body ; usually one side is worst. 
Gradually they pass off, and the epileptic remains quiet and apparently sen- 
sible ; this may pass into sound sleep, from which he may recover, knowing 
nothing of what has passed, except from the pain from straining his muscles 
and the pain from his lacerated tongue. Generally, too, there is headache. 
The fit may last from a few minutes to half an hour, and may recur some- 
times once or twice in one day, often not for very long intervals. There is 
always some risk to the epileptic from being seized in a situation of danger. 
They may fall on the face and bruise themselves, or they may fall in the 
water and drown themselves in a pool a few inches deep. Such are the char- 
acters of a severe and well-marked fit of what the French call the grand mail. 
The petit mal may only mean a slight momentary unconsciousness, instan- 
taneously recovered from, or there may be a faint for a few seconds without 
any fall or dizziness ; or there may be some twitching of the face or one limb, 
followed by an absent feeling for a few minutes or moments. The appearance 
of confirmed epileptics is striking: they have a stolid, immobile look, are 
usually very stupid; and very likely aiso their moral faculties are obtuse. 
Epilepsy is often hereditary, but it may be induced by a variety of causes. 
Treatment : During the paroxysm the patient should be let alone, care being 
taken that he does not hurt himself. The great remedy for epilepsy at the 
present day is bromide of potassium in full doses. To begin, the patient 



BPI 215 EPI 

ought to have at least ten or fifteen grains, three times a day, going up to 
thirty, forty, or even sixty, for a dose, if necessary. Strychnine or nux vom- 
ica is sometimes given with advantage, but it must be used cautiously, and 
ought never to be given without a physician's prescription. At the same time 
every effort must be made to improve the general health. 

Epiphora means an overflow of tears. See Eye. 

Epiphyta are vegetable parasites, of which there are several varieties met 
with on the skin or external surface of the human body. They are conta- 
gious, because the spores may be taken frum one body to another by contact, 
and they are most frequently met with in children. (1.) Pityriasis versicolor 
or chloasma, is due to a parasitic fungus ; the disease is a very common one, 
and often seen on the chests of poor people, especially of those who wear 
flannel next the skin, and who are not very clean. It occurs in fawn-colored 
or buff-colored patches, so that the surface of the skin is mottled with these 
discolorations. A solution of sulphurous acid or hyposulphite of soda, applied 
to the skin after it has been well washed, will often cure this disease ; acetic 
acid or strong vinegar and iodine paint are effectual, but they are more pain- 
ful applications. Microsporon furfur is the technical name given to the par- 
asite. (2.) Tinea tonsurans is the name given to the common affection known 
as ringworm. It occurs in circular patches on the scalp or back of the neck, 
or on the arms, but it may be found anywhere on the skin. Commencing as 
a small red patch, it spreads in a circular manner, so that while the centre 
may be healed there is an outer ring of a red tint, and covered with a little 
scurf ; this scurf is due to the scales of epithelium which are being shed ; 
when these scales are examined, as mentioned above, the spores of the fungus 
may be seen. Trycophyton tonsurans is the technical name for the fungus. 
Although very catching, it may readily be healed by painting the surface af- 
fected with a solution of sulphurous acid or vinegar, iodine paint, or solutions 
of corrosive sublimate. (3.) Facus is a troublesome disease of the scalp, 
which now and then occurs in children. It is due to the presence of a para- 
sitic fungus, Achorian Schonleinii, which attacks the hair follicles and the 
bulbs of the hair itself ; hence the hair becomes brittle and breaks off short. 
Scales are formed in abundance, and these constitute yellow crusts, whose sur- 
face is concave ; they are generally circular in shape, and have a disagreeable 
mousy odor. The only cure is to shave the head as close as possible, and 
pull out the hairs at the spot affected ; then apply a solution of corrosive sub- 
limate ; this must be done constantly, and whenever a fresh crop appears, but 
with every care it is very difficult to eradicate. (4.) Microsporon mentagro- 
phytes is a parasitic fungus met with in the hair-follicles in the disease known 
as sycosis or mentagra. It occurs in man, and affects the mustaches chiefly, 
or the hair close around ; the hairs become brittle and break off, while at the 
roots are little pustules, which break and discharge matter. The hair should 
be pulled out, and treated in a similar way to cases of favus. (5.) Micro- 
sporon Audouini is another fungus affecting the scalp in cases of Tinea de- 
calvans. This disease may be known by bald, circular patches occurring on the 
head. While the centre is devoid of hair, the disease spreads at the circum- 
ference, and here short broken hairs may be seen. It may be cured by the 
free application of acetic acid or sulphurous acid. (6.) Plica polonica is not 
met with in this country ; it is found in Poland and the east of Europe among 
people who, having abundant hair, allow it to become matted together for 
want of due care and cleanliness. By some it is supposed not to be due to a 
parasite; by others a fungus, termed Trycophyton sporuloides, has been found, 



EPI 216 EPI 

but whether as a cause of the disease or as a consequence of the dirt, it is dif- 
ficult to say. (7.) The fungus-foot of India is also due to the presence of 
parasitic fungi, which, penetrating the skin, enter the deep tissues and bones of 
the hands and feet ; a white, red, and black variety has been described, but 
not much is known about it in this country. 

Epispadias is a term applied to a variety of malformation of the wall of 
the bladder and adjacent parts. 

Epispatics, that is to say, things that draw, is the term commonly applied 
to blistering agents, of which the chief are Spanish flies. See Canthar- 

IDES. 

Epistaxis. This term signifies a bleeding from the nose. The blood sup- 
ply of the nose is important. The arterial supply is derived from the eth- 
moidal, spheno-palatine, posterior palatine, and facial, and, as a rule, the veins 
accompany these arteries ; but some of them, the emissory, have no analogy 
with the above-named arteries, and establish an intricate communication be- 
tween the nostrils and the cranial veins — a circumstance of some importance, 
as accounting for the bleeding from the nose in cases of obstinate cephalalgia 
or headache, and for the " efficacy of derivative abstractions of blood from the 
nostrils under such circumstances." The causes of epistaxis are idiopathic or 
traumatic, spontaneous or accidental. Accidental or traumatic is the result of 
a blow, or by any unusual exertion, sneezing, or violent blowing of the nose. 
Spontaneous or idiopathic epistaxis has, as its causes, several different circum- 
stances: thus, capillary haemorrhage dependent on active or passive congestion, 
renal and hepatic disease, ulceration, or the presence of polypi. (See Poly- 
pus.) In young persons of nervous temperament, such symptoms as flushing 
of the face, buzzing in the ears, and severe headache are generally relieved 
by bleeding from the nose. Spontaneous bleeding may also occur in vicarious 
menstruation, scurvy, fever, or in the hemorrhagic diathesis. (See ILemoi:- 
rhagic Diathesis.) Epistaxis is frequently a concomitant of declining and 
advanced life, in which instance it is usually venous. 

Treatment : Simple forms of haemorrhage from the nose, whether accidental 
or spontaneous, can be readily arrested : such as by cold applications to the 
nose and forehead, or snuffing cold water up the nose ; a cold key slipped 
down the back, or cold water dashed on to the nape of the neck, or the 
elevation of the arms as high as possible above the head, are all of great prac- 
tical use ; in some instances the bleeding may be stopped by pressing upon 
the nostrils with the thumb and finger for some short space of time. It must 
be remembered that the head should be maintained in the erect position, as 
it is naturally. If these simple methods prove unavailing, a stream of cold 
water, containing a little perchloride of iron, tannin, or alum, directed through 
the nostrils, will stop the bleeding. The ultimate resort is the plugging of 
the nares, for an account of which see hemorrhage from the nose under arti- 
cle HAEMORRHAGE. 

Epithelium. This is a delicate cell membrane, which invests the internal 
and external surfaces of the body, and which is found lining the various cavi- 
ties. Over the skin, where there are several superimposed layers, it is known 
as epidermis ; but it is much thinner over the mouth, nose, lips, and fauces ; 
it is very thin all the way down the alimentary canal, which it lines through- 
out. The ureter, bladder, and urethra, the peritoneum or lining membrane of 
the abdomen, the pleura or lining membrane of the thorax, and the ventricles 
of the brain, all have a thin coating of epithelium. It is found in arteries and 
veins, and forms a large portion of the liver and kidney ; it occurs in the heart 



EPS 217 ERG 

and lungs, and in the various follicles and glands of the skin and mucous mem- 
branes. It not only serves as a layer to preserve delicate vessels and nerves 
from injury, but it takes an active part in the functions of secretion and ex- 
cretion. 

Epsom Salts, or Sulphate of Magnesia, are one of our most useful 
and most simple remedies. These salts are now commonly got by acting on 
dolomite limestone by sulphuric acid. Formerly they were got from wells or 
pea-water. They occur as fine needles, which are almost identical with those 
of sulphate of zinc, — a somewhat dangerous resemblance. In ordinary doses 
Epsom salts act as a saline purgative, giving rise to a speedy and free watery 
evacuation of the bowels. Given this way, two drachms or half an ounce 
would commonly be required ; but it is common to give it associated with in- 
fusion of senna, which constitutes the familiar black draught. The addition of 
a few drops of dilute sulphuric acid renders the salt more palatable. In this 
way it is best given in the morning, and is an exceedingly valuable remedy in 
cases where there is a tendency to biliousness, with irregular bowels and high- 
colored urine, such as occurs in men who habitually live too highly. 

Epulis. In the simple form, epulis is a fibrous or fibro-plastic tumor of the 
gum, of non-inflammatory origin, often at first connected with a carious tooth 
or necrosed alveolus. It usually commences in the periosteum between two 
teeth, or it may commence in the bony texture itself. ■ It is like the texture of 
the gum in appearance, lobulated and firm in its consistence, slowly increasing, 
and displacing the teeth in its vicinity by its growth. It frequently attains a 
large size, impeding speech and deglutition. With regard to the treatment of 
the simple form, the extraction of the tooth from which it appears to arise 
will frequently be sufficient, with excision of the growth, and the subsequent 
employment of a caustic, or, if the bone be implicated, by removing the portion 
so involved. 

A malignant form sometimes occurs, in which the bone becomes very early 
affected, and the mucous membrane of the cheeks and gums becomes involved, 
the surfaces ulcerating, attended with severe pain ; the patient assumes a 
cachectic aspect ; there is a profuse, fetid, bloody discharge, and the disease 
spread^ rapidly in all directions. Early excision is the only remedy. 

Ergot is the product of a peculiar fungus which attack the grains of rye, 
especially in bad years, and gives rise to a black-looking protuberance from 
the ear of rye. It contains a quantity of oil, and a principle called ergotine. 
Its best preparation is the liquid extract, but it may also be used as an infu- 
sion, if freshly prepared. Ergot exercises its powers, whether directly or in- 
directly, mainly on unstriped muscular fibre. Hence it acts especially on the 
minuter blood-vessels, and still more markedly on the womb, especially during 
pregnancy and at the period of child-birth. Its main use, indeed, in medicine 
is to stimulate the womb, and cause it to contract during delivery. But it 
must always be used with care, for if given in unsuitable cases it may prove 
fatal to both mother and child. Of the powder of ergot twenty or thirty grains 
are given after infusing in water for twenty minutes, grounds and all ; of the 
liquid extract the corresponding dose would be about thirty minims. Ergot U 
frequently of great value in flooding after labor, especially if this arises from 
imperfect contraction of the womb and the retention of blood-clots. From its 
effects on the smaller arteries, ergot, if long taken, may prove dangerous. It 
causes such contraction of their calibre that blood is prevented from reaching 
the extremities in sufficient quantity to keep them alive, and so a kind of mor- 
tification, such as sometimes occurs in old men, follows. This only occurs 



ERG 218 ERY 

from eating rye bread made of badly prepared grain, containing, consequently, 
much ergot. 

Ergotism is the name given to the effects of ergot eaten in impure rye 
bread in the individuals thus fed. See Ekgot. 

Eructation is a term applied to the rising of gases into the mouth from the 
stomach ; it is often a sign of indigestion. 

Eryngo, the Sea Holly {JErryngium maritimum). It grows abundantly on 
almost every sea-coast. A decoction of the root, when made of sufficient 
strength, is said to act on the kidneys and liver, and is useful in cases of con- 
gestion. 

Erysipelas of the face is a disease of pretty frequent occurrence. It is 
rarely seen in children, but it attacks adults of both sexes. It conies on with- 
out apparent cause in many cases, but sometimes a blow or exposure to a cold 
and cutting wind sets up the inflammation. It usually begins at the ear or one 
side of the nose, and then the redness and swelling extend over that side of the 
face ; more rarely it crosses over the median line and affects the whole of the 
upper part of the face. Pain and tingling precede the inflammation, and 
when the latter has reached its height the eyelid is so swollen that it cannot be 
opened; the ear is large, red, and flabby, while the skin adjacent is swollen, 
red, and painful. Erysipelas is, in fact, an inflammation of the skin, and it is 
severe according to the depth to which this tissue is implicated. Sometimes 
only the upper layer is affected, and then the appearance is like that seen in 
erythema. There is but slight swelling, and the constitutional symptoms are 
not severe ; but if the whole thickness of the skin be attacked, and, in addi- 
tion, the loose cellular tissue beneath, then the inflammation is of graver im- 
port, and may spread over a large area. There is, from the first, a high tem- 
perature, quick pulse, thirst, often a sore throat, loss of appetite, and a thickty 
coated tongue. The patient feels very restless, and sleeps badly at night ; in 
many cases delirium comes on towards evening, and this is mostly observed in 
those previously addicted to intemperate habits. The bowels are often consti- 
pated, and the urine high-colored, and containing a little albumen. The mu- 
cous membrane of the throat is of a dusky purple color, and swollen in some 
cases, and when erysipelas attacks this part also, it adds to the danger t>l the 
patient by preventing deglutition, and even by causing suffocation. Erysip- 
elas of the face, without any other complication, usually runs a course of six or 
seven days, when the temperature rapidly runs down, the tongue begins to 
clean, and all the febrile symptoms disappear, leaving the patient weak and 
anaemic. But if the inflammation has affected the deeper layers of the skin, 
or if the patient has been previously in bad health, matter or pus may form 
beneath the scalp from extension of the disease upwards ; when this occurs the 
pus soon burrows about under the scalp, and therefore, when this takes place, 
an opening must be made to let the matter out at once. Treatment: The 
patient must be kept in bed, and fed on light and nourishing diet. The light 
should be kept off the patient's eyes, and the access of air to the inflamed skin 
prevented by dusting the surface with flour, or smearing the part gently with 
a mixture of equal parts of castor oil and collodion, or castor oil alone may he 
used. It effectually keeps off the air, and relieves the tightly stretched skin. 
Some opening medicine may be given at first, if the bowels are confined and 
the tongue much coated. As a rule, the disease will get well with careful 
nursing in a few days ; but if the throat be much affected, the case must be 
watched, and means taken to subdue the swelling. During convalescence, 
tonics, containing iron and quinine, may be given, and for some time any ex- 



ERY 219 ERY 

posure to cold winds, etc., should be avoided ; great moderation in the use of 
intoxicating liquors should also be exercised. 

Erysipelas, Surgical. In the great majority of cases of erysipelas, and 
especially of the more severe forms, the disease has its starting point in a 
wound, open sore, or large ulcer on the surface of the body. Given a recent 
contused or lacerated wound on the scalp or the skin of the leg, in a badly 
nourished and debilitated individual living under faulty hygienic conditions, 
erysipelas will most probably show itself in one of the two following forms, 
simple or cutaneous erysipelas resembling in all respects the affection which 
frequently attacks the face in the absence of any wound or local irritation, 
and the characters and treatment of which have been described. In some 
cases of contused wound of the scalp the redness, swelling, and blistering of 
the skin of the face are associated with much pain and tenderness over the 
whole of the head, and a hard, brawny condition of the scalp. The patient, 
after an attack of intense shivering, becomes very hot and feverish, and often 
loses his senses, and raves violently. The tongue becomes brown, and the 
pulse very rapid. In the course of thirty-six or forty-eight hours the condi- 
tion of the scalp undergoes a change ; it is no longer hard and tense, but now 
very puffy, and raised from the surface of the skull by a collection of fluid, 
which subsequently, if not let out by the surgeon, breaks through at one or 
more points, and shows itself as thick yellow pus or matter. Occasionally 
considerable portions of the skin are destroyed, and bone is very often laid 
bare. If the patient should survive the acute stage of this dangerous affection, 
the erysipelatous redness and swelling disappear, the fever and delirium sub- 
side, and the sloughing wounds on the head are replaced by ruddy ulcers, 
which heal rapidly as the general health improves. In many cases, however, 
death occurs from one or more of the following causes : the' intense general 
action of the erysipelatous affection, which seems to poison the whole mass of 
blood ; pain and cerebral excitement ; a general affection resembling typhoid 
fever, which is associated with formation of abscesses in the liver, lungs, and 
some of the joints ; purging and hectic fever ; exposure and death of a portion 
of skull; and formation of abscess between the inner surface of skull and the 
upper surface of brain. This, which is called the phlegmonous form of erysip- 
elas, may occur after an external injury at any part of the surface of the body 
or limbs. It is often seen after severe contused wounds or compound fractures 
of the lower extremities. There is yet another variety of erysipelas, called 
diffuse cellular inflammation, which may present itself in connection with local 
irritation or an open and discharging surface, but which is generally due to 
the introduction into the system of some animal poison, as in dissection- 
wounds, the bite of a horse, or in snake-bites. Here there is much swelling 
and hardness of the affected part, intense pain, and rapid sloughing, with 
formation of spreading abscesses. The constitutional symptoms are very 
severe, and death generally takes place on the seventh or eighth day, and 
sometimes eailier. The essential cause of erysipelas, though as yet not well 
determined, seems to be a poison engendered from putrid animal matter. The 
predisposing causes are to be sought for in the affected individual, and in the 
condition as to ventilation, living, and the like, under which he is placed. Ex- 
posure to cold, fatigue, and indiscretion in diet are also predisposing causes. 
Of all the causes predisposing to erysipelas, deficient ventilation is probably 
the chief. In the treatment of wounded individuals, care should be taken 
to remove all sources of foul and unwholesome exhalations, and to keep up 
a constantly renewed supply of fresh air. Unremitting attention should also 



ERY 220 ERY 

be paid to the cleanliness of the patient and everything about him. The bed- 
linen ought to be frequently changed, and not be, allowed to remain when 
soiled by discharge. The motions should be at once removed, and a solution 
of carbolic acid, chloride of lime, or some other antiseptic be poured into the bed- 
pan. The wound or raw surface should not be wiped with a sponge, but with 
tow or cotton wool, which must immediately be thrown away or destroyed. 
The patient's bed-room should be emptied of all but indispensable articles of 
furniture, and bed-curtains be at once removed. The treatment of phlegmo- 
nous erysipelas and diffuse cellular inflammation consists in supporting the 
strength of the patient by alcoholic stimulants and by tonics, the most effect- 
ual of which are quinine and the tincture of perchloride of iron. The bowels 
should be freely relieved from time to time. Bleeding and the application of 
leeches are now but rarely resorted to, and then only in cases of threatening 
inflammation of the brain in strong and full-blooded patients. Ammonia is 
a valuable medicinal agent in bad cases of diffuse cellular inflammation from 
snake-bites and animal poisoning. In the local treatment of the severe forms 
of erysipelas, various agents have been used. Of these perchloride of iron, 
sulphate of iron, tincture of iodine, and nitrate of silver, or lunar caustic, have 
proved the most useful. When the swelling is soft and boggy, incisions must 
be made in order to let out the purulent fluid and shreds of gangrenous sub- 
cutaneous tissue. In the absence of surgical aid the simplest and best local 
treatment would be the application around the inflamed parts of flannels 
dipped into boiling water and then well wrung, or of linseed-meal poultices, to 
which, when there is a profuse and ill-smelling discharge of pus, charcoal, car- 
bolic acid powder, or chloralum should be added. 

Erythema is the name given to an eruption of the skin which is attended 
by a diffuse redness over a larger or smaller tract of skin. This disease is 
something like a mild attack of erysipelas, and in some cases may shade into 
it, but it is much less severe in character, and although troublesome is not 
dangerous. Unlike erysipelas, it is not confined to the face and head particu- 
larly ; it is not attended with inflammation of the true skin, nor with any 
marked pain or fever. When the skin is dry, as in old people, and when it 
has somewhat lost its elasticity, it is very apt to become erythematous; the 
face and neck may become in this condition from walking out in a cold north- 
east wind. These simple cases may be treated by resting the affected part, 
keeping it covered up from the air, and bathing it with tepid water several 
times a day. Another kind, which is more important but still very curable, 
has been styled " erythema nodosum." It is generally seen in children, and is 
found in the form of dirty purplish patches in front of the shins. These are 
raised above the surface, and are painful on pressure ; they are worse after 
walking about. This state is due to blood and serum being effused under the 
skin, and it is thus different from the other variety. With rest in bed. plenty 
of nourishing diet, such as milk, meat, strong beef-tea or broth, and a little 
medicine of ;t tonic character, a cure soon takes place. This form is some- 
times met with in cases of rheumatic fever. It more frequently affects young 
women and girls than the male sex ; yet it is met with in feeble boys. There 
is slight fever with it, and a feeling of languor and discomfort. Red, elevated 
spots, oval in form, then come out in a few days, and they are generally situ- 
ated along the length of the limb or in a vertical direction. The lumps in a 
short time become purple, as if they were cold, and this in time dies away, 
leaving no mark behind. The disease, when it occurs, is met with in debili- 
tated persons, and therefore measures should be taken to improve the general 
health. 



221 





Fig xxxv u 



Pig xxxvi 




•Fig XXXVI 1 1 



Fig xxxix 



PLATE VII. 



ESC 223 EVA 

Escharotics are such powerful chemical substances as when. applied to 
the surface of the body destroy the vitality of a portion of it, this subse- 
quently coming away as a slough or eschar. The most important escharotics 
are the red-hot iron, the strong mineral acids and alkalies, chloride of zinc, 
and the strongest acetic acid ; acting in a milder degree they are called caus- 
tics. Their chief use is to remove unhealthy growths, or such as by their 
own malignancy would destroy life, and so to obtain a clean surface after the 
slough has separated, whereby wholesome growth is promoted. 

Essences in the English Pharmacopoeia are preparations in which the 
volatile oil extracted from the plant by distillation is dissolved in spirit. The 
only two essences of this kind are essence of aniseed and essence of pepper- 
mint. The term is frequently employed for a more or less concentrated prep- 
aration of the substance whose name is attached to the title. 

Ether, more strictly sulphuric ether, is a liquid obtained from alcohol by 
abstracting water from the latter. It is a volatile, colorless liquid, with a pe- 
culiar smell and pungent taste. It is most frequently given internally, mixed 
with spirit. When so taken, or by itself, it is a powerful stimulant, acting 
more rapidly and passing away more speedily than alcohol. Hence it is use- 
ful to dispel wind from the stomach, to relieve asthma, spasms, and pains 
about the heart. It may be used locally, so as to freeze the part and so give 
rise to complete loss of sensation. This is sometimes taken advantage of in 
surgery ; and as it also produces insensibility when inhaled into the lungs, it 
is occasionally used for this purpose also. Indeed, anaesthesia was first pro- 
duced by ether in the United States, where it still maintains its place as an 
anaesthetic. It is generally considered safer than chloroform, although the 
practice of English surgeons is generally to use the latter. Given internally 
the dose of ether should not exceed half a drachm. 

Ether Spray. Of late years an ingenious method of producing " local 
anaesthesia " by freezing has been introduced by Dr. Richardson, with a view 
of rendering painless certain minor and superficial operations in surgery, such 
as removing small cyst's, opening abscesses, extracting teeth, toe and finger 
nails, etc. The apparatus is precisely similar to that adopted by the chemists 
for dispersing perfumes : thus one tube dips perpendicularly into a bottle of 
ether ; another tube is so arranged that a current of air blown through it 
shall cross the orifice of the first. This creates an upward-suction current in 
the first tube sufficient to lift the ether, and blows it away in the form of a 
fine mist or spray. 

Euphorbium can hardly be said to be used in medicine. It is, however, 
a violent irritant, whether applied externally or given internally. 

Eustachian Tube. See Ear. 

Evaporation is the slow production of vapor a't the surface of a liquid. 
It is through evaporation from the earth's surface that wet clothes dry when 
exposed to the air, and that open vessels containing water become emptied. 
Aqueous vapor rises in the atmosphere from the evaporation constantly going 
on from seas, lakes, rivers, and the moist soil. These vapors condense in the 
upper regions and form clouds, and finally return to the earth as rain, snow, 
or sleet. Evaporation is much increased by raising the temperature, which 
acts by increasing the elastic tension of the vapor ; its rate is also affected by 
the quantity *of the same vapor in the surrounding atmosphere; no evapora- 
tion could take place at all in a space already saturated with vapor of the same 
liquid, while it would take place very rapidly in air free from those vapors. 
Hence on a damp day evaporation takes place very slowly, while on a fine dry 



EVO 224 EXO 

day it occurs readily. It is evident, also, that a breeze, by renewing the air, 
•will increase evaporation, for if the air which surrounds the liquid be not re- 
newed, it would soon become saturated and evaporation cease ; the more fre- 
quently the air is renewed, the more evaporation goes on. The greater the 
extent of surface exposed, the more rapidly does this process go on. 

Evolution is a term variously applied to different changes going on in the 
body. The enlarged uterus in a case of pregnancy is said to be evolved from 
its simple elements, and an embryo is also said to pass through different stages 
of evolution on its way from the cell-elements of which it is at first composed 
to the complex structures met with in the infant. The term is also used by 
biologists to signify the development of man at different periods of the world's 
history. 

Exanthemata, a name applied to several febrile and contagious disorders 
which are accompanied by a rash or eruption on the skin : the group includes 
measles, scarlet fever, small-pox, chicken-pox, and erysipelas ; some also in- 
clude under this head typhus and typhoid fevers, but these are generally 
spoken of as continued fevers. 

Excisions. By excision is meant the removal, by operation, of a part of 
the body ; in surgery the term does not, however, include amputation. It is 
also applied to tumors or morbid growths requiring removal, or to any part in 
which such a growth exists, such as the upper or lower jaws, eyeball, tongue, 
etc. The remarks made in the article on incision are of course mechanically 
applicable to excision, the instruments for such proceedings being knives, 
saws, cutting forceps, scissors, chisels, gouges, elevators, etc. The excisional 
surgery of joints belongs to a section of surgery called Conservative Surgery 
or Conservatism. See Incision. 

Excretions. Whatever is no longer serviceable to the system is an excre- 
tion, and is thrown off by one or other of the organs of the body. Secretions 
are the healthy juices of the body, which enter into its composition, whilst 
excretions are the waste and useless parts which pass away either by the 
bowels, or bladder, or perspiration. 

Exercise as a remedial agent is too frequently disregarded so far as pre- 
venting is concerned. Its degree and kind is too often left to the patient him- 
self. The various kinds of exercise used to be classified as sailing, carriage, 
horseback, and foot, but practically may be limited to the three last. But 
these do not include the exercise of all the muscles. To do that, gymnastics 
must be employed. (See Gymnastics.) The grand rule in prescribing exer- 
cise is this : the patient should never feel actually tired or fatigued, but rest 
should be grateful after it. 

Exfoliation of Bone. When a superficial layer of bone (such as from 
the shin, for instance) dies and detaches itself, alter an injury or disease, and 
comes away as a scale, the bone is said to exfoliate. It is frequently noticed 
in the jaws after clumsy tooth extraction, or in the shins after blows or kicks. 
A lotion of weak nitric acid is the best application, and when the shell of bone 
is thoroughly loose it should be gently pulled away with forceps. 

Exophthalmic Goitre is a singular disease, of which the chief features 
are an undue prominence of the eyes, bronchocele or goitre, known by the 
swelling in the neck of the thyroid gland, and palpitation of the heart. ' It is 
of rare occurrence, and occurs in young people, being more common in women 
than in men, and in persons of a nervous temperament. It is a different 
disease from the common goitre. This malady is also known as Graves's 
disease. 



EXO 225 EXP 

Exophthalmos is a name given to the condition in which there is great 
prominence of the eyes, so that the individual has a marked and peculiar stare. 

Exostosis, a tumor connected with a bone, and composed of true bony- 
substance. In most instances the unnatural growth is made up entirely of 
bone, but occasionally is met with composed partly of bone and partly of car- 
tilage or gristle. The former is called a true and the latter a false exostosis. 
The bones most frequently diseased in this manner are the arm-bone at its upper 
end, the thigh-bone at its inner surface and close above the knee, the tibia or 
larger bone of the leg at its inner surface and upper extremity, the collar- 
bone, and the bones of the skull. Exostoses take the forms of flattened discs, 
large lumps with broad bases, and oval tumors mounted on a short bony stalk 
or pedicle. In the first two the structure is generally of ivory hardness ; the 
growths of this character are seated on the jaws and the bones of the skull : 
the oval and stalked varieties are most frequently met with in the bones of the 
extremities, and their tissue is more open and spongy. The causes of exos- 
tosis are very obscure. The growths are sometimes produced through blows 
or long-continued pressure. In patients suffering from advanced venereal 
disease, and in scrofulous children, hard painful tumors resembling exostoses 
in form and composition are often met with in different parts of the skeleton. 
These, however, differ from true exostoses in the rapidity of their growth, 
in the pain attending them — very acute in venereal disease, dull and gnawing 
in scrofula — and in their submission to medicinal treatment. True exostosis 
grows slowly, and is amenable to no treatment save a surgical operation under- 
taken for its complete removal. Exostoses, when seated on the bones of the 
trunk or the skull, may cause serious an:l even fatal consequences through 
their pressure on important organs. 

Expectation of Life. This subject is one of much importance to insur- 
ance companies, and tables have been constructed in order to show what is 
the likelihood of living a certain number of years at any given period of 
life. More boys are born than girls, but the greater dangers to which they 
are exposed, the harder life they lead, emigration, and other causes bring about 
an increased mortality among men, so that after the first few years of life 
females are more numerous than males. It will be seen from the accompany- 
ing table (I.), constructed in England, and used there for calculating the gov- 
ernment annuities, that of 100,000 boys alive at three years of age but 94,417 
will reach the age of ten ; while of girls the number will be 94,531. At fifty 
years of age the difference is much greater ; of females there will then be 
65,237 alive, and but 59,123 males. Nine females may reach the age of one 
hundred years, but none of the other sex. The table (II.) of Expectation of 
Life shows the average number of years a man or woman may expect to live 
on attaining any given age. See Tables on pages 226, 227. 

Expectorants are medicines or other remedies which promote the expul- 
sion of fluids from the air-passages. They are of a most diverse character, 
some soothing, some stimulating, some acting directly in altering the kind 
of the secretion, others in altering its quantity. See Ipecacuanha. 

Expectoration is the term applied to the fluid or phlegm which is coughed 
up from the air-passages; it varies much in different diseases : in pneumonia it 
is viscid, tenacious, sticks to the sides of the vessel, and is of a rusty appear- 
ance ; in bronchitis it is frothy, abundant, and often marked with black streaks, 
or it is thicker, and of a greenish-yellow color from the presence of pus ; in 
catarrh, the phlegm is often coughed up in pellets, which are black or iron- 
gray or yellowish in color, due to particles of dirt or smoke in the inhaled air. 
15 



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EXT 228 EXT 

In consumption the expectoration varies from a small quantity of frothy fluid 
to abundant greenish-yellow purulent phlegm. 

Extracts are forms of remedies in which some fluid preparation, infusion, 
decoction, or tincture has been gradually evaporated until a thick paste is 
formed. Some substances lose a good deal of their efficacy in the process; 
others do not. Remedies so prepared are usually given in the form of pill, 
the extract serving as the basis of the pill, and having, perhaps, other remedies 
in the form of powder conjoined with it. There are a few liquid extracts 
which are less dense than the ordinary ones; these are prescribed in minims 
instead of grains. 

Extravasation of Urine. By extravasation of the urine is meant its 
unnatural escape from the kidney, the ureter, or from the urethra. The causes 
of extravasation in each case are either the result of local injury, or the giv- 
ing way of any one of these structures from special reasons. Usually, how- 
ever, the term "extravasation of urine" is meant to convey the idea of the 
giving way of the urethra, and the infiltration of the urine into surrounding 
tissues ; as the result of a blow, a kick, or a fall on the perinaeum, thereby 
rupturing the tube, or from the preexistence of stricture, and a consequent 
preternatural distension of the bladder. When the urine is retained in the 
bladder and cannot escape per urethram, from whatever cause, ulcerative ab- 
sorption, as it is termed, takes place just above the point of obstruction, and its 
most frequent locality is in the membranous urethra, just behind the bulbous 
portion. The train of symptoms occurring from the escape of the urine are 
in general as follows : The sense of fullness of the bladder and inability to 
make water induce violent attempts at micturition, a sudden yielding takes 
place, followed by a great sense of relief, much to the patient's pleasure, but 
to his surprise no water flows from the expected channel owing to the giving 
way of the urethra, and the escape of the urine into the tissues. The effused 
urine soon excites great local irritation and inflammation, and most alarming 
constitutional symptoms. The scrotum, which is rapidly distended, becomes 
dark colored and quaggy to the feel ; the constitutional symptoms are those 
attendant on asthenic suppuration and gangrene, rapidly becoming more and 
more typhoid and ending in fatal collapse if unrelieved. All relief must be 
prompt and active : a free incision is to be made into the perinaeum, through 
the tissues, into the infiltrated structures, hot fomentations applied, and the 
patient's strength supported by wine or brandy, etc. It must be born in mind 
that the scrotum is not necessarily involved in these cases; thus, if the extrav- 
asation take place behind the bulb, the urine, being temporarily confined by 
the deep fascia, burrows, and thus the local signs are obscured ; in these cases 
the glans penis is frequently found to be hard, swelled, and black, indicating 
infiltration into the corpus spongiosum urethra, and this is a most alarming 
symptom, and in such instances free and complete incisions, such as would lay 
bare the source of extravasation, must be made at once. In cases of extrava- 
sation from local injury to the perinaeum, as in kicks or blows, etc., scrotal dis- 
tension is usually very sudden. A full-sized catheter should be passed into 
the bladder to allow of the escape of urine. In extravasation from rupture 
of the kidney, the different symptoms will be in proportion to the severity of 
the injury- The symptoms of such an accident are in general collapse, vomit- 
ing, pain in the loins and along the course of the ureter, retraction of the tes- 
ticle, and numbness of the upper part of the thigh. Such urine as would come 
through a catheter introduced into the bladder will be scanty, high colored, 
and contain a large quantity of blood ; this blood is often stringy and worm- 



BYE 229 EYE 

like, owing to the form given it by the ureter. If urine escape anteriorly, acute 
peritonitis is set up almost immediately ; if posteriorly, the symptoms of per- 
itonitis, perhaps, will not be so early marked ; but rigors, high fever, and a 
general typhoid condition soon make their appearance. Slight cases of rup- 
tured kidney, doubtless, frequently recover ; severe ones, never. Treatment : 
Absolute rest is the first thing, and the free administration of opium, and the 
urine drawn from the bladder daily until it becomes clear. In cases where 
the extravasation is posterior, on the possibility of suppuration, careful exam- 
ination should be made with a view of giving exit to the pus. Extravasation 
from rupture of the ureter has been recorded, but the cases seem somewhat 
obscure. Extravasation from rupture of the bladder has been already dis- 
cussed. See Bladder. , 

Eye, Diseases and Injuries of. The diseases and injuries to which the 
eye is subject may be most conveniently classified thus: (1.) Injuries and 
diseases of the appendages of the eye, that is, of the eyelids and tear-secreting 
apparatus. (2.) Injuries and diseases of the eye itself, that is, of the eyeball 
and its contents. 

(].) Eyelids. The eyelids are two thin movable folds placed in front of 
the eye, protecting it from injury. The upper is the larger, and has the most 
power of action, being provided with a special elevating muscle, the levator 
palpebral, which is absent in the lower one. The angles of junction of the 
upper and lower lids are called the canthi. At the margin of each eyelid at 
the inner can thus are seen two small conical elevations, the apices of which are 
pierced by a small orifice called the punctum lachrymale ; it is through this orifice 
that the tears pass into the nose. The eyelids are composed of the following 
structures taken in order, as in making a section from the surface : Integu- 
ment, areolar tissue, fibres of a muscle called orbicularis, tarsal cartilages, fibrous 
membrane, Meibomian glands, and conjunctiva; and in the upper lid is the 
tendon of the muscle before mentioned, the levator palpebral. 

The eyelashes, or cilia, are thick, short, curved hairs, attached to the free 
margins of the lids; those of the upper lid curving upwards, and those of the 
lower downwards, so that normally there is no interlacement of them. 

Diseases of the Eyelids. Owing to the number of structures which 
enter into the formation of the eyelids, there are necessarily a great number of 
diseases to which they are liable ; but in a work like the present we must con- 
tent ourselves with describing such as come most frequently under observation. 

Ptosis. Ptosis signifies a drooping of the upper lid, owing to paralysis of 
the nerve (the third), which supplies the levator palpebral muscle. The disease 
is sometimes congenital. 

Entropion. Entropion signifies an inversion of the eyelids, and in its 
simplest form is sometimes met with in children who suffer from ophthalmia, 
owing to spasm of the orbicular muscle. Collodion, painted on the skin of the 
lower lid, contracts the part into its proper position, while suitable remedies are 
to be used for quelling the existing ophthalmia (which see). The cicatrization 
following burns, acids, caustics, or severe and ill-dressed wounds is the fre- 
quent cause of entropion. In such cases, the means of cure lie in operative 
proceedings, a variety of which have been devised, and which, of course, must 
be modified to suit the exigencies of the case. 

Ectropion. Ectropion, the reverse of the foregoing condition, signifies an 
eversion of the lids. A spasmodic form exists, which is seen after purulent 
ophthalmia in infants. In adults a chronic form of ectropion occurs, as a result 
of thickening of the conjunctiva after purulent ophthalmia, or after burns, ex- 



EYE 230 EYE 

foliation of bone, etc., and which may be remedied by operation. By far the 
worst examples we have of ectropion are the result of burns or scalds, or indeed 
of the ravages of syphilitic ulceration, aud for the remedy of which a variety 
of operative proceedings, forming a branch of surgery termed " plastic," are 
needful. 

Trichiasis. By trichiasis is meant an irregular growth of the eyelashes, 
such that in some instances three or four lashes will grow inwards against the 
globe of tlie eye, setting up a sense of pricking, and a constant irritation and 
weeping of the eye. These lashes should be plucked out from time to time. 
A good, well-made pair of forceps, not too fine at the points, should be used, 
and the hair should not be jerked or twisted out, but gradually withdrawn by a 
slow, steady pull. 

Styes. These are small boils, beginning at the edge of the lid as a hard, 
itching, stiff-feeling knot ; suppuration and a discharge of matter follow in a few 
days, and the lid soon assumes its usual appearance. They are most common 
in children, especially those of a scrofulous habit. The state of the bowels 
should be attended to, tonics administered, and locally warm water fomentations 
or water-dressings applied. 

Ophthalmia tarsi is an eczematous inflammation of the edge of the lids, asso- 
ciated with a disordered secretion of the Meibomian glands already mentioned, 
whereby the lids stick together, and become encrusted with the dried secretion 
during sleep. Daily attention to the washing off of the accumulation, night 
and morning, is of the utmost necessity. As very minute sores exist at the 
roots of the hairs, they should be kept closely cut with scissors ; by this means 
the formation of crusts is diminished. The edges of the lids should be 
neatly smeared with the diluted nitrate of mercury ointment, or the red mer- 
curial ointment, or the oxide of zinc ointment, diluted with spermaceti or 
fresh lard. 

Crab Lice. A species of louse (phthirius), quite distinct from that infest- 
ing the scalp (pedi cuius), sets up an irritable condition of the eyelids from its 
presence. This rarely-met insect gives rise to a condition termed phthiriasis. 
The parasites are readily destroyed by smearing the roots of the lashes thor- 
oughly with the white precipitate ointment. 

Epiphora and Stillicidium Lachrymarum both signify an overflow of tears, 
but from different causes. In the first case it is owing to an over-secretion of 
the tears, and in the second it is owing to an obstruction of the little channels 
situated on the margin of the upper and lower lids {puncta lachrymalia), and 
which naturally conduct the tears into the lachrymal canal. An ordinary 
epiphora is usually due to some irritability of the eye, or the presence of some 
foreign body. Astringent lotions, aperients, tonics, and antacids appear to be 
the best treatment. In the case where the overflow is dependent on obstruc- 
tion of the puncta. an operation is necessary. 

Obstruction of the Nasal Duct, that is, of the tube which conveys the tears 
from the eye to the nose, generally occurs in strumous persons, and it com- 
mences with an overflow of tears in one eye, and a dryness of the corresponding 
side of the nose. 

Injuries. Ecchvmosis, commonly called a black eye, is the result. of an 
effusion of blood into the areolar tissue, immediately below the skin, generally 
caused by a blow on the eye. The best and readiest way of getting rid of the 
disfigurement is the application of a poultice formed of the freshly-scraped root 
of the black bryony mixed with linseed meal or bread-crumbs. The immediate 
application of tincture of arnica is generally of use. 






EYE 231 EYE 

The eyelids are of course subject, as other parts of the body, to growths of 
various kinds, which require the assistance of the surgeon, such as cysts, warts, 
naivi (mother's marks), carcinoma, and epithelial cancer. 

Wounds. In the instance of wounds of the eyelids, very fine needles, armed 
with fine silver wire, should be used, and the stitches withdrawn directly any 
inflammation or redness appears around them. Cold-water dressings should 
be lightly applied ; and attention to the bowels and diet are of importance. 

Substances in the lids or on the surface of the ey-e. See Foreign Bodies. 

(2.) Diseases of the Eyeball and its Contknts. Diseases of the Con- 
junctiva. The conjunctiva, the mucous membrane which lines the eyelids and 
covers the anterior surface of the eyeball, is subject to several severe forms of 
disease, namely, conjunctivitis or common ophthalmia. The eye feels as if dust 
were in it, hot, smarting, and dry. The eyeball is at first superficially red, and 
in severe cases there is considerable discharge. Chemosis is a condition where 
there is effusion of serum between the conjunctiva and the sclerotic, giving rise 
to great disfigurement by causing the conjunctiva round the cornea to become 
greatly swollen and elevated. Ophthalmia is generally caused by exposure to 
cold and damp, and irregularity of the digestive organs, A dose of calomel 
over-night, followed by a black draught in the morning, and bathing the eyes 
with poppy water or some astringent lotion, will generally produce a cure ; if 
there is great intolerance of light, a green shade should be worn over both eyes. 

Purulent Ophthalmia is a form of the disease which runs a very rapid course, 
terminating in destruction of the coverings of the eyeball, unless attended to 
very promptly and carefully. There are three kinds : the purulent ophthalmia 
of adults, or Egyptian ophthalmia; gonorrhoeal ophthalmia; and the purulent 
ophthalmia of newly-born children (Ophth. neonatorum). In the first form 
the inflammation is very severe, and attended with violent pain, and the forma- 
tion of thick yellow purulent matter. There is great swelling of the eyelids, 
and generally considerable constitutional disturbance and fever. Gonorrhceal 
ophthalmia resembles the foregoing very closely, but it is more severe, and runs 
a very rapid course ; it is caused by the contact of gonorrhceal or leucorrhceal 
discharges. The purulent ophthalmia of infants usually begins about the third 
day after birth, commencing in the lining membrane of the lids ; the edges then 
adhere, and a drop of thick white fluid escapes as the inflammation spreads; 
the lids swell, the discharge becomes copious, the child is restless and fretful, 
and there is great intolerance of light, a most characteristic symptom. The 
discharge is contagious in each case. The treatment of the purulent ophthalmia 
of adults consists, in the first place, of clearing the bowels by giving an active 
purgative ; if the pulse be feeble and the patient weak, quinine, bark, and am- 
monia should be prescribed. Plain food and stimulants in moderation are to 
be given, according to the patient's habits. If the patient be restless and irri- 
table, five grains of extract of henbane, or two drachms of the compound tinct- 
ure of camphor, with ten minims of chloric ether, should be given at bed-time. 
A solution of alum of the strength of eight grains to the ounce of water, or 
a solution of nitrate of silver, one grain to the ounce, should be injected with 
a small blunt-nozzled syringe under the lids every hour. The lids should be 
prevented from adhering by smearing the margins with citrine ointment. 

In the case of children the bowels should be kept freely open with castor oil, 
or a few grains of gray powder with magnesia. The eye should be frequently 
bathed with tepid water, and a solution of sulphate of zinc injected beneath 
the lids six times in the twenty-four hour§. 

Granular Conjunctiva. That portion of the conjunctiva which lines the 



EYE 232 EYE 

lids, and which is reflected on to the globe, is very often the seat of a rough, 
thickened-looking red papillae, a consequence of old-standing ophthalmia, caus- 
ing great pain, and disturbing the proper motions of the eye. It is best treated 
by counter-irritation outside the lids, such as a small blister behind the ear, 
and by endeavoring to improve the general health by iron, quinine, and, if 
possible, change of air. 

Diseases of the Cornea. The cornea is the transparent portion of the globe 
of the eye, through which the rays of light pass to the interior. In the 
healthy eye it is perfectly clear and highly polished in appearance, sharply 
and minutely reflecting any object upon its surface. In acute comeitis, the 
originally clear and polished appearance of the cornea becomes hazy, dim, and 
rough, red, or opaque. The margins adjacent to the sclerotic coat are vascu- 
lar, and the sclerotic itself at the point of junction is pink, owing to its in- 
creased vascularity. There is an abundant secretion of tears, and intolerance 
of light ; it most commonly affects strumous children, or it may be the result 
of injury. The treatment of inflammation of the cornea consists in subduing 
the inflammation by small doses of mercury, given with a tonic, such as 
quinine and ammonia; in very acute cases a leech or two to the temple, or a 
small blister behind the ear, and warm fomentations. All stimulating lotions 
are hurtful. 

Ulcers of Cornea. The cornea is very frequently the seat of ulceration, 
which may result from injury, scrofula, inflammation of the conjunctiva, and 
from insufficient, or non-azotized food. Three conditions are described . 
healthy, with a slight opacity from the adhesive effusion necessary to heal- 
ing ; the inflamed, with a vascular hazy circumference, requiring leeches and 
counter-irritants ; and a third, clear, transparent, cleanly cut, and indolent, 
requiring slightly stimulating applications. 

Staphyloma is a condition following perforation or disorganization of the 
cornea after ulceration, when any of the contents of the eyeball protrude 
through it towards the surface. 

Conical Cornea, is a rare form of disease, wherein the cornea is exceedingly 
convex, in some cases almost approaching to a point, with the apex central. 

Diseases of the Sclerotic. The sclerotic coat of the eye is that winch con- 
stitutes the apparent body of the eyeball. It consists of white fibrous tissue, 
and into it are inserted the muscles controlling the movements of the eyeball , 
it is pierced behind by the optic nerve and covered in front by the conjunctiva 
already described. It is subject to several forms of disease, and the most fre- 
quent is acute sclerotitis, or acute inflammation of the sclerotic, a disease fre- 
quently of rheumatic origin, though not necessarily. It is known by a pinky 
redness of the white of the eye, generally great intolerance of light, a sharp, 
stinging pain, general malaise, and severe supra-orbital pain. With regard to 
treatment, iodide of potass in small doses, with bark, or tincture of colchicum. 
seem the best constitutional remedies, and perhaps a small blister to the temple 
or eyebrow. 

Catarrho- Rheumatic Ophthalmia. This is a combination of conjunctivitis 
and sclerotitis, occurring most frequently in broken-down constitutions. Warm 
opiate collvria. such as sulphate of zinc, with liq. opii sedativ., and the afore- 
mentioned remedies for acute sclerotitis give most relief. Chamomile bags 
dipped in decoction of poppy- heads applied warm to the shut eye and forehead 
are frequently of great use in allaying the aching pain. The bowels should 
be kept well open, but not purged. 

Diseases of the Choroid. The choroid is the vascular coat of the eyeball, 



FAC 233 FAC 

containing pigment ; it extends over the whole of the posterior portion of the 
eye, and is continuous in front with the iris. It is pierced by the optic nerve. 
The coat is subject to an acute inflammation (choroiditis). 

Diseases of the Retina. The retina is the nervous coat of the eye, and lines 
the choroid. It is the most essential part of the eye, receiving the impression 
of light, and is very complex in its structure. Retinitis, an inflammation of 
this coat, is very rare, idiopathically, and is caused by exposure to vivid light, 
the glare of snow or of burnings sands. 

(The diseases of the lens and iris are separately considered, under the arti- 
cles Cataract and Ikitis.) 

Squinting, or strabismus, is a want of parallelism in the position and motion 
of the two eyeballs. The usual forms are the convergent and divergent. The 
convergent is most common in young persons, and is that in which the eye is 
turned inwards. The divergent is more uncommon, and is most frequently 
met with in elderly persons, the eye being turned outwards, generally from 
partial paralysis of the inner rectus muscle. If the deformity be only of a 
few weeks' duration, it may be removed by judicious medical treatment ; 
but if the squint be of long standing and habitual, and if there be inequality of 
vision, the operation of dividing the internal rectus muscle must be performed. 
It is performed thus: the patient, if a manageable adult, should be seated 
on a chair, or if a child laid on a table and etherized, and the eyelid of the 
affected eye, being held apart by a spring retractor, the surgeon pinches up a 
slight fold of the conjunctiva with a pair of fine forceps, opposite the lower 
edge of the inner rectus, just behind its insertion into the sclerotic ; and then 
the tendon of the muscle is sought for and pulled down witli a blunt hook, 
and, lastly, the tendon is freely divided with a pair of blunt-pointed scissors. 

Short-sight, or myopia, is where the parallel rays of light are brought to a 
focus before they reach the retina, caused either by the refracting power of 
the eye being too great, or its antero-posterior axis too long. With regard to 
treating it, all minute work must be avoided, and carefully adjusted spectacles 
should be worn. 

Long-sight, or presbyopia, is a failure of vision for near objects. The near 
point is, in this condition, removed too far from the eye. Spectacles should 
be used, the lenses of which cause the type of a book to appear bright and dis- 
tinct, but not larger than natural, when held ten or twelve inches from the 
eye. 

Hypermetropia. In this case the parallel rays are brought to a focus be- 
hind the retina, and not upon it, and after some time of employment print be- 
comes dim, the lines run into each other, and the eye feels hot and dull. It 
.can be remedied by the use of well-chosen convex spectacles. 

Astigmatism is " irregular refraction, in which different meridians t>i the 
same eye have different power of refraction." Thus certain lines, for instance, 
appear clear and well defined, whilst near ones are indistinct and blurred. 

F. 

Face-ache is a form of neuralgia, sometimes depending on unsound teeth, 
and at other times on an anaemic and debilitated state of the system ; it is not 
uncommon during pregnancy, or during the period of lactation ; it is then 
associated with general pallor and weakness. A liberal diet and tonic medi- 
cines, especially quinine, give the greatest relief. See Pain and Tic. 



FAC 234 F^EC 

Facial Paralysis. See Facial Palsy. 

Facial Palsy is a form of paralysis, which affects more or less completely 
the muscles of expression ; these muscles are supplied by the seventh pair of 
nerves, and any injury to this nerve, either at its origin in the brain or in the 
course of its distribution to the muscles of the face, will give rise to palsy or 
loss of motion. This disorder is often associated with hemiplegia of the arm 
and leg on the same side (see Hemiplegia) ; the injury is then dependent on 
disease of the brain on the opposite side, and it may be due to a clot in the 
vessels, or to haemorrhage, or to white softening ; in these cases the facial 
palsy is always partial, and the patient can always have some movement of the 
muscles of the face ; if the person lives, the paralysis often passes off in a few 
weeks, and no special treatment is required. A more common cause of this 
affection is exposure to a draught of cold air, as by sitting next an open win- 
dow when traveling, or when a cold east wind is blowing ; the paralysis is 
then very complete, and is unaccompanied by any other affection ; the attack 
is quite sudden and begins by slight pain and numbness over the cheek, fol- 
lowed by inability to laugh or close the eye on that side. As the opposite 
side is healthy, the muscles draw the mouth over to that side, while the par- 
alyzed muscles lie flaccid and useless. This disorder is at first very apt to 
alarm those who are attacked, but no fear need be entertained, as it is a very 
harmless affection, and recovery will go on gradually and be complete in six 
weeks or two months without any treatment being adopted. Since the eye 
cannot be closed well, it should be lightly covered over by a handkerchief, so 
as to prevent any dust getting into it and so setting up irritation. A more 
dangerous form presents itself in cases of disease of the bones of the ear, which 
may occur in the course of syphilis or scarlet fever ; then the facial palsy 
comes on gradually, when the patient is suffering, or has lately suffered, from 
one of those diseases ; there will be great pain over the ear of that side, and, 
perhaps, some discharge and deafness. The treatment must be directed to 
the constitutional affection, while the pain may be relieved by hot fomenta- 
tions and poultices. An enlarged gland on the side of the neck may cause 
facial palsy, but this will pass off when the gland returns to its usual size; 
steel wine and cod-liver oil may be given for this purpose. A severe blow 
over the ear, or a stab with a knife over the same part, may cause this dis- 
order by destroying the nerve just as it emerges from the bones of the skull ; 
in some of these cases the nerve may be so injured that permanent paralysis 
results. 

Faecal Accumulation is a not unfrequent consequence of the habitual 
use of strong purgatives, especially in elderly females. The proper stimulus to 
the gut is distension ; when it is full at one particular part, it has a tendency 
to evacuate its contents. But if the stimulus is unheeded or resisted, then as 
time goes by the fluid from the fasces is absorbed by the gut and they become 
hard, and wedged into the bowel apparently, what is technically termed im- 
pacted. Many people, the subjects of constipation, only have their bowels 
opened after they use purgative medicines, and they too often have recourse 
to the more powerful remedies for this purpose. Of these, compound colocynth 
pills may be taken as an example, though not the most injurious one. Elderly 
females are particularly prone to this mischief. The part of the bowel where 
these most frequently accumulate are the beginning and end of the great gut, 
the coacum and the rectum, though frequently the whole of the large intestine 
is blocked up in this manner. Not un frequently such accumulations have been 
taken for tumors of a very different kind. In dealing with such accumulations, 



FMG 235 FAI 

powerful drastic remedies are to be avoided, and gentler remedies, like castor 
oil and Glauber's salts used, and if remedies given by the mouth fail, enemata 
must be employed. See Constipation. 

Faecal Vomiting, or the vomiting of substances already converted into 
ordure, may arise from various causes, but the essence of them all is arrest of 
the passage of the refuse food downwards, so that it passes upwards again 
when converted into faeces, all downward passage being denied. Hence it is 
a symptom of various import ; in perhaps the majority of cases it indicates 
strangulated hernia (which see). But it may also arise from other forms of 
obstruction, such as twists of the gut. Even great accumulation of faeces, 
from the bowels having been long unmoved, may give rise to this symptom. 
Another cause, though a less frequent one, is a communication between the 
great gut and the stomach, which does sometimes occur, and then a mingling 
of the contents of the two takes place. In this way faecal vomiting occurs 
from passage of the faeces into the stomach, and undigested food is passed by 
the rectum. As to treatment, that resolves itself into removing the cause of 
the obstruction if possible. Each much be dealt with on its own basis. That 
form most amenable to treatment is the one due to faecal accumulation without 
any distinct cause. See Faecal Accumulation. 

Faeces, the*excrementitious contents of the bowels, on the proper nature of 
which health very generally depends. The color of the excretion depends on 
the admixture of bile with the mass of refuse which passes from the stomach 
into the bowels. When healthy it should be of a light brown color and mod- 
erate consistence ; the presence of too much or too little bile is indicated by 
the dark or light color of the motions as the faeces are called in the common 
language. 

Fainting. See Syncope. 

Faintness, though produced by many different causes, may be said to de- 
pend in all cases on impaired circulation in the brain, however brought about. 
In itself it constitutes a peculiar sensation, and people are often accustomed to 
speak of being faint, when faintness, as we here use the word, is very far from 
being present. In such faintness as we now speak of, the countenance, includ- 
ing the lips, becomes deadly pale ; the muscles relax, so that the individual can 
no longer stand erect and will fall, or does fall, if he does not lie down ; the 
skin, too, is relaxed and is covered with a cold perspiration ; there is an uncom- 
fortable beating of the heart, indicating imperfect contraction of that organ, 
and if the pulse be felt at the wrist it will be found to be either extremely 
quick and feeble or else imperceptible. All these symptoms may be brought 
about in various ways. Thus pain, alarm, dread, and a great variety of men- 
tal emotions acting on a delicate system may give rise to it. A great number 
of affections connected with the bowels and other abdominal organs, espe- 
cially (he stomach, give rise to it. Interference with the heart's action, from 
whatever cause, is perhaps the most potent cause of all, and it is in this way 
these mental emotions act, affecting one special nerve, called the vagus, which 
in its turn affects the heart. This same nerve is distributed to the stomach, 
and it is probably through it that any irritation of the stomach causes faint- 
ness, not directly, but in a way we term reflex. Thus the irritant, whatever 
it may be, affects the nerve in the walls of the stomach ; by the nerve this ir- 
ritation or stimulus is conveyed to the brain, and from the brain a fresh stimu- 
lus is sent forth which affects the heart. One of the most powerful, if not the 
most powerful, cause of faintness is loss of blood, from whatever cause. If 
there is not enough blood in the body to enable it to carry on all its functions, 



FAL 236 FAL 

the brain requiring a good supply to carry on its work, these must be more or 
less interfered with. All this, however, must be but little apparent whilst 
the individual is lying quite flat and at absolute rest, but if he attempts to rise 
or to sit up, the extra exertion on the mucles of the body and the extra work 
to the heart in driving the blood to the head may be too much ; failure is the 
consequence, and so faintness, which may be deadly. Such an occurrence is, 
unfortunately, by no means unknown in midwifery practice after childbirth, 
where there has been great loss of blood. Faintness is by no means, however, 
without certain concurrent advantages. Thus, where an individual is bleeding 
from wounds, except the bleeding be artificially arrested, he is likely to perish. 
But if faintness should supervene, the lessened force of the circulation, due to 
interference with the heart, may give the blood time to coagulate, and so 
prevent further haemorrhage, as it is called. For the cure of faintness the 
first thing is to secure as favorable blood supply to the head as possible, and 
accordingly the patient should be laid down flat on the ground, with nothing 
under the head. It is better to place him on the face, lest the faintness bring 
on vomiting, and if the patient were lying on his back and unable to eject the 
vomited matters from his throat, some of it might be drawn by the breath 
into the windpipe and thus produce suffocation. Restoratives may be given, 
but not till the patient can fairly swallow ; before these, smelling-salts, burnt 
feathers, or any ordinary preparation of ammonia may be held to the nose. 
If the patient can swallow, it is better to give some stimulant internally, spirit 
of some kind, or ammonia, especially its aromatic spirit, commonly called spirit 
of sal volatile. Thirty drops of this on a piece of sugar do well. A small 
quantity of brandy diluted with warm water may be given, if this is not to be 
had. Spirit of chloroform also, called chloric ether, is another useful remedy. 
Thirty drops should be given. But it is far more important to let the patient 
lie quietly at absolute rest, without interference, than to bother him or her 
with a lot of remedies. Of course there are cases where another rule prevails, 
where the patient would die if something were not done, but these are not ordi- 
nary cases. 

Falling Sickness is a popular term applied in some parts of the country 
to an attack of epilepsy, commonly called Jits. 

Fallopian Tubes' are hollow canals forming appendages to the womb ; 
they connect the ovaries with that organ, and convey the ovum from the ova- 
ries into the uterus or womb. 

False Joints. There are certain bones in man which after fracture rarely 
become whole again, and the broken pieces of which do not usually unite in 
the ordinary manner by the deposit around and between them of new bone. 
The two fragments of a transversely fractured knee-cap, and the detached pro- 
cess of bone at the back of the elbow called the olecranon, retain a certain 
amount of freedom during the life-time of the individual, and are joined by a 
thick and flexible structure resembling, and indeed closely analogous to, nor- 
mal ligament or sinew. This failure of true osseous union, which is the rule 
in the knee-cap. the neck of the thigh-bone, the olecranon, and the back part 
of the heel-bone, occasionally follows the fracture of a long bone, where the 
surgeon usually expects at the end of six weeks or two months to find a hard 
mass of callous or bony deposit at the seat of injury, and restored continuity of 
the limb. In these cases the ends of the fragments remain movable, and the 
limb painful and useless. In most instances, after perseverance in the treat- 
ment for another mouth or more, the usual and expected result takes place, 
and there is enduring recovery. Occasionally, however, the continuity of the 



FAR 237 FAT 

bone remains broken and the fragments glide freely upon each other when- 
ever an attempt is made to use the injured limb. In the former case surgeons 
say that there is delayed or retarded union, in the latter that there is non-union 
due to the formation of a false joint. The opposed ends of the two long frag- 
ments of broken bone are reduced in thickness, and are connected like the 
fragments of a broken knee-cap by strong ligamentous bands, or are inclosed 
in a sac or capsule of similar tissue, the inner surface of which is lined by a 
smooth and moist membrane resembling the synovial layer found in healthy 
joints. In this latter case the ends of the fragments of bone are tipped with 
gristle or cartilage, and glide upon each other when moved by the muscles of 
the injured limb. Here there is a close analogy to the conformation of a sound 
and normal articulation, and hence the name of false joint which has been 
given more especially to this condition. Non-union of broken bones, except in 
those mentioned above, is an uncommon event. The bones in which union after 
fracture most frequently fails, or is retarded, are the humerus or arm-bone, the 
thigh-bone, and the bones of the fore-arm. Delayed union and the formation 
of a false joint may be due either to constitutional or local causes, or to these 
combined. The principal constitutional causes are the presence of diseases 
such as syphilis, cancer, and scurvy, which cause poorness of blood and general 
debility, profuse discharges, fevers of a low type, excessive bleeding, and se- 
nility. The withholding of an habitual stimulus is often a cause of delayed 
union. The following are some of the local causes to which the failure or de- 
lay of union has been attributed ; diminished supply of arterial blood in con- 
sequence of tight bandaging, wound and division of the nerves of the injured 
limb, much displacement and overlapping of the ends of the fragments, inter- 
position between the fragments of a small piece of bone and of a piece of ten- 
don or muscle. In the great majority of cases the condition is due to debility 
and premature removal of splints from the injured limb. For delayed union 
of a fractured bone the most effectual treatment is that which consists in im- 
proving the geieral health of the patient by allowing him a full and nutritious 
diet, and in keeping the limb at absolute rest and evenly and firmly compressed 
by splints and bandages, or by an apparatus of plaster of Paris. In obstinate 
cases where some kind of false joint has been formed, a surgical operation is 
generally indicated, the object to be attained by which is to set up inflamma- 
tion about the ends of the fragments. Inflammatory processes of bone gener- 
ally result in the deposit of irregular masses of new osseous tissue. In some 
cases union may be brought about by violently rubbing the ends together. In 
those cases that are less amenable to bloodless proceedings, the introduction of 
a seton, or of ivory pegs, or the simple puncture of the false joint with a long 
needle, are often resorted to by surgeons. Occasionally it is thought necessary 
to have recourse to more severe operations, and to cut down upon the rest of 
the false joint, and to saw off the ends of the fragments, and then, after drill- 
ing the bone above and below the breach, to secure the upper to the lower 
fragment by means of ligatures or metallic pins. False joint sometimes, and 
especially in children under the age of ten years, obstinately resists every treat- 
ment, and finally necessitates amputation of the limb. 

Farcy. See Glanders. 

Fat. See Adipose. 

Fatty Degeneration. See Degeneration. 

Fatty Heart. This is a not uncommon form of degeneration of the sub- 
stance of the muscular wall of the heart, in which the fibres become softened 
and friable, and the different cavities dilate, as they are less able to overcome 



FAU 238 FEI 

the pressure of the blood current. This disease is generally associated with 
changes elsewhere, and especially in the coats of the large vessels. It comes 
on in middle life or in old age ; often it is met with in those who have led 
intemperate lives, and chiefly in those who have suffered from delirium 
tremens. Those who are affected in this way generally suffer from debility; 
their skin is pale and flabby ; the cornea of the eye is marked by an areas 
senilis (see Arcus Senilis) ; they cannot walk fast or undergo any great 
exertion, as they suffer from shortness of breath, palpitation of the heart, and 
are very liable to prolonged and serious attacks of fainting ; sometimes this 
disease is accompanied with attacks of angina pectoris. The fatty change 
affects the left ventricle chiefly, and must be distinguished from fatty growth 
on the surface of the heart, which is of much less consequence, ami often found 
in stout people. Fatty heart is a common cause of sudden death, and the 
patient may fall down in the street, and after one or two gasps die in a minute 
or two ; hence it is very important for such persons to avoid any hurry or 
exertion or excitement of any kind, as such may prove fatal to them. Over- 
crowded and heated rooms are injurious. Care should be also taken to prevent 
the onset of any lung affection, as bronchitis or a common cold, and such 
people should wear flannel next the skin in the winter ; anything which tends 
to obstruct the free circulation of blood through the system tends to aggra- 
vate the disorder. See Degeneration. 

Fauces. The back of the mouth and the commencement of the pharynx, 
extending from the tonsils and uvula to the root of the tongue and the epi- 
glottis, and sometimes called the gorge. The fauces is often the seat of in- 
flammation, causing sore throat. 

Favus is a name given to a skin disease, usually occurring on the scalp, 
and sometimes met with in children ; it is due to a vegetable parasite called 
Achorion Schonleinii. . See Epiphyta and Parasites. 

Febrifuge. A medicine to dispel fever, such as quinine, bark, and 
arsenic. 

Febrile Disorders are complaints in which fever or a rise in temperature 
forms a prominent symptom. See Fevers. 

Feeding. See Diet. 

Feeding Bottle. The best kind is that which, having an elastic tube 
connected with the inside of the bottle, causes the infant to draw up the last 
drop of food in the bottle without imbibing air. The one point to be observed 
where a bottle is used by an infant is its scrupulous cleanliness. Much disorder 
of the bowels is caused in infants by the neglect of this; for a very small por- 
tion of the curd of sour milk which may have been carelessly left in the bottle 
will taint the whole of the fresh food, and give a fit of illness to the child. 

Feigned Diseases. Diseases are most frequently feigned among soldiers 
and sailors to avoid duty and to obtain exemption from service ; and by the 
beggar to excite sympathy, and thus to obtain the fruitful harvest of alms he 
often reaps. Others ofteu do the same to obtain better diet ; prisoners, to be 
exempt from prison labors ; whilst yet another and not uncommon class of 
feigned diseases are those in young women of an hysterical turn, who desire 
to obtain the sympathy of friends and neighbors. A good classification of 
feigned diseases is into fictitious and factitious; the former having no real ex- 
istence, the latter having actual existence, but being of artificial and voluntary 
origin, for it is wonderful what tortures malingerers will inflict on themselves 
or voluntarily undergo in order that they may attain their end. Frequently, 
among bodies of men, such attempts at imposture become epidemic, and can 



FEN 239 PEN 

be got rid of only by sharp measures. No fixed order will be here observed, 
but the above distinction may be borne in mind. Swellings of various kinds 
are often produced by soldiers and prisoners ; they tie a piece of string tightly 
round the arm or leg, and so a swelling resembling dropsy is produced. Such 
are easily discovered by watching the supposed patient for an hour or two, 
when its effects will have disappeared and no swelling be left. Windy swell- 
ing of the abdomen (tympanitis) is easily simulated by swallowing air, and as 
easily got rid of by a stiff dose of turpentine and castor oil. As for sores, 
manufactured or feigned, their name is legion. Ulcers of all kinds are favorite 
subjects of simulation. Corrosive substances are applied to a part either 
before or after the skin has been otherwise removed, and the sore thus formed 
is prevented from healing by similar means. Skin diseases are also frequently 
feigned. Ophthalmia is very frequently manufactured among soldiers. All 
kinds of irritants are used, and the right eye is generally the one affected. 
Vomiting is frequently simulated, especially by women. The habit once in- 
duced is easily kept up, and of course should lead to emaciation and an 
appearance of disease. Most frequently, though not always, this is not the 
case when feigned. Diarrhoea is also most frequently simulated by women, who 
will introduce all kinds of things into the motions. Alterations of the urine 
have been tried to be passed off in a similar way, and gonorrhoea has been 
feigned sometimes with the worst intent. Blood-spitting — haemoptysis — is 
a favorite disease among simulating females. Sucking the gums will generally 
induce it, and it is not easy to detect it. Careful watching will usually elicit 
the truth. Epilepsy of convulsions of any kind are favorite subjects of study 
and practice among rogues of the mendicant class. Among those who have 
much to do with such rascals there is a rather effectual, as being very powerful, 
way of detecting them. That is by thrusting some sharp body under the 
thumb nail of the malingerer. It is not pleasant, but is generally effectual. 
Paralysis of all kinds is frequently feigned, but it needs a skillful impostor to 
escape detection. Very frequently this is easy ; the physician makes an aside 
remark, apparently not intended for the patient's ear, stating that' such and 
such a symptom is not quite as usual. Having taken care to state the reverse 
of what is actually the fact, he will generally find not long after that the symp- 
tom has appeared exactly as he pretended to say it ought. Deafness and 
dumbness have often been feigned, sometimes with singular success. Blind- 
ness of various kinds and degrees is frequently feigned. Short sight used to 
be often feigned in the army among recruits. This was detected by giving 
the person long-sight glasses to read with. Of course, had he been short- 
sighted, this, with such glasses, would have been impossible. Usually the 
trick succeeded. Jaundice has sometimes been tried, as, indeed, have most 
diseases. Staining the skin with saffron or rhubarb was the commonest 
form of deception. Affections of the mind are very frequently assumed by 
criminals. See Insanity. 

Felon. See Whitlow. 

Fennel or Sweet Fennel, the fruit of Fcenicidum didce, grows in most 
parts of Europe. It is chiefly imported from Malta. It belongs to a group 
of plants of which hemlock is the type, but it has none of the properties of 
that plant. Its properties rather approximate to those of anise, coriander, 
caraway, and dill, all of which belong to the same group. These are described 
as being stimulant, aromatic, and carminative. Briefly, they are given mainly 
for flatulence and for gripes caused by it, especially in children. Fennel 
water is the preparation commonly made use of, or its oil may be given on 
sugar like oil of anise, and in the same quantity. 



FER 240 PEV 

Fern or Male Fern {Asplenium Filix mas) is a remedy of very great 
value in the treatment of intestinal worms. It grows in this country, and 
should be collected in the summer. The powder of the root may be em- 
ployed, but the preparation commonly used is made by steeping the powdered 
rhizome or stem in ether, and then allowing the ether to percolate through it. 
Partial evaporation of this leaves behind it a thick dark-colored liquid com- 
monly called oil of male fern ; technically it is termed a fluid extract. The 
ordinary dose of this fluid is thirty drops, which should be taken in any con- 
venient vehicle, such as an aromatic water, the first thing in the morning. 
Some time thereafter — about an hour or so — a small dose of castor oil should 
be given, just as much as will gently move the bowels, for the male fern has 
no effect that way. This will generally bring away the worm quite dead. 
This dose may be repeated on more than one occasion, if necessary. The 
worms against which male fern is most useful are of the tape or flat kind. It 
is useless for small round worms. See Intestinal Worms. 

Fever is an abstract term signifying a condition in which there is increased 
heat of the body accompanied by a quick pulse, furred tongue, headache, and 
a general feeling of languor. There may be also loss of appetite, thirst, and 
restlessness. All these symptoms are met with in inflammatory disorders, as 
pneumonia, pleurisy, and peritonitis, as well as in those cases which are classi- 
fied under the head of '•zymotic disease." Under the different special head- 
ings will be given a detailed account of each variety of fever ; it will therefore 
suffice for us here to give (1) a classification of the various kinds of fevers, 
(2) an account of the exciting and predisposing causes, and (3) the general 
treatment to be adopted. 

Classification of Fevers. For this purpose a simple arrangement may be 
made. Under the head of each fever will be given its history, mortality, 
causes, results, and degree of contagion and infection. The following are 
usually enumerated as fevers : — 

( Typhus fever. 
Continued fevers. j Typhoid, or enteric fever. 
( Relapsing fever. 
r Smallpox, or Variola. 
j Chicken-pox, or Varicella. 
Exanthemata. -< Scarlet fever, or Scarlatina. 
j Measles, or Morbilli. 
V Erysipelas. 
Rheumatic fever. Febricula. 

Puerperal fever. Yellow fever. 

Pvamiia. Intermittent fever. 

Diphtheria. Remittent fever. 

Cerehro-spinal fever. Milk fever, or weed. 

Most of these fevers are spoken of as " zymotic diseases." See Zymosis. 
The seven principal zymotic diseases are : small-pox, measles, scarlet fever, 
diphtheria, whooping-cough, fever (including those mentioned above as con- 
tinued fevers), and diarrhoea. Cholera also comes under this division, and 
other diseases which are less common. 

Causes: There is hardly any subject of more importance than the proper 
understanding of the causes of fever ; every year the returns of mortality 
show the enormous number of lives lost to the country by epidemic disorders 
which in many cases might be stamped out, or their ravages at least much 
lessened by simple sanitary arrangements. Yet it may be hoped that with the 
general diffusion of knowledge a time may come when the community will 
take a more active interest in the subject of public health, and that they will 



241 




Fig. xl. 




Tig. sli 



Fig. xlii. 



PLATE VIII. 



PEV 243 FBV 

bear in miud the old adage that "prevention is better than cure." In treat- 
ing of the causes of fevers, we shall here speak of those only in which a morbid 
poison is assumed or shown to exist. Of such diseases some are said to be 
contagious, some infectious, and some partake of both qualities. When a 
fever is said to be contagious, it is meant that another person in close contact 
with the one attacked is very liable to catch it ; thus measles and scarlet fever 
are very contagious affections, and often the disease will run through a whole 
family, one after another. When a fever is said to be infectious, it is meaut 
that although persons in the house are liable to catch the fever, yet actual con- 
tact is not essential; thus typhoid fever is an example ; but in truth the value 
of these distinctions is of very little use, as most of these disorders are conta- 
gious and infectious, and so no hard and fast line can be drawn. Typhoid or 
enteric fever is not what is commonly called contagious, yet it may infect a 
very large section of a community ; the way it spreads is pretty clearly made 
out. The stools of a person so affected may be thrown into a sewer or cess- 
pool ; now, supposing that the fluid portion percolates through the soil and 
drains into a well from which several families draw their daily supply of 
water, it is quite clear that in this way persons drink in the poison, and that 
therefore it must be absorbed by the stomach or intestines ; it has been shown 
over and over again that cholera may be communicated in this way. But again, 
the stools may be thrown into an open drain, and in this case, when there is a 
dry season and the drain is not well flushed, decomposition goes on and noxious 
exhalations are given off and may give rise to the disease. It is most proba- 
ble that decomposition of organic matter itself is a sufficient cause for the dis- 
ease, and thus sewer gases which leak from a worn-out pipe into a house may 
give origin to the attack. In these cases we breathe in the poisonous particles, 
and thus the virus enters by the lungs. In typhus, on the other hand, the 
poisonous particles are exhaled from the skin and breath of the patient, so 
that a person in daily contact with him is very liable to catch the fever by in- 
haling the virus. In yet other cases we may ourselves convey the poisonous 
elements in our clothes, letters, etc., to a third person, and this is often the 
case in scarlet fever, and also in puerperal fever. Causes are generally di- 
vided into predisposing and exciting causes. Under the first class may be 
enumerated age, sex, occupation, and country. Children are very liable to 
measles and scarlet fever. Typhus affects people in middle life, and the 
majority are attacked after thirty years of age. Typhoid, on the contrary, is 
met with in the young, and the majority are attacked under thirty years of 
age. Relapsing fever is met with at all ages pretty equally, but it is very 
rarely fatal. Small-pox may attack people at any time of life if not guarded 
by vaccination. Sex has very little, if t any, influence, although some are by 
their occupation more liable to catch some diseases than others. Country makes 
some differences ; thus there are several disorders, as yellow fever and dengue, 
met with in tropical regions, but not heard of in cold ; and again, typhus is 
more common in Germany than typhoid, while here both are very prevalent. 
The exciting causes are poverty, overcrowding, destitution, bad air, bad food, 
and bad water. It may be stated as a rule that typhus and relapsing fevers 
are met with in overcrowded courts and alleys, and originate in a badly-fed 
family ; but when once the disease has been started in a town or village it may 
soon spread i-apidly among the better class of inhabitants. Typhoid fever has 
been already mentioned as propagated by bad sewerage which taints the air, 
or by bad water. The other fevers are not so much affected by these condi- 
tions, but they seem to be communicable, and people of all classes are liable to 
the disease. 



FEV 244 FEV 

The treatment of fevers is a subject of the greatest importance ; in this class 
of diseases, more than in any other, the greatest benefit may be derived by care- 
ful attention to a few ordinary sanitary rules. With regard to ventilation, a 
distinction must be made between it and a draught. It is often very injurious 
for a patient to lie exposed to a draught of cold air, although this is often done 
under the erroneous idea that this is the way to ventilate. It is essential that 
all foul air should be removed from the apartment, but for this purpose the 
window may be opened three or four times a day while the patient is partially 
covered over, or if the weather be very warm the window may be open all 
day. A small fire is of great use in airing a room, as it aids the entrance of 
fresh air through the crevices of the door and window. The smaller the room 
the oftener the air requires renewal ; it is therefore wise to make use of a 
room as large as possible, and disconnected from the other rooms in the house 
where practicable. All useless furniture should be taken away, such as bed- 
curtains, ornamental hangings, carpets, etc., as these tend to retain noxious 
emanations, and may cause the spread of the disease afterwards to other 
people. The bed on which the patient lies should not be placed in a direct 
line between the door and window, as he is exposed to a draught every time 
any one enters the room. When the room smells close, let the window be 
opened a little way, so as to allow the heated, stuffy air to escape. The light 
from the window is sometimes very disagreeable to a patient, as in measles, 
typhus, etc. ; hence the blind should be drawn, or the bed be so situated as to 
prevent any annoyance in this respect. The temperature of the room should be 
about 05° Fahr., or even a little higher when there is any long complication. 

Cleanliness is also very needful ; for this purpose a mattress is preferable 
to a feather bed, as the soiled sheets can be more readily taken away, and the 
patient does not sink so low in the bed. All excreta should be taken away 
as soon as possible, and after being disinfected by pouring some Condy's fluid 
over them they should be thrown away. The patient's body may be sponged 
with warm water every morning unless he is very ill, and much comfort is 
experienced by having the hands, feet, head, and neck washed daily. In every 
case, at the commencement of an illness, a warm bath is very beneficial, as it 
opens the pores of the skin and may aid afterwards in throwing off the poison ; 
amongst the poor, who are often begrimed with dirt, it is most necessary. 
Another thing of great importance is the subject of diet. When a person is 
attacked with a high fever and has a furred tongue, the appetite for solid food 
is gone, and therefore all food must be given in a liquid state. In all fevers, 
and until the tongue begins to clean and the temperature commences to go 
down, milk is the main support we ought to give to the patient. If good fresh 
milk cannot be obtained, the preserved milk sold in tins is equally efficacious ; 
one tin will make three pints of good sweetened milk. Cold milk is often 
more agreeable than hot. Let the patient have something every two or three 
hours, and in very bad cases, where they can take very little at a time, it may 
be needful to give it every hour. Tea may be given, when desired, or a rice 
pudding with plenty of milk. It is bad to drink large quantities of cold 
liquids ; a little at a time should be given, so as to quench the thirst. In 
summer lumps of ice may be put in the milk. Beef-tea is a very useful article 
of food; to obtain the most nourishment, take coarse beef, cut it in small 
pieces, place them in cold water in a jar, and let them simmer in the oven for 
a few hours ; then, when cold, remove the fat, and warm up half a pint for 
the patient to drink. When the appetite returns and a desire for solid food is 
felt, much care should be taken for the first few days: a small piece of fried 



FIB 245 FIL 

sole or boiled mutton may be given with a little bread or dry toast; vege- 
tables are not good to take; jelly, blanc-mange, light puddings made of tapi- 
oca, arrowroot or rice may be given, and an egg for breakfast or tea. As a 
rule, for mild cases of fever, no stimulants at all need be given until the stage 
of convalescence, when two or three glasses of sherry may be given daily. 
Stimulants should be given with much caution in the early stages ; they fre- 
quently tend to congest the stomach and make the patient restless and 
oppressed, and prevent him absorbing the nutrient food, which is so essential 
for his well-being. If attention be properly paid to all these points much good 
will arise, and any one who aspires to be a good nurse will make such her 
careful study ; and let it always be borne in mind that in fever cases good 
nursing will do more than anything else to expedite recovery. Quietude is 
always advisable. When food is given only a little should be brought at a 
time, and that in a tempting form. The patient's strength should be saved as 
far as possible by avoidance of exertion or excitement, at least in severe cases ; 
he shoidd not be allowed to sit up, and when the sheets, etc., have to be re- 
moved the patient should be shifted from one side of the bed to the other 
without being taken out of the bed. Charcoal may be placed in a pan under 
the bed, as it has the power of absorbing noxious gases, or saucers containing 
Condy's fluid or solutions of carbolic acid may be placed about the room. 

Fibrine is a constituent of healthy blood ; when blood is drawn from the 
body it separates into a clot and an opalescent straw-colored fluid ; the clot is 
mainly formed of fibrine, holding in its meshes the red blood-corpuscles, which 
give it the dark color. It is composed chemically of carbon, hydrogen, oxy- 
gen, and nitrogen. It is sometimes found during life in the veins or arteries 
of the body, and may then give rise to clots in the vessels, forming emboli or 
thrombi. Later researches seem to show that fibrine arises from the chemical 
combination of two bodies, called respectively fibrinogen and fibri no-plastic 
substance ; coagulation of the blood will not occur unless both these bodies are 
present. See Blood. 

Fibrinogen exists in the plasma of the blood, lymph, and chyle. It re- 
sembles globulin very closely, and may be thrown down from serous exudations 
by the action of carbonic acid. Serous exudations are met with in cases of 
dropsy or anasarca. 

Fibroid Degeneration. See Degeneration. 

Fibrous Degeneration. See Degeneration. 

Figs are the ripe fruit, or rather inflorescences, of the fig-tree growing in 
# Asia Minor and elsewhere. When nearly ripe they are dried and exported. 
In medicine they are not much employed. They are supposed to have a 
slight laxative effect, and are contained in the confection of senna. Split 
open and heated they have been used from time immemorial as a poultice 
to boils and such like sores. 

Filaria Medinensis, or Guinea Worm, is the name of an animal para- 
site met with on the coast of Guinea, and in other parts of Africa. It pene- 
trates the skin of the feet and legs and causes painful symptoms. See 
Ectozoa and Parasites. 

Filters are used for purifying water for drinking purposes. The water of 
our rivers and ponds contains a varying amount of inorganic and organic 
matter, and since the presence of the latter is often attended with most in- 
jurious effects, it is necessary that careful measures should be taken to rid the 
water of these impurities. Rain-water and melted snow are very pure, and 
may be collected in clean vessels and drunk with impunity. Spring water 



FIN 246 FIN 

often contains lime salts, which render it "hard;" it will not then form a 
lather with soap, and is therefore not useful for domestic purposes ; such 
water may, however, be taken without injurious effects, although, if the lime 
salts are very abundant, a form of goitre or large neck may come on. But 
the case is different when the surface drainage manages to find its way into a 
well, for then organic matters enter and may give rise to typhoid fever and 
other diseases. The water supply from wells is by no means adequate to the 
quantity required daily in large towns, and therefore it is usual to collect 
water from an adjacent river into large reservoirs, and then pass it through 
filters for the sake of purification. Pure animal charcoal is now considered 
the best filtering material. It should be deprived of all the lime salts by 
washing it in hydrochloric acid. The particles of the charcoal should be well 
pressed together, and the water must not pass through too quickly. This 
substance removes, in a great measure, dissolved organic and mineral matter, 
as well as the suspended particles; it also takes away the color, so as even to 
make a muddy water quite clear and bright. It is said that the power which 
charcoal has of removing organic matter is lost after a time, but this power is 
restored by washing the filter with a little potassium permanganate. Charcoal 
also appears to exert an oxidizing change on organic matter, and converts it 
partially into nitrites. Vegetable and peat charcoal are both inferior to ani- 
mal charcoal. Magnetic carbide of iron, manganic oxide, silica, and charcoal 
may all be used with much benefit. The filters used at the present time for 
domestic purposes are generally made of animal charcoal or magnetic carbide 
of iron pressed into blocks, and these can be relied on. As there is a limit to 
all purifying power, the action of all filters is only temporary. The various 
substances which have been removed accumulate and block up the filter, and 
therefore the filters should be taken to pieces and cleaned every two or three 
months, or a dilute solution of potassium permanganate may be passed through 
to get rid of the organic matter, and then a little weak hydrochloric acid to 
remove the lime salts ; then pass through two or three gallons of distilled water, 
and the filter will be quite fit for use again. When a new charcoal filter is 
used, the water which first passes through should be rejected, as the substance 
of which the filter is composed gives off some substances to the water; a pre- 
liminary washing is therefore needed. A pocket filter is useful for soldiers, 
or for those who are traveling in a country where fresh pure water is not 
easily obtained. In hot countries it is often very rash for people to drink from 
the stream ; a common plan for purifying the water is to have two barrels of 
different sizes, one within the other; the outer one is pierced with holes at the 
bottom, and the inner one at the top ; the space between is filled with char-' 
coal and sand, through which the water percolates into the inner cask. Water 
should be boiled first, and then allowed to cool, or tea may be made and the 
cold tea saved for the next day ; this is a very refreshing drink. When the 
water supply is very short, advantage should be taken of every rainfall ; salt 
or brackish water should be distilled, as is done at Iquique and other tropical 
places on the west coast of South America. In a running stream, men and 
cattle should be watered at different places, the former above the latter; all 
washing should be done lower down the stream, and the excreta must not be 
allowed to contaminate the drinking water. 

Fingers. Supernumerary Fingers. This congenital malformation, which 
is called polydactylism, is often hereditary, and in most instances affects to an 
equal degree both hands. The most common form consists in a small though 
well-formed a;;d unmistakeable digit springing from the root of the fourth or 



PIN 247 FIN 

little finger at the inner side of the hand, and attached by a fold of skin. An 
additional digit is sometimes met with, springing from the outer side of the 
thumb. The presence of a supernumerary finger furnished with a long meta- 
carpal bone is a very rare event. Two cases are on record in which a double 
hand existed. The adjacent normal digit is almost always reduced in size. 
As supernumerary fingers form unpleasant objects, and are generally in the 
way when the child grows up and begins to use the hands, the surgeon usually 
advises their removal during the period of infancy, and whilst the abnormal 
growths are still small. 

Absence or defective development of one or more fingers is sometimes met' 
with, though much less frequently than the previous condition. 

Webbed fingers. In this condition the fingers, instead of being free and 
isolated, are bound together. This is a congenital deformity which usually 
affects both hands symmetrically, and in the same patient the toes almost al- 
ways are similarly affected. This deformity is due to persistence of a foetal 
condition of the digits which is present at the second month of intra-uterine 
life. A condition somewhat similar is sometimes observed as a result of 
severe burns or scalds of the hands, but in cases of this kind the affected fin- 
gers are surrounded by scar-tissue, and not by true and sound skin. In con- 
genital webbing of the fingers the extent of the deformity varies greatly in 
different cases. The fingers may be bound together along their whole length, 
or only as far as the first or second joint. The operative treatment of this de- 
formity, though not dangerous, is attended with much difficulty. Simple divis- 
ion of the web is quite useless, as the fingers always grow together again. 
This result may be obviated by passing some foreign body into the cleft 
whilst the wounds are closing by granulation. 

Congenital contraction. This deformity rarely implicates more than one 
finger. It is due to deficiency of integument, in consequence of which the 
finger is bent forwards towards, the palm. When an attempt is made to 
straighten the finger, a tight ridge of skin starts up along its concavity. It 
may generally be treated successfully by prolonged and continuous extension 
of the abnormally placed digit. 

Acquired contraction of the fingers is often met with in adult males, as 
a consequence of increasing rigidity and shrinking of the palmar fascia and 
other fibrous tissues that intervene between the muscles of the palm and the 
integument. These changes in the tissues of the palm are supposed to be 
due either to violent blows or to long-continued pressure ; and this view is 
supported by the fact that the affection in question is often observed in navi- 
gators, gardeners, carpenters, and those whose employment necessitates much 
compression of the palm. The finger most frequently contracted is the ring 
finger, and next the little finger. The thumb and index finger are never af- 
fected. The contraction comes on gradually, the patient at first experiencing 
some stiffness in the knuckle-joint. The finger is then turned forwards and 
cannot be raised, and after a time the adjoining fingers also become stiff and 
bent. When the affection is well-marked, the finger is bent forwards at the 
knuckle-joint, whilst at the second and third joints it is free and movable. 
The flexure of the distorted finger is occupied by a prominent and curved fold 
of skin, under which can be felt a tense hard band of the contracted fibrous 
tissue. This band is tense and rigid, and prevents the finger from being 
straightened. The patient is unable to grasp large bodies and experiences 
much pain when he attempts to move the fingers. This deformity cannot be 
relieved save by a surgical operation. This consists in dividing the skin 



FIS 248 FIS 

longitudinally along the summit of the fold in front of the bent finger, in 
dissecting this back and then in cutting across the exposed fibrous cord. 

Tumors. The bones of the fingers are the most frequent seat of cartilagi- 
nous tumors. These form hard rounded growths, which commence in child- 
hood or youth, and continue to grow slowly for twenty-five or thirty years. 
For descriptions of other affections and of injuries of the fingers, the reader 
is referred to other articles. See Nails, Whitlow, Paronychia, Frac- 
tures, and Dislocations. 

Fish, as Food. The class of fishes yields a larger number of species used 
as food by man than either birds or quadrupeds. There are but few fishes 
caught in the fresh water or seas of America that may not be eaten with im- 
punity. The flesh of some fish is poisonous, and upwards of twenty species 
are known that possess poisonous qualities. In some countries the only ani- 
mal food known is fish. The flesh of fish contains less nitrogenous matter than 
that of birds and mammals. It usually contains less oil or fat, and a larger 
quantity of mineral matters. Fish is not so digestible as butcher's meat, and 
therefore not so nutritious. Fish, when unfit for human food, acts as a valu- 
able manure. The skins of eels, soles, etc., may be converted into gelatine. 
Many fish are used for obtaining the oil which they possess, aud this is es- 
pecially the case with the shark and the cod. The livers of the latter yield 
the well-known cod-liver oil. 

Fish, Poisonous. That a certain number of fishes are poisonous is not 
to be denied, but the exact causes of their giving rise to symptoms of poison- 
ing are by no means clear. In a certain number of instances, undoubtedly, the 
quantity has had more to do with giving rise to them than the quality. In 
yet other instances the use of putrid fish has induced symptoms of poisoning. 
Various tropical fishes are poisonous at all times, but in this country shell-fish, 
as they are called, which at one time are undoubtedly wholesome, at others 
have given rise to poisonous symptoms. Chief among these are mussels. 
The symptoms produced are the same in almost all cases ; they are the symp- 
toms of slight irritant poisoning. Sickness and vomiting, sometimes with 
purging, and marks of prostration are those commonly observed. These it is 
not desirable to interfere with, but rather to promote until all the irritant 
matters have been expelled. After this a slight cordial or carminative 
draught, with a little iced water, a little brandy and soda water, or such like 
should be given to compose the stomach, when the patient will probably go to 
sleep and awake well. Lukewarm water or mustard and water should be 
given to aid the vomiting. Occasionally rashes on the skin are observed, but 
these require no treatment. 

Fissure of the Anus. This is generally a long and shallow ulcer situ- 
ated either within or on the verge of the anus. In most cases it is met with 
on the posterior wall of the anus in the median line of the body, occasionally 
on one side, very rarely in front. It occurs much more frequently in women 
than in men. The symptoms caused by this affection are considerable irrita- 
tion about the anus, and severe scalding pain with a throbbing sensation which 
comes on immediately after an evacuation, and gradually increases in intensity, 
aud continues for some two or three hours. After the pain has lasted for 
about three hours it gradually subsides, and the patient remains quite free 
from pain until the next evacuation. The general health at last becomes af- 
fected by the repeated attacks of pain, and the patient becomes weak, indo- 
lent, and sallow. There are often dull, heavy pains in the loins and groin. 
On local examination a small red fissure will generally be found just on the 



FIS 249 FLA 

verge of the anus ; this extends upwards along the mucous membrane of the 
rectum and measures from the sixth of an inch to half an inch in length. 
The ulceration but seldom implicates the whole thickness of the mucous mem- 
brane. The edges of the ulcer are generally smooth and level, but in ad- 
vanced and very bad cases they are thickened and elevated. The outer ex- 
tremity of the fissure is often covered by a small lump of thickened skin, or 
by an external j)ile. The causes of anal fissure are constipation and direct 
irritation of the mucous membrane of the rectum by purulent discharges, or 
by the contact of foreign bodies. The palliative treatment of this affection 
consists in the administration of sedative enemata, and rest'in the recumbent 
position. The patient should take a small dose of castor oil every morning, 
and pass the evacuations over hot water. The application of solid nitrate of 
silver (lunar caustic) or sulphate of copper will often produce a permanent 
cure. In most cases, however, the surgeon finds it necessary to advise an 
operation in which the base of the ulcer with more or less of the muscle be- 
low is divided by the knife. 

Fistula. In surgical language, a fistula means a narrow channel or tube 
leading to a cavity containing matter or dead bone, and lined with a membrane 
which secretes a puriform fluid. The fundamental cause of fistula is abscess, 
and the reason of the unhealed tract is an unhealed abscess, where proper out- 
lets to the discharge have not been made, or where some " foreign body " 
intervenes, such as a piece of dead bone. They usually exist in connection 
with the rectum, urethra, salivary glands, and bladder. With regard to treat- 
ment, all sources of irritation must be removed. If matter forms, it must be 
let out by what is termed a " counter opening" and the "fistulous tract" stim- 
ulated to healthy action by some such injection as a strong solution of nitrate 
of silver or nitric acid. The operation of' slitting up fistula? is in the hands of 
the surgeon. 

Fits. A "fit "is a term popularly applied to any condition in which a 
person suddenly falls down insensible, and has convulsions or not ; but as so 
many diseases are associated with the so-called " fits," the reader must refer to 
articles such as Coma, Convulsions, Syncope, Epilepsy, Intoxication, 
Apoplexy, Hysteria. 

Flanks, a term corresponding to the lumbar regions, on either side of the 
abdomen. See Abdomen. 

Flannel, though not strictly speaking a remedy, is one of the most valu- 
able means for preserving the health we possess. Its great virtue consists in 
that it prevents the body from being too rapidly cooled after being greatly 
heated. Flannel is a non-conductor of heat, even when saturated with perspi- 
ration, and so prevents the heat of the body from being wasted in evaporating 
the fluid after the body ceases to generate excessive heat. This great lowering 
of the bodily temperature is accompanied with danger, especially in the tropics, 
where it has been assigned as the true cause of ague. For similar reasons, an 
individual clothed in flannel will be able to resist exposure to cold and wet 
better than one clothed in a better conducting material. Such exposure, as 
we well know, is a frequent cause of rheumatism, and one attack of rheuma- 
tism almost invariably predisposes the individual to a second attack. It is 
therefore a good rule for individuals who have once suffered from this malady 
never to go about without flannels in future. Those, too, in whom the chest 
is weak should invariably wear flannels, especially when they go abroad in 
winter. Health resorts almost invariably have a great range of tempera- 
ture, broiling in the middle of the day, freezing almost at night, especially if 



FLA 250 FLA 

the wind blows. The only thing which will prevent the change doing harm 
instead of good, is appropriate clothing, of which the basis must be flannel. 

Flat-foot. Flat-foot (spurius valgus, see Club-foot) is said to exist 
when a person treads on the inner margin of the foot, the toes are turned out 
and the arch of the foot destroyed, and its cause is a general want of tone in 
the fibrous structures. In a slight degree it is common in young children, 
particularly females, in the upper classes, and can be greatly remedied by 
reducing their standing and walking, the avoidance of fast walking in the 
company of adults, tonics, attention to digestion, embrocations, and manipula- 
tion of the feet, so that inversion and contraction may be prevented. Laced 
boots, or boots with stiff leather sides, a cork, india-rubber, or felt pad under 
the inner margin of the foot, greatly assist in preserving the arch. 

Flatulence, or the undue collection of gas or air in the stomach or bowels, 
may be brought about in various ways. It may be swallowed, it may be formed 
from the food, or it may be apparently secreted from the wall of the stomach 
and bowels. It is a common and exceedingly unpleasant symptom of indiges- 
tion (see Indigestion), sometimes very hard to get rid of. It is also a very 
troublesome symptom in other diseases affecting the bowels and abdominal 
cavity. In a very great number of instances, flatulence is due to improper 
food, or the abuse of certain articles of food, especially tea. The symptoms 
produced by flatulence are often exceedingly unpleasant. There may be 
a feeling of faintness, of giddiness, or of choking, accompanied by most trouble- 
some belching. The gases thus expelled are most frequently tasteless aud 
odorless, and if so are most probably due either to swallowing of air, or to 
the formation of such simple gases as carbonic acid or carburetted hydrogen, 
at the expense of the food. Such forms of flatulence are best treated by 
dieting, mainly solid food with stale bread, a little dry sherry or weak brandy 
and water, but no vegetables, tea, beer, or pastry. Flatulence may often be the 
only symptom of such dyspepsia, and it is often capable of relief by a slight stim- 
ulant, as aromatic spirits of ammonia, but spirituous liquors should be avoided. 
A little acid, or alkali with a bitter, is often of very great service, and mix 
vomica is an exceedingly valuable remedy in such cases. Occasionally the 
patient is the subject of horribly nauseous flatulence. He belches up gas of 
the most horrid odors, disagreeable to himself and every one round him. These 
gases indicate putrefactive changes in the food, and commonly occur in individ- 
uals who have some obstruction preventing the passage of food from the stom- 
ach, especially if the obstruction be cancerous in its nature. In cases where 
there is such obstruction, the stomach sometimes expands to an enormous size, 
and vomiting after food is not unfrequent. In these vomited matters are mi- 
nute organisms called Sarcince, and these are supposed to have much to do 
with the development of the gas, just as the yeast fungus has in the formation 
of alcohol from starch and sugar with the evolution of carbonic acid. In all 
such cases the use of antiseptic remedies to prevent the putrefaction of the 
food is indicated. The two most important forms of antiseptic remedies are 
carbolic acid and sulphurous acid. Carbolic acid may be given in the dose of 
one or two drops in a wineglass of water, half an hour after food. Its taste 
is somewhat disagreeable, but it is exceedingly efficacious. Sulphurous acid 
may be given in the same way, thirty drops of the diluted acid in a wineglass 
of water, or it may be given as sulphite or bisulphate of soda. Flatulent ac- 
cumulation in the intestines may be due to any of the foregoing causes, but 
especially to putrefaction of the food, and apparently in certain cases to secre- 
tion of gases from the vessels in the walls of the gut. In children the other 



FLO 251 FLU 

variety is not uncommon, especially if they have been allowed to suck empty 
bottles or breasts, their thumbs, or the like, and they are fruitful , sources of 
gripes. (See Colic.) Flatus in the intestines often gives rise to very £reat 
pain, and the patient urgently demands relief. Perhaps the best remedy in 
such cases, if it can be borne, is turpentine. It tends, however, to upset the 
stomach, and so it is better given as an enema. If given by the mouth, about 
a drachm should be given for a dose; if as an enema, half an ounce or so, 
beaten up with an egg in a pint of hot water. 

Floating Tumors. This term has been applied to the singular hard and 
very movable lump which is sometimes observed in the abdomen, generally 
on the right side. In most instances the patients are women. No pain is 
complained of, but only an uncomfortable sensation due to the movements of 
the lump. Sometimes there is obstinate indigestion. On examination of the 
floating tumor, it will be found to be smooth, very firm, and generally of the 
size and shape of a healthy human kidney. It is very loosely attached, and 
can be moved over a considerable extent, both between the ribs and the haunch 
bone, and from side to side. The nature of this tumor has never yet been 
clearly made out. From its shape and consistence it has been supposed to be 
a kidney, which, in consequence ofjts loose attachment to the spine by fat and 
membrane, and of elongation of its vessels, has become freely movable. It is 
probable that in some cases it is an ovarian cyst. 

Flooding. See Labor. 

Flowers of Sulphur is a well known form of that substance obtained by 
heating the crude substance, converting it into vapor, and afterwards condens- 
ing the vapor in a cool chamber. This resembles a very fine powder, but mi- 
nutely examined it is crystalline. See Sulphur. 

Fluctuation implies the wave-like movement imparted to the hand when 
there is any accumulation of fluid in a part; it is often very marked in cases 
of ascites, and when an abscess is forming. 

Fluids, Atomized, though recently introduced into practice, have already 
become one of the standard and most frequently employed means of treating 
certain diseases at our disposal. They are commonly employed in the treat- 
ment of diseases of the nose, mouth, throat, larynx, and windpipe; occasion- 
ally too, for those of the lungs. The principle on which the fluids are atomized, 
as it is called, is tolerably familiar to all, in the shape of a toy for dispersing 
perfume in a room; one end of a glass tube is introduced into a bottle con- 
taining perfume, the other end being drawn to a very fine point. Another 
and similar tube is arranged and fastened at right angles to the former, so that 
its fine point terminates close to, and just above, the level of the fine point of 
the tube ending in the perfume. If now, one blows through the tube at right 
angles to the bottle, the force with which the air is driven from the fine point 
across the fine extremity of the other, creates a partial vacuum, in which it 
draws the fluid to the top. Thence it is dispersed in spray in the line of the 
current of air driven from the mouth. Of course this plan of driving by the 
mouth would be objectionable in practice, and so two kinds of apparatus have 
been invented: one, in which steam is driven through a narrow orifice instead 
of air, the fluid being drawn up from the bottle containing it as before. An- 
other is employed where the air is driven by means of a hand ball made of 
india-rubber. The fluids best adapted for use in this way are nitrate of silver 
in strong solution, from three to five or more grains to the ounce of distilled 
water. Sulphurous acid of pharmacopoeial strength is a most valuable rem- 
edy, administered in this way. Tannic acid, 20 grains to the ounce, is also 



FLU 252 FOO 

very valuable. Lime-water of pharmacopoeia! strength, or saturated liquor, or 
Condy's potassic permanganate fluid and water equal parts, liquor ferri perchlo- 
ridi of pharmacopoeial strength, are all excellent in their several ways. The 
diseases best treated by means of the spray producer are, first, those of the cav- 
ity of the nose; frequently, for instance, after scarlet fever, there remains a 
tendency to the formation of purulent matter in the upper part of the nasal 
cavity. This may go on to destruction of the bones of the nose, and the mat- 
ter discharged has got a terribly fetid odor. Smell is often completely and 
irretrievably lost, if the process goes on too long unarrested. For this and all 
similar disorders of the nose, a good strong spray is the best remedy ; it softens 
and breaks down the hardened masses, which form troublesome crusts, and 
after a time brings them away. This done, a bare surface is exposed to the 
spray, and healing follows. The best fluids for this condition are sulphurous 
acid and nitrate of silver. Condy's fluid too is not without its use. If the 
mouth can be opened widely, it is often better to make use of stronger appli- 
ances than the spray, but where the month cannot be opened, and its cavity is 
diseased, it is invaluable. The diseases it is mainly used in are tonsillitis and 
diphtheria, and syphilitic affections of the throat beyond the fauces. For these 
sulphurous acid of nitrate of silver is best, hut lime-water tends to soften the 
patches of false membrane in diphtheria. For regions beyond these, there is 
hardly any means of treatment equal to the spray. Inflammation of the larynx, 
whether of a common kind or due to tubercular or syphilitic states of the con- 
stitution, can hardly be treated in any other way. When there is ulceration, 
chloride of silver solution is perhaps the best remedy; if only inflamed, 
sulphurous acid may be tried ; if ccdematous, perchloride of iron will do good. 
The general symptom, hoarseness and loss of voice, may often be relieved by 
using hot vapor spray. (See Vapors.) In certain diseases of the lungs, the 
same apparatus may be employed, but otdy mild applications must be used. 
The diseases most likely to benefit in this way are croup, as it affects the 
windpipe, bronchitis, and phthisis, if the lungs are affected. The preparations 
thus made use of must be carefully adapted for each case. Plain hot water 
will, however, very rarely do harm. 

Flux implies a flow of fluid: thus, when the stools are very liquid, in some 
cases of diarrhoea, the patient is said to have a watery flux; or a bloody flux 
when blood flows from any cavity of the body. 

Foeticide signifies killing the foetus while yet in the mother's womb. 

Fcetus is the name given to the child when in the womb. 

Food is the term applied to all those materials consumed by man, and 
which are employed by the body to build up its fabric during growth, and 
renew the tissues which are lost during the performance of the functions of 
life. What fuel is to a fire, food is to the body. As fire transforms the fuel 
into other compounds, which it throws off, so the body transforms food into 
other substances during its vital activity. In the same manner as a fire dimin- 
ishes as the fuel is diminished, and goes out without fresh fuel, so the human 
body wastes with insufficient food, and dies from its absence. Just in propor- 
tion to the work a man has to do is the amount of food he should consume. 
Not only do those who work hardest require most food, but just in proportion 
to the extent of the appetite and the vigor of the digestion will be the ability 
to perform hard work. As it is with muscle-work, so it is with brain-work. 
The hard student consumes more food than the idle man who lounges about 
all day without troubling himself to think. The ultimate elements of the food 
we take are precisely similar to the ultimate elements of the human body. 



FOO 253 FOO 

(See Composition of the Body.) The principal elements which enter into 
the composition of the human body are carbon, hydrogen, nitrogen, and oxygen. 
These elements are sometimes called organic elements, because they enter into 
the composition of all the growing tissues of the animal body. It is princi- 
pally through the chemical relations of these elements that we find the func- 
tions of the body carried on. A human body weighing 154 
contain 



Oxj'gen 
Hydrogen 
Carbon . 
Nitrogen 



is founc 


I to 


Lbs. Oz. 




Ill 




14 




21 




3 10 





The other elements which enter into the composition of the body are called 
inorganic elements. They consist of phosphorus, sulphur, chlorine, fluorine, 
calcium, sodium, iron, potassium, magnesium, silicon. The compounds contain- 
ing these elements weigh about 5 lbs. 10 oz. Many of these compounds con- 
tain the organic elements ; thus, in the ashes of a human body weighing 
154 lbs., there is found 7 lbs. 9 oz. of ashes which contain mineral compounds. 
These compounds consist of phosphates, sulphates, carbonates, chlorides and 
fluorides of lime, potash, soda, magnesia, and iron. 

The compounds of the body in which the organic elements exist, and their 
weight in a body weighing 154 lbs. are as follows : — 

Water, containing oxygen and hydrogen 

Gelatine, containing the four elements 

Albumen " " " 

Fibrine ." " " " 

Fat, containing carbon and hydrogen 12 

Water is found everywhere in the body ; by its agency all other substances 
are taken up into the system. All food must contain water, and it is only by 
being dissolved in the water that the other substances can be used as food. 
The quantities of water found in 100 lbs. of different kinds of solid food are 
as follows : — 

Vegetable Food. 



Lbs. 


Oz 


Ill 





16 





4 


3 


4 


4 


12 






Potatoes .... 


Lbs. 
. . 75 


Rve 


Lbs. 
... 13 


Carrots 


. . 86 


Peas 


... 14 


Parsnips .... 


. . 79 


Rice 


... 13 


Manuel Wurzel . . 


. . 85 


Beans .... 


... 14 


Cabbage .... 


. . 92 


Bread .... 


... 44 


Flour 


. . 14 


Cocoa .... 


... 5 


Barlev Meal . . . 


. . 14 


Lentils .... 


... 14 


Oatmeal 


. . 13 


Buckwheat . . . 


... 14 


Indian Meal . . . 


. . 14 








Animal 


Food. 






Lbs. 




Lbs 


Milk 


. . 86 
. . 30 


Beef 


... 50 


Bacon 


Lamb 


... 50 


Veal 


. . 62 


Mutton .... 


... 44 



Fat is a very important constituent of the body ; it is found diffused around 
all the tissues. It is the fat that gives roundness and plumpness to the body. 
When it is deficient, persons are said to be " thin " or "lean." In wasting 
diseases, as consumption and scrofula, the wasting arises from the loss of the 
normal fat of the body. In such cases it is usual to recommend a fatty diet, 
and cod-liver oil or other animal oils (see Cod-liver Oil) are given. 



FOO 254 FOO 

Albumen and Fibrine are two constituents of the body which contain the 
four organic elements. Albumen differs from fibrine chemically, but very 
slightly. It is, however, soluble in water, and easily separable from it by heat, 
alcohol, nitric and other mineral acids. It is found dissolved in the blood, 
where it exists in the proportion of about four per cent. It constitutes the chief 
compound of nerve-matter, out of which the nerves are formed. It enters 
into the composition of the eggs of all animals. Its property of coagulating 
when boiled, forming the "white" of the egg, is well known. Fibrine is 
found in small quantities in the blood, but is principally distributed over the 
body, of the muscular tissues of which it constitutes a large proportion. 

Gelatine is much more conspicuous in the human body than either albumen 
or fibrine. It constitutes the cement of the bones, and is the substance out of 
which the cell walls of all the tissues of the body are formed. It is the waste 
of these substances that renders food necessary. They do not, however, waste 
with equal rapidity. "Water passes away most rapidly. It does so by the 
lungs, the skin, the kidneys, and the bowels. The fibrine and albumen pass 
away less quickly than water. Then come gelatine and fat. Last, the min- 
eral matters which are employed in constructing the tissues of the body are 
removed. Calculating the quantity of material removed daily, it would ap- 
pear that a period of forty days would suffice for removing the whole of the 
used material of a human body. Consequently, a man should eat and drink a 
quantity of food equal to the weight of his own body in forty days. The class 
of foods which supply the waste of the fibrinous, albuminous, and gelatinous 
tissues are called " flesh-giving." They all contain the element nitrogen, or 
azote, hence they are called " nitrogenous or azotized " foods. They do not, 
however, pass away from the body in the form in which they go in. They are 
thrown oft* the body in the form of a substance which is known by the name of 
urea. This compound appears to be formed in the blood, and is drawn out of 
it by the kidneys and then passed to the bladder dissolved in the urine. Heat 
is generated in an animal body by the union of the carbon of the blood with 
the oxygen of the air. The oxygen is introduced into the blood by the agency 
of the" function of respiration, which consists in the taking into the lungs of 
oxygen gas, and the returning into the air of carbonic acid gas. The quantity 
of carbonic acid thrown out is precisely the measure of the quantity of carbon 
consumed in the food and the oxygen taken from the air. AVhilst the oxygen 
is uniting with the carbon, an increase of temperature takes place, and the 
heat of the animal body is thus maintained at a given temperature. This tem- 
perature is different in different animals, but in man it is i)8° by Fahrenheit's 
thermometer. It is quite independent of external temperature, and whether a 
man is exposed to the heat of the equator, or the cold of the poles, his tem- 
perature is the same. The great agent by which this is effected is the skin. 
The skin is copiously supplied with blood-vessels, which are distributed over 
its surface and are influenced by the external temperature, so that when the 
temperature of the air is great the water in the blood is converted into vapor ; 
and so delicate is the operation of this structure that the temperature is always 
kept at the same point, whether the atmospheric heat is great or small. The 
food possessing this power of maintaining animal heat and force is sometimes 
called " heat and force-forming." It embraces certain substances not existing 
in the animal body, known by the names of starch and sugar. The following 
table is an attempt to estimate the quantity of food daily taken into the 
stomach, and changed during twenty-four hours : — 



FOO 



255 



FOO 



FOOD ACCOUNT. 
Taken in. 

gases. Oz. 



"^s 1 -" • • • 

Water. 

In beverage 
In food . 


LIQUIDS. 
SOLIDS. 

leese . . 


Oz. 
68 
25 


Gr. 




Flesh-forming. 
Fibrine . 
Albumen 
Caseine in c 


3 





300 
137 


Heat-giving. 


12 
5 
2 





Fat and butter . , 
Suo-ar 












Mineral matters 







Given out. 

GASES. 



Carbonic Acid. 

Carbon 
Oxygen . 



Water. 

By Kidneys 
Lungs 
Skin . 
Bowels 



Oz. Gr. Oz. 
11 

24 



Gr. 



51 

31 

16 

5 237 



SOLIDS. 

Urea 

Mineral matter 



200 




19 
1 

141 141 o 

This table must be regarded only as an estimate. It is drawn up on the 
supposition that all the food taken in passes into the blood, and is disposed of 
as indicated by the substances thrown out. The probability is that a large 
quantity of the matters taken in pass through the bowels without being 
changed. Persons take food very differently, according to age, height, occupa- 
tion, climate, and season. Children and young persons take more in propor- 
tion to their size than adults, as their food supplies the material of growth as 
well as waste. Persons employed in sedentary and indolent occupations do 
not require so much food as those who are more actively employed. Those 
who live in cold climates consume more heat-giving food than those who live 
in warm and tropical climates. The excretion of carbonic acid is greatly in- 
creased in cold weather. Water is also very variously got rid of by the skin, 
the kidneys, and the lungs, in proportion as the body is exposed to external 
heat or cold. It is not all food that is taken into the stomach that is digesti- 
ble. Cellulose, though apparently digested by many of the lower animals, is 
not digested by man. It therefore passes through the bowels unchanged. 
Another substance, called gum, is not absorbed in the stomach or bowels, and 
therefore cannot be regarded as nutritious. Gelatine alone is incapable of sup- 
porting the life of an animal ; it ought to be regarded as a valuable accessory 
rather than as one of the assimilable and necessary articles of food. Besides 
substances necessary or accessory, there are a number of things taken as food 
which are not necessary, or mixed naturally with nutritious food. These sub- 
stances are mostly added by choice, or voluntarily sought by man either to 
gratify his palate or to act upon his nervous system. These substances are 
called "medicinal" or "auxiliary" foods: medicinal, because they act like 
medicines on the system; auxiliary, because they stimulate the powers of the 
stomach, and aid in the digestion of the food. This class comprises such sub- 
stances as alcohol, volatile oils, tea, coffee, and tobacco. 

In order to get an idea of the various kinds of food, and the purposes they 
supply in the system, some kind of classification must be pursued. The fol- 
lowing table is supplied in order to give a general view of foods and their 
principal action. 



FOO 256 FOO 

CLASSIFICATION OF FOOD. 
Class I. — Alimentary or Necessary Food. 
Group 1. Mineral. Examples : Water, salt, saline constituents of plants and animals. 
Group 2. Carbonaceous, respiratory, heat and force giving. Examples : Starches, sugars, 
fats, acids. 

Group 3. Nitrogenous, nutritious, or flesh-forming ; protcoids. Examples: Albuminous 
compounds, fibrine of meat, caseine of milk. 

Class II. — Accessory Food. 

Examples : Cellulose, gum, gelatine. 

Class III. — Medicinal or Auxiliary Food. 

Group 1. Stimulants. Examples : Alcohol, volatile oils. 

Group 2. Neurotics. Examples : Tea, coffee, tobacco, opium. 

One of the best types of animal food is milk. It is supplied by the mothers 
of all animals belonging to the group of mammals, and is capable of furnish- 
ing all the materials of their growth till they are several months or years old. 
It must therefore contain all substances necessary for the growth of the body, 
and the maintenance of its various functions. For an analysis of cow's milk, 
see Milk. 

The principal difference between the diet of adults and that supplied by 
Nature for the young consists in the fact that the diet of the adult contains 
less water and is seasoned with more or less of the group of accessory foods. 

We shall now speak of the various groups of foods, as given in the above 
classification : — 

(1.) Mineral Foods. The importance of water in this group is at once 
evident, and although so large quantities are found in all our solid food, it is 
necessary to add more for the purpose of dissolving all those constituents which 
are necessary to the functions of life. Although the group of heat-giving and 
flesh-forming foods are many of them insoluble in water, they are rendered so 
during the process of digestion. (See Digestion.) Starch is rendered solu- 
ble by the action of the saliva of the mouth, by which it is converted into 
sugar. The proteoids are acted on by the gastric juice, and are thus rendered 
soluble in water. The fats taken as food are decomposed by the bile and pan- 
creatic juice, and converted into soluble soaps, which are readily dissolved by 
water, and taken into the blood. 

Water is taken either cold or hot. It is made into soups, tea, coffee, and 
chocolate, by the infusion and boiling in it of various substances. In all cases 
where water is taken pure, the greatest precaution should be employed to ren- 
der it free from impurities which can generate disease. There is no doubt 
that diarrhoea, cholera, and typhoid fever are spread by the agency of impure 
water, or water contaminated with the poisons that generate these diseases. 
The water-supply of a house should be well looked to, and when any suspicion 
exists, the water should be boiled and filtered before it is drunk. See Water, 
Filters. 

The other substances besides water belonging to the mineral group are com- 
mon salt and salts. Common salt is chloride of sodium, and exists in abun- 
dance in sea-water. It has the power of preserving vegetable and animal sub- 
stances from decomposition, and is found in certain quantities in the bodies of 
all animals. The human body contains about three ounces, which is princi- 
pally found in the blood. Unless certain quantities are taken daily, diseases 
characterized by debility are likely to occur. It may be taken in large doses 
from day to day, and no harm occurs, as that which is not necessary for the 
use of the body is got rid of. 



FOO 257 FOO 

The other saline matters found in the human body, and which are excreted 
by the urine and bowels, are obtained from all forms of food. (See table in 
Dietaries, Public.) Animal and vegetable food lose some of these saline 
matters by cooking ; hence the importance of taking uncooked food of some 
kind or another every day. This should be effected by fruit, or vegetables in 
the form of salads. (See Salads.) An instance of the value of fresh vege- 
tables as an .article of diet is seen in the treatment of . sea-scurvy. This dis- 
ease is brought on by the absence of fruit, vegetables, or fresh meat on board 
ships. It is prevented by the supply of lemon or lime juice, and vegetables 
cooked and preserved in tins. 

(2.) Heat and Force-giving Foods. These consist principally of starch, 
sugar, and fat. At the same time they may be divided into two groups. The 
starch and sugar have the following composition : — 

Carbon 12 parts. 

l^ST. ::::::::::::::: }w*,.«r-» 

In fact, they contain oxygen and hydrogen in the proportion in which those 
elements form water, and when taken the carbon is alone oxidized, and forms 
the heat-giving element. It is different with fat and oleaginous foods. Their 
composition is as follows: carbon, 11 parts; hydrogen, 10 parts; oxygen, 1 
part. Not only the carbon, but a large part of the hydrogen is thus left free 
to be oxidized by the oxygen taken in during respiration. 

Starch is found in nearly all our articles of vegetable food. It is almost 
pure in < arrowroot, sago, and tapioca. It is also contained in a peculiar form 
in sea-weeds and Iceland moss. 

Sugar is found in both plants and animals. It is taken as food in the form 
of cane or crystallized sugar, and grape sugar or glucose. The latter is found 
in all fruits. (See Sugar.) It is the only form which undergoes fermenta- 
tion, and is the basis of all fluids containing alcohol. Sugar is found also in 
animals. The sugar of milk, although differing but little from grape sugar, 
has, nevertheless, a distinct composition, and of course is constantly taken 
where milk is used as an article of diet. (See Milk.) Sugar is also found in 
the liver and the blood, and its increase in the system constitutes a disease 
called diabetes. (See Diabetes.) 

Oleaginous Foods are those which consist principally of oils, butter, fats, or 
lards. These foods are not generally eaten alone, but are added to starchy 
diets. The action of oils on the system is principally to maintain animal heat 
and force, and, practically, they are most largely eaten by those who do the 
largest amount of work. They not only act in this way, but they also assist 
in the digestion and assimilation of other foods. It is on this account that 
cod-liver oil, pancreatic emulsion, and butter, cream, and fat have be'en rec- 
ommended as articles of diet in cases of consumption, scrofula, and other 
wasting diseases of the body. 

(3.) Flesh-forming Foods. The substances which lie at the foundation of 
this group of foods are albumen, fibrine, and caseine. These compounds are 
found nowhere pure, but exist in various forms of vegetable and animal food. 
The most common form in which the flesh-formers are taken is bread. (See 
Bread,) Bread contains fibrine. The flesh of animals, birds, and fishes also 
contains fibrine. Albumen is found in the white of eggs, and also in the blood 
of animals. Caseine is found in milk. It is separated with the butter in 
cheese. (See Cheese.) 

In addition to the flesh-forming principles and fat, animal food contains vari- 
17 



FOR 258 FOR 

ous other chemical compounds, which are the result of the life of the animal, 
and act in a beneficent manner on the system. If, for instance, we take the 
flesh of an animal and squeeze it, we get out a juice called the "juice of 
meat," and when evaporated it is called the " extract of flesh." This compound 
contains little or no albumen, no fibrine or fat, but it consists of salts and or- 
ganic substances, resembling, in their composition, quinine. They are called 
by such names as creatine and sarcosine. When this substance is taken with 
water, in the form of tea, it increases the appetite, and renders digestible the 
food that is taken with it. See Liebig's Extract. 

(4.) Medicinal or Auxiliary Foods. These constitute a very large group of 
substances, which are used for the sake of flavor and their action on the nerv- 
ous system and circulation. Their various sources, qualities, and uses will be 
found under the head of their various names scattered throughout this Dic- 
tionary. See Alcohol, Beer, Wine, Condiments, Spices, Neurotics, 
Tea, Coffee, Chocolate, Tobacco, Cocoa, Camphor. 

Forceps. Scarcely any instrument in surgery has so many different forms 
or uses as the forceps, suited as they are to almost every surgical operation. 
The most common, and perhaps most useful, are the ordinary simple, bowed, 
or dissecting forceps, which can be most conveniently applied for the removal 
of foreign bodies, such as thorns, splinters, etc. They should not be too strong 
in the spring, and should have broad and deeply serrated blades, best with a 
groove in the centre. Then there are forceps named specially after the oper- 
ations for which they are used, such as bullet forceps, lithotomy or stone for- 
ceps, tooth forceps, polypus forceps, urethral forceps, vulsellum forceps, for 
piles, etc., artery forceps, etc. 

Foreign Bodies are substances which have been introduced either into 
some structure or cavity in the body foreign to it in composition. In some 
cases nature will expel such bodies ; in any attempt to do so, assistance is in 
almost all cases needed. 

In the Abdomen. Bodies, such as bullets, for instance, frequently penetrate 
the abdominal parietes, and either pass into the intestinal canal or remain 
lodged in the cavity of the peritonaeum. Any body so lying in the abdomen 
it will be desirable to remove as soon as possible, and its size and shape must 
guide the surgeon as to his proceedings. Early and prompt measures should 
be taken if any operation appear likely to save life. See Wounds of In- 
testine. 

In the Male Bladder. Foreign bodies in the male bladder are generally 
introduced per urethram. Of bodies introduced into the bladder along the 
urethra, and which have been removed by surgical operation (see Lithot- 
omy), the following may be mentioned as having been met with: portions of 
catheters and bougies, both metal and flexible, straw, grains of corn, tobacco- 
pipe, sealing-wax, penholders, hair-pins, a piece of French chalk, slate-pencil, 
a bodkin-case, and piece of coal. Portions of catheters and bougies are by no 
means rare ; patients in the habit of passing such instruments upon them- 
selves, after leave given them by the surgeon, frequently break a piece off; if 
this remains long in the bladder, it becomes crusted with urinary deposits (see 
Urinary Deposits), and thus becomes the nucleus of a stone, which has 
eventually to be removed by the operation of lithotomy. In many instances 
portions of a catheter have been removed by forceps or by the lithotrite. It 
has been shown that bodies impacted in the urethra are most easily removed 
by an external incision down to them, owing to the ready way in which 
wounds of the urethra and corpus spongiosum heal up, and all such incisions 



FOR 259 FOR 

should be made parallel with the long axis of the urethral tube ; the edges of 
the wound are to be allowed to heal by granulation. 

In the Female Bladder. The list of articles introduced far outnumbers that 
mentioned in the case of the male, the female urethra being so short, straight, 
and dilatable, that bodies of almost incredible size have been found, either im- 
pacted or forming nuclei for calculi ; tin jelly moulds and scissors are amongst 
such as may be met with in the curiosities of museums. When the presence of 
such a foreign body has been detected it must be removed, and this may be 
accomplished by dilating the meatus, and making use of forceps specially made 
for the purpose. Failing this, the lithotrite mast be used and the bodies either 
crushed or withdrawn. The operation of lithotomy has been needed in such 
cases. 

In the Air-passages. Morsels of food get into the larynx or trachea more 
frequently than other substances, the accident happening when a person is en- 
gaged in laughing or talking when the mouth is full of food ; the symptoms 
being sudden spasmodic cough, protrusion of the eyes from the sockets, blood 
or froth issuing from the mouth and nose ; the patient gasps for breath, turns 
black in the face, and perhaps falls down insensible. If the morsel of food be 
light and of small size, it is sometimes expelled during a fit of coughing. Many 
bodies may find their way into the larynx and trachea, coins, cherry-stones, 
beans, or in fact anything which may happen to be in the mouth, and their 
presence sets up precisely simihir symptoms. Inversion of the body, combined 
with a shaking or jogging motion, will sometimes cause the foreign body to 
fall through the larynx. The operations of laryngotomy and tracheotomy are 
generally needed. 

In the Nose. These are often introduced by children ; such substances as 
peas, beads, pieces of pencil, etc. They are generally removed readily enough 
by a small polypus forceps or a scoop. If the body cannot be extracted 
through the nose it should be pushed backwards into the pharynx, taking care 
that it does not pass into the larynx. Very frequently they work out if left to 
themselves. 

In the Ear. The substance introduced frequently becomes covered and 
escapes without surgical interference, but in cases where instruments must be 
used they should be passed along the upper wall, so as to avoid the membrane. 
The passage should be syringed with warm water, a proceeding which alone 
frequently removes a foreign substance. A piece of wire bent into a loop and 
insinuated around the substance is a method sometimes attended with suc- 
cess. Insects and larvas sometimes lodge in the ear, causing severe inflamma- 
tion and local suffering, with great constitutional disturbance ; warm oil dropped 
into the passage until it is filled, or white precipitate suspended in milk, and 
injected, will be found sufficient to kill the animals. 

In the Eye. The cornea (see Cornea) should be first examined by evert- 
ing the lid and telling the sufferer to look up, or down, so that both the upper 
and lower surface of this part of the globe can be seen. A substance, such as 
a piece of cinder, or a piece of metal or wood from a turning lathe, etc., stick- 
ing in the cornea, can generally be removed by a silver toothpick or fine for- 
ceps, or, still better, an eye "shud" or scoop. If the substance be lime or 
mortar the lids should be everted and the eye well syringed with weak vinegar 
and water, or oil or water only. A drop of c'astor oil or of pure glycerine 
is a most soothing application in painful cases, where the conjunctiva (see 
Conjunctiva) has been scratched or stripped off the cornea. Very often a 
piece of dust may be removed by blowing the nose smartly. 



FOR 260 FRA 

In the Rectum. These consist of the following, namely, those composed of 
materials, which have first passed along the upper part of the alimentary canal 
and those introduced into the anus. In the first class we find bones, apple or 
pear cores, fruit stones, scybala, substances taken as medicines, coins, etc. 
These bodies must be removed with care, the bowel must be well lubricated 
with oil, and a warm water enema used. If this will not dislodge the mass, 
it must be seized with forceps or broken up with some instrument, and removed 
piecemeal. A full-sized speculum should be first introduced so that the bowel 
is not lacerated or hurt by these attempts at removal. 

In the Vagina. Substances are frequently introduced into the vagina, and 
one of the most common is a pessary the strings break and the instrument re- 
mains in, setting up the most offensive discharge. Glass bottles are occasion- 
ally made use of, and set up ulceration, establishing an unnatural opening into 
the bladder (vesico-vaginal fistula). These bodies require great care in their 
removal. The speculum is frequently required. 

In the (Esophagus. Substances retained in the oesophagus are usually held 
at the commencement opposite the cricoid cartilage (see Larynx), or at its 
lower extremity, just above the diaphragm, as the tube is the narrowest at 
these points. Various substances have been cited as having been retained in 
the oesophagus: thus crust, imperfectly chewed meat, bones, coins, stones, pins, 
needles, buttons, Jknives, forks, scissors, spoons, keys, chestnuts, a small apple, 
fish-hooks, artificial teeth, the handle of a punch bowl, a pencil-case, etc. The 
symptoms produced by the presence of such a body vary of course with its size ; 
if it be small it produces considerable irritation, with difficulty in swallowing. 
In time it sets up inflammation, followed by ulceration of the oesophageal 
coats, causing most serious consequences and oftentimes terminating fatally. 
When a foreign body is impacted in the oesophagus it should be removed as 
quickly as possible ; in the instance of a small piece of bone it may be pro- 
pelled onwards to the stomach, by making the patient swallow a good mouth- 
ful of bread. If the substance is one which on its arrival in the stomach can 
be easily digested, it may be pushed gently down the canal with an instru- 
ment termed a probaug. If high up, it may be reached with the finger or long 
forceps ; gentle pressure with the finger on the side of the neck, opposite to the 
spot where it is felt, will sometimes dislodge it. Hard, angular masses, such 
as glass, stones, etc., require removal with forceps. If no other means are at 
hand, the induction of vomiting is occasionally of use. In cases where all these 
means fail, the operation of cesophagotomy must be performed. 

Formication is the peculiar feeling, like the creeping of ants, which is felt 
in the onset of some forms of paralysis ; also around the arms, when the patient 
is suffering from worms, and in the limb when a nerve has been pressed upon 
and is cramped, as in hanging the arm over the back of a chair. 

Foxglove. See Digitalis. 

Fracture. This term is applied in surgery to the breaking of a bone, 
which, after an incised wound, is probably the most frequent serious accident 
in civil life. When one or more bones have been broken, whilst the skin and 
subjacent soft parts are not torn or wounded, the injury is called simple fract- 
ure. When, in addition to the breaking of the bone, there is a large wound 
through the skin and muscles leading down to the seat of injury, and exposing 
the fragments, the fracture is called compound. When a portion of bone is 
broken into several small fragments, it is said to be comminuted. Fractures, 
both simple and compound, may be complicated, — by dislocation at a neigh- 
boring joint, by wound or division of a large artery or nerve, or by stripping 



FRA 261 FRA 

away from the surface of the fractured bone of a large extent of the perios- 
teum or external membrane. The bones most frequently broken are : the 
clavicle or collar bone in children ; the bones of the leg and fore-arm and the 
thigh-bone in middle-aged persons ; and the neck of the thigh-bone and the 
lower extremity of the radius or spoke-bone near the wrist in persons beyond 
the age of sixty years. The immediate causes of fracture are two : external 
force applied either directly to the bone at the seat of breakage, or at some 
more or less remote part, and sudden and powerful contraction of muscles. 
The bones of weak and sickly persons can be more readily broken than the 
bones of those in robust health. In the subjects of cancer, rickets, and of a 
peculiar disease of the bone called mollities ossium, and also in those who have 
been confined to bed for a long time, fracture may be produced through slight 
violence. Sometimes infants are born with one or more bones fractured, the 
injury having been caused by strong contractions of the womb during labor, 
or by a blow or kick on the abdomen of the pregnant mother. The symptoms 
of fracture are not very difficult to make out; a stout muscular man walking 
along the street makes a false step or slips, and then falls heavily to the 
ground, with the right leg twisted and bent under him ; in his fall he hears a 
sharp crack, and, on attempting to move, finds that there is great fam and 
loss of power in the right limb at a short distance above the ankle. He feels 
also a peculiar grating sensation — the so-called crepitus — at the seat of pain, 
and finds, on looking at the injured limb, that at this part there is swelling, 
distortion, and unnatural mobility. The most decisive symptoms of fract- 
ure are mobility of the bone at the injured part, and the peculiar grating 
noise produced by rubbing together the ends of the fragments ; but these may 
often be absent. In fractures of the ribs, the haunch-bones, the skull, all 
small and short bones, and the extremities of long bones, it is generally diffi- 
cult to make out the nature 'of the injury without submitting the patient to a 
close and prolonged examination. In fractures of the shafts of long bones, as 
the thigh-bone, the arm-bone, and the bones of the leg and fore-arm, all or most 
of the symptoms can be readily recognized, and the result of the accident learnt 
without delay. When a bone is broken in several places or into several smali 
fragments, the case is much more serious than that of a simple transverse fract- 
ure. The greater the obliquity of the fracture, the more unfavorable is the 
case. In debilitated or diseased subjects the setting of a simple fracture takes 
an unusually long time. Compound fractures are always very serious acci- 
dents. When the wound in the skin is large, and the muscles, blood vessels, 
and nerves are much lacerated, amputation of the limb will be necessitated. 
In less severe cases the patient is still liable to the dangers of inflammation, 
erysipelas, tetanus, and pygemia. The most severe fractures, cceteris paribus, 
are those of the skull, chest, and pelvis, on account of the important viscera 
contained within these cavities, and which may be primarily or consecutively 
involved. Fractures of the upper extremity are less serious than similar in- 
juries in the lower extremities. Fracture of one or more of the long bones in 
the arm or leg frequently results after union in puffiness of the skin, wasting 
of the muscles, and weakness of the whole limb. Stiffness of the joints imme- 
diately above and below the broken bone is also a frequent after-affection. 
Those affections retard the convalescence, and sometimes last for several 
months, but are usually much relieved by stimulating liniments, shampooing, 
and the cold-water douche. In the treatment of fracture the surgeon has two 
objects to fulfill : in the first place he removes any displacement that may exist, 
and returns the fragments to their proper position, both in relation to each 



FRA 262 PRA 

otlier and the parts around. This having been done, he then applies splints 
or some retentive apparatus to keep these fragments in place, and the whole 
limb below the fracture in a correct anatomical position until the injured bone 
is thoroughly set. The process of recovery consists in the effusion between 
and around the ends of the fragments of a plastic material, which sets as it 
were into tough gristly tissue, and is finally converted into a mass of true bone, 
which is called the callus. In the long bones of the extremities the fracture 
is not firmly united until the end of six weeks or two months ; in fractures of 
the ribs, collar-bone, and lower jaw the process of recovery occupies a shorter 
period. The removal of the displacement, reduction, or reposition, as it is 
called by surgeons, is effected simply by keeping the upper fragment fixed, and 
pulling downwards the lower fragment until both are in the same line. Re- 
duction is sometimes unnecessary, and occasionally has to be deferred in con- 
sequence of much bruising and inflammation, and also of muscular spasm. In 
some instances the fragments are so interwedged that the displacement cannot 
be removed. There are several methods of keeping the fractured bone in 
position : most surgeons in this country use splints, which are flat, slightly hol- 
lowed pieces of wood or iron, well padded with tow, cotton wool, or some other 
soft material. These are applied in varying number to the surfaces of the 
fractured limb, and are retained by means of bandages. In fracture of the 
thigh-bone a long splint is usually carried from the arm-pit to the foot along 
the outer side of the injured limb for the object of preventing shortening. Some 
surgeons, instead of wooden or iron splints, use long pieces of paste-board, 
gutta-percha, or some other material which is light and capable of being readily 
moulded, after submersion in hot water, to the surfaces of the injured limb. 
These, when applied, are retained by bandages saturated with some solution 
which speedily sets, and helps to form a hard and solid case. Plaster of Paris, 
starch, dextrine, and water glass or silicate of potash, are the materials most 
frequently used for this purpose. In a case of injury to the arm or leg, the 
first thing to do before allowing the patient to move is to expose the seat of 
injury. If the pain be great, the clothes covering the limb should be cut, and 
not pulled off as in the usual way, and the sides of the boot divided with a 
sharp knife. The situation of the fracture will then be indicated by deformity, 
swelling, and local tenderness. If one or both bones of the fore-arm have been 
broken, the limb should be placed in a sling made of a handkerchief or neck 
wrapper, the ends of which are tied lightly at the back of the neck. In cases 
of fracture of the arm-bone at some point between the elbow and shoulder, 
some thick pad — a small pillow, or thin cushion will answer the purpose very 
well — should be placed between the arm and the side of the chest, and the 
injured limb then fixed to the body by some extempore bandage, the elbow 
and fore-arm being supported in a sling. After the patient has been helped 
into bed, this apparatus should be removed, and the arm laid out on a pillow 
at an acute angle to the side of the body with the fore-arm bent. In a case 
of fracture of the leg or thigh it should be a rule never to transport the patient 
in a carriage, cab, or any kind of vehicle which will not permit of his lying at 
full length. The best temporary arrangement of a fractured thigh or leg is to 
place the limb, when half bent at the hip and bone, ou its outer surface. In 
this position the muscles are relaxed, and the whole length of the limb is sup- 
ported. P^xtempore splints may be made of thin pieces of wood. These should 
be covered on one surface by thick pads, made of linen, folded into several 
layers, or of single layers of linen inclosing tow, cotton wool, feathers, bran, 
or, if nothing else is at hand, and the accident has occurred in the country, dry 



263 




Fig xt.tit 



■i 



m?" 




Fig xdv 




Fig xlv 




Fig xevi 



FRA 265 FRA 

grass. Useful temporary splints may be made of bark, leather, paste-board, and 
of wheat straw or reeds tied tightly into compact bundles. Splints should be 
fixed over the seat of fracture by two or more handkerchiefs, or by a bandage 
formed by tearing a sheet or tablecloth, great care being taken not to constrict 
the seat of injury so as to give pain, and to obstruct the upward flow of blood 
through the veins of the limb. If the skin has been wounded, the blood should 
be gently wiped away, and a piece of linen dipped in cold-water placed over 
the raw surface. When the patient has been placed in bed, and the fracture 
again exposed by removing the temporary splints and bandages, cold should be 
applied to the injured part either through rags dipped in cold water, or through 
ice placed in a sponge-bag or sheep's bladder. The surface on which the patient 
has to lie during the treatment should be firm and level, and therefore no 
feather bed should be allowed. The head pillow should be removed and re- 
placed by a bolster. 

Special Fractures. Fracture of Nasal Bones. Generally caused by a 
blow of the fist. As this injury is frequently associated with much bruising and 
swelling of the soft parts, it is frequently overlooked. The lower fragments 
are usually displaced backwards, and if not returned to their proper position 
and kept there by plugs of lint, or cotton wool introduced into the nostrils, give 
rise to great subsequent deformity. A fractured nasal bone unites, in seven or 
eight days, more rapidly perhaps than any other bone in the body. This acci- 
dent is frequently complicated by a wound in the skin and by bleeding from 
the nose. During and after treatment, the patient may be troubled with ulcera- 
tion and a discharge of ill-smelling pus, death of bone, lachrymal fistula, im- 
peded respiration, and impairment of the sense of smell. 

Fracture of Lower Jaw is generally caused by a direct blow. The bone is 
generally broken at some point between the insertion of the middle incisor and 
that of the first bicuspid teeth, the fracture extending through the whole width 
and thickness of the jaw. Sometimes the jaw is broken on each side of the 
middle line, so that the piece carrying the incisors or the incisors and canines, 
is loose and detached from the rest of the bone, and displaced downwards 
and backwards. Sometimes, though not so frequently, the jaw is broken 
through at its ramus or ascending portion, or at the neck or part immediately 
below the head, which is forced into the socket in front of the external 
ear. The symptoms of this fracture are generally well marked. Crepitus 
can be distinctly felt on moving the fragments on each other ; there is free 
mobility, and also some distortion ; the pain over the seat of injury is in 
nearly all cases unusually severe ; the gums are frequently wounded, and one 
or more teeth loosened and perhaps entirely detached. Fracture of the lower 
jaw generally unites speedily and firmly, although with some distortion along 
the chin, and irregularity of the lower row of teeth. The following are some 
of the very many kinds of application that have been devised by surgeons in 
the management of a broken jaw: interdental ligatures; interdental splints 
laid along the crowns of the teeth, and grooved so as to be easily retained in 
place; external splints, made of leather, gutta percha, or some other flexible 
material that can be moulded to the chin. The most useful and simple applica- 
tion, however, in the treatment of a broken jaw, is the four-tailed bandage, the 
central undivided part of which is placed under the chin, the two anterior 
tails being carried backwards to be fastened at the back of the head, and the 
two posterior tails upwards to be tied over the upper part of the scalp. The 
posterior should then be fastened to the anterior tails of the bandage on either 
side by cross-pieces of bandage in order to prevent the former from slipping. 



FRA 266 FRA 

Fracture of Collar-bone. This, with the exception of the outer bone of the 
fore arm, is more frequently broken than any other bone of the body. An 
oblique fracture at the junction of the outer and middle thirds of the collar-bone 
is a very frequent injury in children, and is caused generally by a fall upon the 
hand when the arm is stretched out. It is sometimes produced in adults by a 
blow upon the front of the shoulder, as in the recoil of an overloaded gun. In 
this fracture the shoulder falls downward, forwards, and inwards. The inner 
fragment of the broken bone is very prominent, and externally to this there is 
a depression caused by the downward sinking of the outer fragment. The 
patient feels great pain when he attempts to raise the arm from the body, or to 
carry the fore-arm across the front of the chest. He is unable to raise the hand 
to his head, or to move it forwards or backwards, without suffering. On draw- 
ing back the shoulders so as to bring the fragments of collar-bone into contact, 
distinct crepitus may usually be felt. A broken collar-bone unites speedily 
and strongly, but always with some amount of shortening and deformity. It 
is a very difficult matter to keep this bone at perfect rest, and to restore the 
outer fragment to its proper position. The most certain method of treatment to 
insure union without deformity is for the patient to remain in bed until the 
fracture has been set, the head being kept as much as possible in one position, 
and the arms confined to the side of the body. With children and adults, the 
usual apparatus consists in a figure-of-8 bandage carried from one shoulder to 
the other across the back of the chest, a stout wedge-shaped pad in the arm-pit 
on the injured side, a broad bandage to confine the arm to the side of the chest, 
and, finally, a sling to support the elbow. 

Fracture of the Thigh. The most frequent seats of fracture in this bone 
are the upper extremity and neck, the middle of the shaft, and a part about 
four inches ab'>ve its lower extremity. Fracture of the neck may occur either 
within or without the bag or capsule which invests the head. In the former 
case it is called intra-capsular fracture, and in the latter extra-capsular 
fracture. The intra-capsular fracture occurs in old people, and is produced by 
very slight violence — the most frequent cause being a slip off the curb-stone. 
It is attended with very little bruising and not very severe pain, and hardly 
ever unites by bone, the two fragments being joined together by ligamentous 
tissue. Extra-capsular fracture, on the other hand, is generally the result of 
great direct violence, as in a heavy fall upon the outer part of the hip, is fol- 
lowed by much bruising and intense pain, and almost always ends in firm 
bony union. The common symptoms of these two kinds of fracture are loss 
of power in the limb, shortening, eversion of the foot. Crepitus is usually 
absent or very indistinct. The subjects of intra-capsular fracture are in most 
cases over sixty years of age ; extra-capsular fracture may occur at any age 
beyond thirty. There are several difficulties attending the treatment of fract- 
ure within the capsule. The patient is generally old and infirm, and may 
sink rapidly in consequence of confinement to bed. When this is the case it 
would be well to allow the patient to get up and make as much as possible of 
crutches. When the patient seems to be strong and hearty he should be kept 
in bed for five or six weeks with the whole limb stretched down between two 
large sand-bags, or with the hip and knee bent and the thigh and leg supported 
by a well-cushioned double-inclined plane, made of pieces of wood which can 
be lowered or elevated at will. For extracapsular fracture the usual treat- 
ment is a long splint of wood about four inches in width, extending from the 
arm-pit to beyond the sole of the foot. The foot having been secured to the 
lower end of this by means of a bandage, a band, the central part of which is 



FRA 267 FRA 

composed of tow or cotton wool covered by wash-leather, is carried round the 
inner surface of the thigh at its upper part, and its two ends are then fastened 
to the upper end of the long splint which touches the arm-splint, the foot of 
the injured limb having previously been dragged down to the level of the foot 
on the opposite thigh. The leg aud thigh are then bandaged to the splint, and 
a broad band or sheet is carried round the chest and the upper part of the 
splint. By pulling at the ends of the band which passes under the upper part 
of the thigh the whole limb can be extended. The shaft of the thigh-bone is 
most frequently fractured at its middle third. This injury may be caused by 
the passage of a heavy body across the thigh, by the fall upon the limb of 
some heavy mass, or by the patient falling from a height. The line of fracture 
is usually oblique, and there is shortening to the extent of one or one and a half 
inch. There is much displacement of the bones, and consequent deformity, 
and crepitus can be distinctly felt. This fracture and also that near the lower 
end of the bone are usually treated by the long outside splint, applied as in 
the last-mentioned fracture. 

Fracture of the Knee-cap. Of this injury there are two varieties. In one 
the bone is broken into several fragments, in the other there is a simple trans- 
verse line of fracture extending from one lateral edge of the bone to the other. 
The cause of the first, the stellate fracture as it is called, is direct violence, as 
a blow or fall. The second, or transverse fracture, is usually the result of mus- 
cular action. In this injury there is a wide separation of the two fragments, 
forming a distinct gap, aud a depression in front of the joint. The limb can- 
not be straightened by the patient, and there is generally much pain and 
swelling of the knee. This fracture, like that of the neck of the femur within 
the capsule, unites by ligament instead of by true bone. It may be treated by 
keeping the limb stretched on a mattress between two large and firm sand- 
bags, reaching from the upper parts of the thigh to the sole of the foot. The 
inflammation and swelling of the knee may be best treated by the local appli- 
cation of ice or of linen rags frequently clipped in cold water or weak lead- 
lotion. The patient should be kept in bed for at least six weeks. 

Fractures of the Leg. The following are the fractures most frequently met 
with in this region : that of both bones at the middle or lower third ; that of 
the shin-bone alone at its upper third ; that of the splint-bone alone at a 
point about two and a half inches above its lower extremity. In the first- 
mentioned fracture there is generally much displacement and free mobility of 
the fragments, unci crepitus can be easily felt; it is frequently associated with 
much bruising, and large blebs, containing a thin and dark-red fluid, are formed 
on the surface of the skin. In fracture through the upper part of the shin- 
bone the nature of the injury is not so evident; there is very little if any 
displacement, and crepitus is usually very indistinct. Fracture of the shin- 
bone at its lower third is in most instances marked by a peculiar distortion 
and outward displacement of the foot ; the lower end of the shin-bone projects 
very must at the inner surface of the ankle, and the outer edge of the foot is 
drawn upwards and outwards, and corresponding to the seat of fracture in the 
splint-bone there is a well-marked superficial depression. When both bones 
are fractured, with much displacement, the limb is generally placed upon an 
iron splint, and compressed laterally with two well-paclded splints of wood 
which extend from above the knee to the foot. In cases of fracture of one 
bone only, and when the fragments are not displaced, the best treatment seems 
to be the application of the starched or plaster-of-Paris bandage, as the patient 
may then be allowed to get up and move about on crutches. In fracture near 



FRA 268 FRA 

the lower end of the shin bone, associated with dislocation of the foot, the 
lower limb should be well Hexed, both at the hip and knee, and then be 
placed on its outer surface, either on a bent wooden splint or between sand- 
bags on a hard mattress. 

Fracture of Arm-bone. This bone may be broken at any point between 
the head and the lower expanded extremity, but most frequently about its mid- 
dle. In fracture near the head there is much bruising and severe pain, and 
crepitus can be felt distinctly on grasping the upper end of the arm-bone and 
moving the elbow. The most simple treatment of a fracture in this region is 
to place between the injured arm and the side of the chest a small pillow or a 
cushion, arranged so as to form a pyramid, the apex of which is to be applied 
to the arm-pit; the elbow and arm are then to be fixed by means of a bandage 
carried round the chest. When there is much displacement it will be better to 
apply a bent leather splint, one limb of which is to be fixed to the side of the 
chest, and the other to the inner surface of the injured arm, so that the angle 
occupies the arm-pit. Fracture of the shaft of the bone is generally caused by 
direct blows; is generally very oblique, so that there is much displacement 
and distortion. There is generally considerable bruising and also some swell- 
ing of the whole limb. It almost always results in shortening aud a certain 
amount of deformity. Union sometimes fails, and a false joint or ununited 
fracture is formed. The treatment of a broken arm consists in the applica- 
tion of a long external splint, extending from the tip of the shoulder to the 
elbow, and of two or three smaller splints to the other surfaces of the arm, all 
being well padded and retained in place by bandages. The fore-arm should 
then be supported by a sling carried under the wrist, and not under the elbow. 
Fracture at the lower and expanded extremity of the arm-bone is a common 
injury in childien, in consequence of blows or falls on the back of the elbow. 
Here, as at the upper extremity, there are several varieties of fracture. Some- 
times the line of fracture extends into the elbow joint, and causes much swell- 
ing and subsequent stiffness, and impairment of the articular movements. In 
cases where there is preternatural mobility above the joint, great pain and 
swelling, and distinct crepitus, a large pad should be placed in the bend of the 
elbow, and the fore-arm bent over this, and retained in the same position by 
means of a bandage. 

Fracture of Bones of the Fore arm. The prominent upper extremity of the 
internal or cubit bone of the fore-arm is sometimes broken in adults by a fall 
on the back of the elbow, the detached fragment varying in extent in differ- 
ent cases from a mere shell to the whole of the process. It is generally widely 
separated from the rest of the bone, being pulled upwards by the strong ex- 
tending muscle which runs along the back of the arm. In this injury the 
movements of the arm are much impaired. In treating it the arm should be 
kept straight on a padded splint of wood or stout gutta percha. extending 
along the front of the limb from the shoulder to the wrist. The fragment is 
subsequently joined to the rest of the bone, not by bone, but by tough, flexible 
tissue resembling ligament. One or other of the bones of the fore-arm may 
be broken singly, or both may be broken at the same time. In fracture of 
the shafts of both bones, there is distinct crepitus, and the fore-arm is much 
bent. In fracture of the shaft of one bone only, there is less deformity, but 
usually much bruising and swelling of the soft parts. Crepitus may in most 
instances be obtained by holding the upper fragment firmly and moving the 
lower fragment from side to side. The usual treatment for fractures of these 
bones is the application of two long wooden splints, one to the posterior sur- 



FRA 2G9 FRA 

face of the fore-arm, the other in front. The front splint should extend from 
the hend of the elbow to the ends of the fingers. Both splints should be fur- 
nished with pads, so made as to be thicker in the middle than at the sides, in 
order to press between the bones of the fore-arm and to prevent the broken 
pieces of bone from falling inwards. Fracture of the lower extremity of the 
radius is attended with much pain and considerable deformity about the wrist. 
The lower fragment of the broken bone forms a marked projection at the back 
of the limb, and leaves in front, just above the line of the wrist-joint, a corre- 
sponding depression ; the lower pointed extremity of the cubit bone is unnat- 
urally prominent, and the hand is carried backwards and outwards. In most 
cases crepitus is indistinct or quite absent. There are several methods of 
treating this injury. The chief point is to keep the hand turned towards the 
inner side of the fore-arm. This may be done either by a single curved or 
pistol-shaped splint applied along the front of the fore-arm and the palm, or 
by fixing the hand between a front and a back splint carried downwards from 
the fore- arm. 

Fracture of the Fingers. The first or long bones of the thumb and fingers 
extending from the wrist to the web of the hand are occasionally broken by 
direct violence, as in a fall or in giving a blow. The bone most frequently 
broken is that of the thumb. There is usually distinct crepitus, and the end of 
the lower fragment is often displaced, and projects at the back of the hand. 
This injury is best treated by causing the hand to grasp a billiard-ball, a large 
circular pad of linen, or an ordinary rolled bandage, and then to fix the fingers 
over this by means of strapping or a few turns of a bandage. One or more of 
the bones of the fingers, most frequently the bone nearest the hand, may be 
broken by direct violence. When the fracture is simple, a narrow splint of 
gutta percha or thin wood should be applied to the front of the injured digit, 
and be carried upwards over the palm of the hand as far as the wrist. In 
compound fracture, if there be any chance of saving the finger, the same treat- 
ment should be carried out, care being taken not to apply the bandage too 
tightly. The wound should be covered by wet lint. 

Fracture of the Ribs. One or more of these bones may be broken, either 
by very great force applied directly or by counter-strokes. The ends of the 
fragments project inwards in the former case, and outwards in the latter. These 
injuries are of frequent occurrence, and are produced very often by the wheel 
of a cart or some other vehicle passing over the chest, or by crushing in a crowd. 
Fracture with inward projection of the broken bones is generally a very serious 
injury, as it may be complicated by wound of the lung or compression of the 
heart. It is very ofteu followed by pleurisy and inflammation of the lung. 
The most frequent seat of the fracture is at some point in the anterior third of 
each rib. The fracture unites in about twenty-five days. The chief symptom 
of fracture of the ribs is an acute pain over the seat of injury, which is much 
intensified when the patient coughs or takes a deep breath. Crepitus cannot 
always be felt. This injury is usually treated by applying broad pieces of 
plaster to the injured side of the chest, each piece being carried from the spine 
as far forwards as the breast-bone. The plaster should be carried to about 
four inches beyond the fracture in both the upward and downward direction. 
Another plan of treatment is to roll firmly a flannel bandage about eight inches 
in width around both sides of the chest, and to fix it securely by stitching. 

Frankincense is the product of a certain species of pine growing in the 
Southern United States. Jt has little use in medicine, and its propierties cor- 
respond with those of ordinary resin. Fine frankincense, the product of an- 



FRA 270 FRO 

other pine, is rarely imported into this country. It forms an ingredient in 
incense, and in fumigating pastilles. 

Freckles are minute spots or specks of pigment or coloring matter, which 
are often seen on the skin, especially in persons of fair complexion. They are 
most frequent in those parts which are exposed to the action of the sun's rays, 
so the face is the part most often affected. 

Friar's Balsam, or Compound Tincture of Benzoin, is a remedy at 
one time much in favor as a " vulnerary," that is, as an application to open 
and fresh wounds. It is still used sometimes as an application to ulcers to 
stimulate them, but the principles on which it used to be applied to fresh wounds 
are superseded. Friar's balsam is composed of benzoin, storax, balsam of 
tolu, and socotrine aloes, all allowed to macerate in spirit. It is not often used 
nowadays. 

Frost-bite. Exposure of the body to severe and continued cold produces 
results as dangerous as those following the application of intense heat, although 
they differ somewhat in character. These results may be divided into general 
and local phenomena. The former having been already described under the 
head of Cold it is proposed to deal here only with the effects of cold on portions 
of the surface of the body. Frost-bite varies very much in severity. The 
simplest form and the most common is the ordinary chilblain ; in a more intense 
form the affected part becomes cold, livid, and puffy, and feels benumhed. This 
latter condition, if the cold be no further prolonged, is followed by intense heat 
and redness, and all the symptoms of acute inflammation, but if no heat or 
protection be then afforded passes at once to mortification. In this country, 
however, except among the very poor and destitute, mortification from frost- 
bite is a rare affection. The subjects most frequently affected are old people 
and those whose circulation is sluggish, badly-nourished individuals, and drink- 
ers. Though met with in a great majority of instances in the winter months, 
it is not so often produced by frost as by cold and wet together. Continued 
compression or constriction, associated with cold, is occasionally a cause of local 
mortification. Gangrene may also be produced by suddenly submitting to heat 
any part of the extremities that has been exposed for several hours to the in- 
fluence of cold and has become numb and livid. In the most advanced stage 
of frost-bite the affected parts are black and dead ; between this portion and the 
sound skin there is a groove lined by florid tissue, resembling that on the sur- 
face of a healthy ulcer, the so-called line of demarcation, and beyond this the 
surface of the skin for a short distance is reddened. In some cases the skin 
only is mortified, in others all the tissues of an extremity down to the bone. 
On the formation of the line of demarcation the dead tissues commence to sep- 
arate, and the subsequent changes are similar to those which take place in 
ordinary gangrene. The above morbid changes are primarily due to the action 
of cold which suspends and arrests the flow of blood through the veins. The 
parts most frequently affected are the toes, the nose and ears, and the fingers; 
those structures, in fact, which are most remote from the heart and most ex- 
posed to external influences. The treatment of the mildest and the advanced 
gangrenous forms of frost-bite should be similar to that of chilblains and 
gangrene respectively, and will be found described under these two heads. A 
person, when exposed to the risks of frost-bite, should endeavor by active 
exercise to keep up the circulation of the blood until he obtains some protection 
against the cold. When a part is livid and cold great care should be taken not 
to submit it suddenly to heat, to place it in hot water or to place it near a 
fire. The temperature of the frost-bitten part should be raised gradually, first 



PUM 271 FUS 

by friction with snow, if obtainable, then by friction with the hand, and finally 
by surrounding the part in thick layers of warmed cotton wool. 

Fumigation. This term has been applied to a plan of treatment which 
consists in bringing the vapors of a medicinal agent into contact with the sur- 
face of the skin, either at a certain diseased part or over the whole of the body. 
The vapors thus applied act locally and at the same time are absorbed by the 
skin, so that the remedy is diffused throughout the system. Fumigation is 
seldom carried out save in the treatment of venereal disease by mercury. The 
compounds of mercury that are used in this way are the bisulphuret, cinnabar, 
corrosive sublimate, and, most frequently and most effectually, calomel. The 
selected powder is placed either on one of the several kinds of lamp that have 
been specially designed for this purpose, or on a brick or tile heated to redness 
and deposited in a pan containing boiling water. The lighted lamp or heated 
brick is placed under a cane-bottomed chair, and the patient, stripped of his 
clothes, then sits upon the chair and covers himself closely, except over the face 
and head, with a warm blanket, or a mackintosh, or common cloth cloak. In 
the course of ten minutes light mercurial powder is deposited on the surface of 
the skin. When all the mercury is volatilized the patient should at once get 
into bed, taking care not to remove any of the grayish deposit from the skin, 
as this, during the night, may be partly absorbed. This proceeding is generally 
repeated every night, or on alternate nights, until the gums become sore. In 
a general fumigation the amount of calomel usually required is about ten or 
fifteen grains. This plan of treatment is not well tolerated by every patient ; 
one bath, even, sometimes causes great prostration and general disturbance. 
Great care, too, is necessary on the part of the patient to avoid catching cold. 
Venereal affections of the mouth and throat, and ulcers on certain limited parts 
of the surface of the body, are often treated by local fumigation. 

Fungus Hcematodes. This is a variety of soft or medullary cancer, in 
which the tumor is large and of rapid growth, and composed of very soft and 
pulpy cancerous tissue, mixed with large clots of blood. The manner in which 
a true fungus hcematodes is generally formed is this : a rapidly growing soft 
cancer causes ulceration and destruction of the skin covering its most prom- 
inent part ; the tumor then protrudes, and being no longer subject to resist- 
ance grows in all directions, forming a large sprouting tumor, the base of 
which is much constricted by the margins of the opening in the skin, so that 
the return of blood along the veins is obstructed. In consequence of this ob- 
struction, the vessels of the tumor become much distended with blood and 
often give way. Blood in large quantities is then poured out into the interior 
of the tumor, and forms large clots mixed with the pulpy and broken cancer 
structure. 

Fusel Oil, also known as Amylic Alcohol, is contained in greater or less 
quantity in all forms of crude spirit, from which it requires to be carefully sep- 
arated by redistillation. Being much less volatile than ordinary alcohol, it 
comes over last, or may be allowed to accumulate in the last portions of spirit 
whence all the good spirit has been distilled. It is the substance to which bad 
spirit mainly owes its noxious qualities. By oxidation it forms valerianic acid, 
and it is for this purpose only that it is used in medicine. 



mown 



GAL 272 GAL 

G. 

Galbanum is a gum resin that is a mixture of gum and resin of unki.„. 
origin. It comes from Western Asia in small agglutinated masses of a green- 
ish-yellow color. In its properties, galbanum is supposed to approximate to 
assafcetida, and is contained in the compound assafoetida pill. Probablv it is 
of little value, but may act by virtue of its oil as a stimulant substance. 

Gall-bladder, an oval sac or bag, about three inches long, formin"- an 
appendage to the bile duct, and situated on the under surface of the liver ; it 
is a receptacle for any surplus bile, and sometimes gall-stones are formed in 
this cavity. 

Galls, or Gall Nuts, are small excrescences produced upon the buds of 
the Querrus infectoria, growing in Asia Minor, by means of an insect. This 
insect deposits its eggs in the young buds of the tree, and around them grows 
a hard mass, which m course of time becomes the gall-nut. These so-called 
nuts are more or less globular in shape, and tuberculate on the surface, and are 
generally about the size of a marble. Two varieties are imported, the blue 
aud the white. The former are much heavier than the latter, which, more- 
over, are marked by a little round hole perforated in their substance. The 
only difference between them is that the blue galls are still occupied by the 
young of the insect, which have not had time to consume any portion of their 
substance ; whereas in the white galls the young one has eaten its way out, 
and escaped by the rounded orifice. Galls contain a large amount of tannic 
acid, and a smaller amount of gallic acid ; they owe their properties entirely 
to these two substances. See Tannic Acid, Gallic Acid. 

Gall-stones, or solid concretions formed of bile, are usually formed *in the 
gall-bladder, but sometimes, though rarely, also in the bile ducts. Most gall- 
stones are mainly made up of a fatty material of crystalline character called 
cholesterine, mixed with the coloring matter of bile, and may grow to very 
considerable size. When there is only one gall-stone in the' bladder it may 
grow to the size of a lien's egg, which it somewhat resembles in shape. More 
frequently a number are formed, and then they have facets or smooth surfaces, 
corresponding to the points where they have come in contact one with another. 
They are very light, and when dried float in water till they have absorbed 
some of it, and then slowly sink. Gall-stones are more common in women 
than men, perhaps owing to the modes of life differing considerably, for of all 
inducing causes sedentary occupations and confinement seem to be the most 
potent. If the bile have a tendency to form deposits, whatever favors long 
retention of it in the gall-bladder may lead to the formation of gall-stones. 
The formation of gall-stones does not seem to be specially associated with any 
diseases of the substance of the liver, except one, that" is cancer; but, inas- 
much as that disease in its later stages is frequently associated with obstruc- 
tion to the flow of bile into the alimentary canal, it is most probably the con- 
dition so induced which favors the formation of gall-stones rather" than the 
disease itself. So, too, age has some effect in the same way, for gall-stones are 
rare during the most active period of life, that is, under thirty. Their forma- 
tion is often associated with a tendency to gout, and may possibly be accounted 
for in the same way, namely, a sluggish life of over eating and drinking. 
Most frequently, when of small size, the gall-stones may be discharged through 
the natural passages into the intestine, but sometimes "they are got rid of by 
ulceration of the gall-bladder or bile ducts into the intestine lower down in its 



GAL 273 GAL 

course. Sometimes, instead of escaping into the gut, the gall-stone may give 
rise to inflammation or sloughing of the part where it is confined, and so escape 
into the general cavity of the abdomen. This is followed by inflammation and 
death, but its occurrence is rare. Usually the inflammation causes adhesion 
to the wall of some portions of the intestine, and so (he two walls giving way, 
the escape of the gall-stone costs much less pain than does its passage along 
the natural channels, presently to be described. In the gall-bladder the only 
symptom ordinarily produced by gall-stones is a feeling of weight in the right 
side, or at the lower corner of the corresponding shoulder-blade. In the tube 
which lies between the gall-bladder and the liver they may cause little incon- 
venience beyond obscure affections of the digestive powers, but in the tract 
lying between the liver and gall-bladder and the intestine, what is called the 
common duct, they ordinarily give rise to jaundice. The symptoms from the 
passing of a gall-stone generally come on quite suddenly, often two or three 
hours after food, and the pain is described as a kind of spasm. Its situation is 
on the right side of the abdomen, just below the false ribs, and generally ex- 
tends through to the back, near the lower angle of the blade-bone, or between 
that and the spine. The pain is not constant ; it comes by fits and starts, and, 
while it lasts is so severe that the patient writhes in agony, or rolls on the 
floor, pressing bis hands on his side, for pressure frequently relieves the pain. 
This pain is moreover attended with a feeling of constriction in the lower 
part of the chest, which is frequently interpreted as a difficulty in breathing, 
so that a slight attack may be put down to pleurisy. The fit, as it is called, 
of gall-stones produces severe exhaustion ; the pulse becomes weak, the face 
pallid, and the whole body covered *with cold sweat. Often the patient ques- 
tions whether life is worth having on these terms. The pain of irritation in 
the vicinity of the stomach causes it to contract, and so there is vomiting, 
which sometimes aggravates, but more frequently relieves the pain. Perhaps 
the nausea arrests the spasmodic contraction of the bile duct round the stone, 
to which doubtless the pain is due. Jaundice, as already pointed out, is a com 1 
mon symptom, but not necessarily present in all cases. If the stone be small 
or angular, it may give rise to some degree of irritation in passing, but may 
not be large enough to choke up the duct, and so not produce jaundice. It is 
rare for gall-stones to cause death during their passage through the bile ducts, 
and in the majority of cases, especially if the period of the passage has been 
short, as soon as the passage is accomplished the patient is well, though, if the 
passage has been long delayed, or gall-stone follows gall-stone, as sometimes 
happens, the constitution may be greatly shattered. Once in the intestine, as 
a rule, all danger is past ; but if the stone be very large it may stick in the in- 
testine, and cause obstruction of the bowels ; or, if it be very small it may be- 
come fixed in that troublesome spot, the vermiform appendix, and so cause in- 
flammation. Either event is rare. Individuals who have once suffered from 
gall-stones are unfortunately liable to do so again. This comes in two ways, 
as pointed out : several gall-stones may exist and only one at a time be passed, 
or the conditions which gave rise to one may prevail and give rise to others. 
In all cases it is desirable to secure the stone by carefully examining the fasces, 
as indications are furnished by it as to the existence of others, or as to a likeli- 
hood of the return of the symptoms. In the treatment of gall-stones the first 
thing to be done is to relieve the pain and spasm while the stone is passing, 
and to attempt to get rid of those still left in the gall-bladder, if any, by dis- 
solving them, and so to prevent new ones forming. For relieving the pain and 
spasm there is nothing like opium. It is best given by the subcutaneous 
18 



GAL 274 GAM 

method. But the sickness is a thing not to be slighted, and so for it we pre- 
scribe spirit of chloroform, ice, and the like remedies. Frequently, however, 
for this purpose large draughts of hot water and carbonate of soda may be 
given, partially effervescing with tartaric acid, for the effervescence passes off 
instantaneously, and does much good. The hot water may be repeated as often 
as necessary. On the other hand, ice is one of the best remedies we can use. 
But if hot water inside does good, the hot bath sometimes does more, especially 
accompanied by opiate subcutaneous injections. Thus sleep may often be pro- 
cured, when it is possible in no other way. Chloral, too, would be well worth 
trying in good full doses, but meantime our experience with regard to it in these 
cases is almost nil. To get rid of any gall stones left in the bladder, various 
remedies have been recommended. Chief among these are alkalies and alka- 
line carbonates, and chloroform or ether. Chief among preventives are air, 
exercise, and plain food. Beer should be avoided, but a fair allowance of 
light wine taken. The bowels should be moved daily, if necessary, by Plillna 
or Friedrichshall water ; in the evening a small dose of blue pill may be taken 
from time to time. If the patient can afford to go abroad, he should try a 
residence at an appropriate watering-place such as Vichy, Ems, or Carlsbad. 

Gallic Acid is prepared by making the powder of gall-nuts into a thick 
paste with water, and keeping it in this state for six weeks at a temperature 
of 60° or 70°. This paste is then boiled and strained, and gallic acid is allowed 
to crystallize out of the fluid. After this it requires to be purified. It differs 
from tannin in not precipitating gelatine, albumen, or alkaloids, like strychnia: 
but it forms a blue black with persalts of iron. It moreover exists in fine silky 
crystalline needles, whereas tannin has noncrystalline shape. It does not taste 
so astringent as tannin, and is more frequently given internally than that sub- 
stance, which in the system is converted itself into gallic acid. In the Phar- 
macopoeia there is a glycerine of gallic acid, which is a useful astringent ap- 
plication in certain forms of sore throat, especially to the tonsils after being 
inflamed when they show no great tendency to contract to their proper size, and 
there seems danger of their remaining permanently enlarged. Gallic acid is 
frequently given internally, mainly for checking bleeding. It is usually com- 
bined with sulphuric acid, and may be given in doses of from five to twenty 
grains. It is used this way in bleeding from the lungs and stomach especially. 
It may be also used in bleeding from the kidney, but with less hope of success. 

Galvanism is a power like electricity, named after its discoverer, Galvaui, 
and is often applied to the body in case of nervous pains, by means of a small 
portable machine. An invention known as " Pulvermacher's Chains'' is a 
form of machine which is very portable, and the electric current is continually 
kept up. pas.ing through the body almost imperceptibly. See Electricity. 

Gamboge is a kind of gum-resin, imported from Siam. The juice of the 
tree is collected in hollow bamboos ; hence the outside of the pipes or sticks, 
in which form the drug is imported, is marked with streaks corresponding to 
those on the inside of the bamboo. It is hard and brittle, breaking with a 
shiny fracture, bright yellow in color. Rubbed up with water, the gum dis- 
solves and suspends the resin, forming an emulsion. It is more used as a 
pigment than as a drug. Its only preparation is the compound gamboge pill, 
which is not often used. Gamboge is a powerful drastic purgative, giving 
rise to copious watery motions. It often causes vomiting, and always griping, 
and so is seldom given by itself. Perhaps, if given at all, cream of tartar is 
the best adjunct. The two cause copious watery motions of the bowels. Gin- 
ger, cayenne pepper, or some oil should always be given along with it to pre- 



GAM 275 GAR 

vent the griping. It is mainly given as a purgative in dropsies where the 
power of causing watery stools is of value. It is also sometimes used to get 
rid of worms. It is the basis of some quack remedies, and being used injudi- 
ciously, as these are apt to be, has given rise to inflammation of the bowels, 
and so to death. 

Game. See Birds. 

Ganglion in surgery is a tumor connected with the sheath of a tendon, 
arising either from a partial sprain, the fibrous and synovial sheaths being 
torn, or from the sheath being attenuated and distended with the albuminous 
secretion. It appears as a fluctuating, translucent swelling, compressible, vary- 
ing in size and shape from that of a small pea to a hen's egg, and the swell- 
ing, though tense, distinctly fluctuates. Their usual situation is at the back of 
the wrist or upper aspect of the foot. It will be noticed in many instances 
that they appear to be multiple, or that there are several ; this, however, arises 
from the fact of the tendons, generally extensor, passing over them and divid- 
ing them into apparently distinct compartments. The fluid contained is thick, 
rancid, and glairy, like white of egg. It consists of water, mucus, and epi- 
thelium, fat, albumen, and extractive matter, and salts. The treatment con- 
sists, if they are very small and have evidently thin walls, in dispersing them 
into the surrounding tissues by a smart squeeze of the thumb, or a sharp blow, 
friction, and pressure ; these generally cure them. A blister placed immedi- 
ately over the tumor often excites a sufficient amount of irritation in the sac 
to absorb the contents. In larger cysts, a fine knife should be introduced flat- 
wise through the walls of the ganglion, so that by pressure its contents may 
be extended into the surrounding structures, and become absorbed after dis- 
persion. A compress and bandage should next be applied, and if the cyst 
refills the process must be repeated. Sometimes the tumors may be dispersed 
by iodine or a mercurial ointment. Persons who are subject to these ganglia 
should wear some firm india-rubber webbing round the wrist-joint, when about 
to use the hand much ; or, if subject to them on the back of the foot, firm, 
well-fitting boots, bracing up the instep. 

Ganglion in anatomy is a swelling consisting of nervous matter. Gan- 
glia are found in all forms of the nervous system. 

Gangrene is the partial death of a part of the body, the preliminary step 
to mortification, or the absolute death of a part. 

Gargles, or Mouth Washes, are remedies in a liquid form intended for 
local application to the mouth and throat. Gargles are intended to fulfill vari- 
ous purposes : some only to cleanse the parts, some to brace them up, some 
to allay inflammation, some to heal sores, and so on. Of those intended to 
cleanse the mouth pure water may take the lead. It should be warm, and in 
this form too it proves of great service in the acute stage of inflammation of 
the tonsils, to which many are very liable. Not unfrequently it happens that 
from some cause the covering of the mouth and tongue forms on its surface a 
mass of decaying material, the odor of which is excessively unpleasant. To 
remove this something more than water is necessary, and, on the whole, there 
is nothing better for the purpose than Condy's fluid and water. Where there 
is at the same time inflammation of the throat, sulphurous acid and water had 
better be used. Certain conditions of constitution are accompanied by relaxa- 
tion of the soft palate and uvula, for which gargles are commonly employed. 
Chief among the substances used this way are tannin and alum, either sepa- 
rately or in combination. Tannic acid or catechu lozenges may be used for 
similar purposes. For ulceration of the mouth in children, borax and honey 



GAS 276 GAS 

is a favorite remedy. If the ulcers are very foul, as sometimes happens in 
syphilis or after salivation by mercury, the best gargle to use is made by add- 
ing hydrochloric acid to chlorate of potass. This may be used freely, well 
diluted with water. Atomized fluids, produced by the spray instrument, have 
to a considerable extent replaced the use of gargles, but cannot do so entirely. 

Gas Coal, Products of. When hard coal is burned in the open air, the 
principal products of combustion are carbonic acid and water, accompanied by 
small quantities of ammonia and sulphurous acid. But when the decomposition 
takes place in closed vessels, more complicated products are produced. A 
great deal of volatile matter is expelled, partly as uncondensable gases, partly 
as vapors, when cooled at the ordinary temperature of the air in the form of 
liquids and solids, while a light porous material, known as coke, is left behind 
in the retort. Amongst the gaseous products the most important are marsh 
gas, defiant gas, hydrogen, carbonic acid, carbonic oxide, ammonia, and sul- 
phuretted hydrogen ; the liquid products are complicated in character, and form 
coal tar and coal naphtha. The illuminating power of coal gas is due to the 
marsh gas, or light carburetted hydrogen, and to the olefiant gas, mixed with 
small quantities of volatile compounds ; the hydrogen and carbonic oxide are 
of no use for lighting purposes, but at present it is not possible to separate 
them satisfactorily. Gas, thus purified, consists almost wholly of compounds 
of carbon and hydrogen, and when set fire to in the ordinary way these ele- 
ments combine with oxygen of the air, and form, respectively, carbonic acid 
and water. If any sulphur is present in the gas, through neglect of properly 
purifying the gas, it will combine with the oxygen of the air and form sul- 
phurous acid, which has an irritating effect on the nostrils. The presence of 
carbonic acid in a room after burning gas can be shown by placing a dish 
of lime-water in the room, when the solution will become turbid from the 
formation of chalk or carbonate of lime. To the presence of this gas is due 
the languor and headache felt in working in a close room where much gas is 
burnt, for the air becomes impure, with the products of consumption. Thus, it 
is necessary to allow a free current of air, as by opening the door or window 
occasionally, if the atmosphere becomes at all oppressive. 

Gastric Fever is another term for typhoid fever. 

Gastric Juice. This is a thin acid fluid, poured out from the glands of 
the stomach during digestion. Its acidity arises from the presence of hydro- 
chloric or lactic acids, but in addition to these constituents the gastric juice 
possesses another called pepsin, to which most part of its peculiar action is 
due. When the food is swallowed and enters the stomach, the movements of 
that organ, when its walls contract, roll the food about and thoroughly mix it 
with the gastric juice. If small pieces of meat or hard-boiled egg are placed 
in acidulated water with which some gastric juice has been mixed, and kept at 
a temperature of 100° Fahr., it will be found that in a few hours these sub- 
stances have been nearly, if not quite, dissolved and reduced to a pulpy state. 
This is called artificial digestion, and it has been proved that precisely similar 
changes go on in the stomach of a living animal. There, soluble substances 
are then rapidly absorbed by the vessels of the stomach, while some portions go 
on to enter the intestines. Advantage has been taken of this fact to aid di- 
gestion by giving the patient pepsin a short time before a meal ; this is usu- 
ally obtained from the stomach of a pig, and since the active properties of the 
gastric juice are mainly due to this body, it follows that much benefit may, in 
some cases, result from its use. See Diet, Digestion, and Food. 

Gastric Ulcer, or Simple Ulceration of the Stomach, occurs most 



GAS 277 GAS 

frequently in youngish persons, especially females of the servant class, though 
by no means limited to them. Its symptoms are mainly these : pain, vomit- 
ing, bleeding ; in females, absence of menstruation; there is loss of flesh and 
pallor of countenance, and finally the ulcer may perforate the wall of the 
stomach, give rise to general inflammation of the cavity of the abdomen, and 
so cause death. To take each of these in turn. The pain, which is usually 
the first symptom, is very characteristic. It commonly begins from a few 
minutes to half an hour after taking food. At first it resembles a feeling of 
weight, later it resembles burning, later gnawing and sickening, but rarely if 
ever of the sharp, darting character, common in cancer. The pain is most fre- 
quently situated just below the extremity of the breast bone, and there is often 
a corresponding pain in the back, between the shoulder-blade and spine. Tlie 
spot where the pain is felt is generally very tender on pressure, but not always 
so, and the painful spot is rarely of any considerable size. As the ulcer is 
rarely at either end of the stomach, but generally in its middle, and most fre- 
quently on its back wall, lying on the face will sometimes relieve the pain 
very greatly. Vomiting is a symptom of gastric ulcer of very grave signifi- 
cance, and may itself be the source of very considerable danger. Ordinarily it 
occurs when the pain is at its height, the whole contents are evacuated, and 
relief to the pain follows. If vomiting comes on speedily after taking food, 
the food itself comes up little altered if digestion has advanced somewhat, then 
the matters ejected are sour, and later still they may be mixed with bile. Oc- 
casionally the vomiting comes on in the intervals of digestion : if so the sub- 
stances so ejected may consist mainly of glairy mucus. The danger of this 
symptom consists partly in that the food being completely expelled none is re- 
tained to nourish the body, and so wasting and weakness follow. Besides, there 
is the fatigue engendered by the act of vomiting, which, in a wasted frame, is 
no slight matter. Moreover, the violent straining of the stomach may favor 
the occurrence of the two most fatal accessories of gastric ulcer, bleeding and 
perforation. Haemorrhage or bleeding is a very grave symptom, and one which 
not unusually proves fatal. It is due to the ulcerative process eating through 
the coats of the stomach until that where the larger vessels are situated is 
reached. If the bleeding be small in quantity there may be no sign of it ex- 
cept that the faeces are a little blacker than ordinary, which is not easy to de- 
tect. But should the vessel be of some size and the bleeding free, speedily 
the stomach becomes distended with blood ; vomiting is set up, and the blood 
is at once detected. Blood ejected in this way is usually dark ; rarely, how-, 
ever, it is bright red. More rarely still the vessel opened bleeds so freely that 
the patient faints and dies before there is time to vomit. In these cases after 
death the stomach and bowels are found enormously distended with blood, 
often clotted. Usually in gastric ulcer the bowels are constipated, but not al- 
ways so. The small quantity of food which passes on into the bowels is one 
great cause of this. There is nothing to void. In ulceration of the bowel 
itself this is quite different ; in it diarrhoea is the rule, with hardly any excep- 
tion. Perforation is at once the symptom and the result most to be dreaded 
in gastric ulcer. If the process of ulceration go on uninterruptedly, by and by 
the coats get very thin ; from some unusual distension or exertion the thinned 
part gives way, and the contents of the organ escape freely into the cavity of 
the abdomen. The signs of such an occurrence are unmistakable. After suf- 
fering more or less severely from the symptoms already enunciated, the patient 
is suddenly attacked with excruciating pain in the abdomen, spreading rapidly 
all over it. The patient becomes collapsed, the pulse fails, and in not many 



GAS 278 GAS 

hours the patient sinks and dies. Dilatation of the stomach sometimes re- 
sults from a healed ulcer causing constriction at one part, but this is not very 
common in simple ulcer. 

Treatment: To begin with, the simplest and the best, especially when 
there is bleeding, is ice. The patient may eat it freely, not sucking it only, 
but champing it and swallowing it in the rough. When there is bleeding, ice 
should also be kept applied over the pit of the stomach and below the false 
ribs on the left side. For the pain, which is often very severe, perhaps opium 
is the best remedy, and it is best given locally, that is, by the stomach, in this 
particular case. The best preparation is the extract made into small pills, — 
the smaller the better, half a grain at a time. If these are rejected, morphia 
in smaller dose might be tried the same way ; if that fail, it must be given sub- 
cutaneously. For the pain, when there is no bleeding, bismuth is often one 
of the best remedies we can give, but it must be in goodly quantity of twenty 
or thirty grains or more. For the vomiting, ice is the best remedy, and rest. 
The stomach will not bear food, and so food must be given in the smallest 
possible quantity, and of the most un irritating quality possible. Of all foods 
perhaps the best is milk ; after a time essence (not extract) of meat is to be 
given, but not at first. In case of vomiting still continuing, all food must be 
stopped and nutrient enemata used. When bleeding occurs, the same rules 
are to be carried out, together with absolute rest. Stimulants are not admis- 
sible, except excessively dry iced champagne. Remedies, however, may be 
given to arrest the bleeding, opium among the number. The most reliable un- 
doubtedly is gallic acid, twenty grains for a dose, along with ten drops of di- 
lute sulphuric acid, given in the smallest possible quantity of water which will 
enable the patient to swallow the mass in comfort. By and by, when the pa- 
tient begins to improve, iron is to be given, but cautiously, beginning with 
non-astringent preparations like the ammonio-citrate or tartrated iron weak. 
Infusion of calumba, too, is most useful, especially later on, when a few drops 
of acid can be given with it to aid digestion. Of course such a mode of treat- 
ment confines the bowels, and these must be opened ; first of all by enemata, 
later by gentle laxatives, such as compound rhubarb powder or castor oil. 
Great care in dieting must be observed long after recovery, for relapse is fre- 
quent and dangerous. 

Gastrodynia strictly means pain in the stomach. In this country it is 
meant to include all degrees of pain, from the sensations that one possesses in 
stomach-ache to pain of an almost unendurable character. This pain is not al- 
ways felt in the same spot, nor is it of the same character. Weight, oppres- 
sion and distension are the sensations most frequently complained of; and this 
is the form which ordinarily indicates slight form of disease of the stomach. 
More severe forms are commonly accompanied by a sensation of burning, — 
not heart-burn, — and others still by a horrible feeling of gnawing or tearing. 
Pain in the stomach may come from various causes, such as the presence of 
irritant matters, disease of its walls, alterations in its own secretions, and per- 
versions of its innervation. Foreign substances of an irritant character may 
be either indigestible articles of food, regurgitated bile, or corrosive substances 
swallowed, such as strong acids or alkalies; these, however, being rare, com- 
pared with the former. The diseases affecting the substance of the stomach, 
and giving rise to pain, are mainly two, simple ulcer and cancer. The pain of 
the former ordinarily comes on soon after swallowing food, and is relieved 
when the food is ejected or passes on into the bowel. The pain of cancer, on 
the other hand, comes on, as a rule, either earlier or later during swallowing, 



GEL 279 GEN 

or when the food begins to pass away from the stomach. It is, moreover, 
somewhat different in character: sharp and lancinating, instead of dull and 
heavy. Altered secretions are a very important cause of pain. But most fre- 
quently the excessive acidity complained of is not so much due to alteration 
in the gastric juice itself as to alterations in the food. What are technically 
known as neuroses, that is to say, disorders purely nervous, have much to do 
with pain in the stomach. This variety of pain is most common in delicate 
nervous women, and in hypochondriac men, hroken down by some debilitating 
cause. A kind of cramp of the stomach, too, may occur. Pain may be re- 
flected to the stomach from the womb or ovaries in females, or it may be due 
to pure neuralgia. The meaning of pain in the stomach is far from easy to 
understand, for pains, exactly the same in character, may have a totally differ- 
ent signification. The great point is to find out which pain is neuralgic, and 
which due to disease of the organ itself. This is very difficult ; still some clew 
is afforded by the fact that in pure neuralgia food often relieves the pain, 
whereas in ulceration this is commonly the reverse. So, too, nervous symp- 
toms, if purely nervous, are seldom limited to the stomach, but manifest them- 
»selves elsewhere also. So, too, the effects of pressure and position help, as 
pressure is generally badly borne where the surface is broken, but does good 
in neuralgia. Change of posture may often entirely relieve in ulceration; 
but, except as increasing pressure, is not likely to influence nervous pain. 
Frequent pain in the great gut may he mistaken for pain in the stomach ; but, 
as a rule, this is generally due to flatulence, and extends to other parts of the 
abdomen, which pain of the stomach alone cannot do. Rheumatic pain of 
the muscles covering the stomach might also be confounded with true gastro- 
dynia, but it is rare. So, too, are certain cases of spinal disease, giving rise to 
pain in the region of the stomach. As to treatment of pain in the stomach, 
that must be entirely guided by the nature of its causation, which may he 
mainly grouped under three heads : indigestion, gastric ulcer, and cancer of the 
stomach (which see). Heat or cold will, however, frequently give relief, and 
may be applied either externally or internally, or both. Neither of these is 
likely to do any harm. 

Gelatine, in the form of calves' foot jelly, is a favorite article, used among 
invalids and others. It is used, too, for the thickening of soups. The gelatine 
so used is commonly called isinglass, and is the sound of the sturgeon, dried 
and cut into shreds. It would hardly deserve notice here were it not for the 
sake of warning the public of the want of nutritious qualities which character- 
izes it. We do not mean to say .that it is absolutely innutritious, but it does 
not contain the amount of nourishment jellies are commonly supposed to pos- 
sess, and hence people may be cramming the delicate stomachs of invalids 
with an almost useless material. 

Gentian, as employed in medicine, is the dried root of the yellow gentian 
( Gentiana luted) which grows on the slopes of the Alps and Pyrenees. As 
imported the root is in cylindrical, often twisted pieces, and is very tough. Its 
odor is sweet, its taste somewhat sweetish, followed by an excessively bitter 
after-taste. Its active principle is readily given up to water, and the infusion 
of gentian is a favorite preparation ; it, as well as the gentian mixture, con- 
tains, however, other ingredients. The extract is also in use for pills. The 
tincture too is used, but seldom by itself. Gentian is one of the most valuable 
simple bitter tonics we possess. It may be given in a variety of complaints ; 
but, perhaps, is most useful in certain forms of dyspepsia. The infusion, un- 
fortunately, does not keep well, but this may be overcome by adding to it a 



GID 280 GLA 

small quantity of spirit, such as brandy. In preparing the infusion for home 
use, half an ounce of root chopped may be used for a pint of water. After 
standing for about five-and-twenty hours it will be ready for use ; two table- 
spoonfuls for a dose. 

Giddiness. See Vertigo. 

Gin. See Distilled Spirits. 

Gin-drinker's Liver, so called because drinking large quantities of gin is 
one of the causes of chronic disease of that organ. See Cirrhosis. 

Ginger is the root, or rather the under-ground stem, technically called a 
rhizome, of a plant growing in both the East and West Indies. Its appear- 
ance is tolerably familiar to all, — knotted, yellowish-white in color, easily 
breaking, and possessed of a hot taste and agreeable smell. Its powder is yel- 
lowish-white. There are two forms, the white and the black. The white is 
scraped, scalded, and dried in the sun ; the black is not scraped, and hence its 
color. It has in it some vohitile oil and some resinous matter, which are prob- 
ably its active ingredients, but it also contains a lot of starch. Its tincture 
and syrup are the preparations most used, but the powder is, perhaps, more 
extensively used than both. It is an aromatic stimulant substance, when taken 
internally producing a feeling of warmth and comfort, and frequently appears 
to aid digestion. It is accordingly useful as an adjunct to griping purgatives, 
and to other remedies for indigestion, especially if there is much flatulence. 
We have sometimes seen obstinate flatulence, accompanied by no other symp- 
tom of indigestion, cured by the persistent use of ginger, where other reme- 
dies had proved useless. 

Glacial Acetic Acid is a form of the acid which is solid at ordinary tem- 
perature ; any little elevation will, however, cause it to assume the fluid condi- 
tion. Its uses are those of ordinary acetic acid, but being somewhat stronger 
it has slightly marked escharotic powers. It is on this account one of the 
best applications possible to warts and corns, which have little inherent vital- 
ity and are easily destroyed. To that end the top should be shaved off, but 
not so as to make the part bleed ; then the glacial acetic acid may be applied 
to the spot. The end of a lucifer match is one of the best things for the pur- 
pose of applying the acid. 

Glanders. This is a peculiar disease met with in the horse tribe, which 
may be either spontaneously developed or communicated by contagion from 
animal to animal. This disease in the horse is attributed by Mr. Youatt to 
improper stable management, namely, want of ventilation, ill drainage, bad 
pavement, want of cleanliness and comfort; anything that injures or impairs 
the vital energy of the nose, such as fractures of the bones of the nose, vio- 
lent catarrh, prolonged discharge from the nose ; want of regular exercise, ex- 
cessive and undue exercise, as after a hard day's travel, or at the close of a 
severe campaign. It is now a much less frequent disease than it was thirty 
years ago, and it is only found to prevail where neglect, dirt, and faulty venti- 
lation exist. In the horse there are two different forms of glanders, or equinia 
glandulosa, as it has been called. One is characterized by swelling, conges- 
tion, and ulceration of the nose, or by a discharge from the nostrils, which 
at first is thin and watery, and afterwards thick and sticky like glue, and by 
hardening and enlargement of the glands over the lower jaw. This is glan- 
ders proper. The other form, called farcy, is characterized by cord-like swell- 
ings along the course of the absorbents of the legs, and by hard glandular 
swellings called farcy-buds, which are observed about the lips, nose, neck, and 
thighs. In this form, as in glanders proper, the animal loses flesh and strength, 



GLA 281 GLO 

and generally dies from exhaustion. Farcy in its advanced stage is often as- 
sociated with glanders. This disease is sometimes, though very rarely, met 
with in man as a result of contagion from an affected horse. It is generally 
caused by the application of the virus contained iu the nasal discharge of the 
diseased horse to some abraded or raw surface. The. following are the symp- 
toms of the disease : the patient at first suffers from intense febrile disturb- 
ance, associated with much perspiration, headache, and pains of a rheumatic 
character in the limbs ; there is often severe shivering, and at times mental 
disturbance and delirium ; the glands in the neck, arm-pits, and groins next 
become swollen ; over the face, neck, and abdomen there may be seen a crop 
of small shot-like papules, resembling very much those met with in small-pox ; 
the skin covering these breaks down, so as to leave small ulcers ; large and 
soft superficial abscesses form on the arms and legs, chiefly near joints ; the 
mucous membrane of the nostril then becomes inflamed, and furnishes a sticky, 
thick discharge of a dirty-yellow or tallowy color, which is sometimes marked 
by streaks of blood; the skin of the face and nose becomes swollen and shin- 
ing; the inner surfaces of the eyelids also are involved, and their edges are 
glued together by a thick gum-like discharge ; finally, large patches of inflam- 
mation often appear at different parts of the surface ; these increase in size 
and become livid and gangrenous. The severe external symptoms are as- 
sociated with diarrhoea, delirium, and coma. Most cases of severe or acute 
glanders are fatal, death taking place generally between the fifth and four- 
teenth days. The affection is sometimes chronic, and consists in a constant 
discharge of viscid and very fetid pus from the nose, and by swelling and in- 
flammation of the face and eyelids ; these symptoms are attended with much 
constitutional disturbance, and the patient often dies from exhaustion. In 
acute farcy, there are hard and painful swellings, extending like thick cords 
along the limbs ; the glands in the groins and arm-pits are also inflamed, and 
there is diffused erysipelatous swelling of one or more limbs. The treatment 
should be directed to supporting the strength of the patient by strong broths 
or beef-tea, milk, and alcoholic stimulants. The nostrils should be frequently 
syringed out with lotions containing creasote, tincture of iodine, chloralum or 
chlorate of potash. Poultices of bread-crumbs or linseed meal should be ap- 
plied over abscesses and inflamed glands, and hot fomentations along the cord- 
like swelling, corresponding to swollen absorbents. 

Glands are small bodies, mostly of an oval shape, found in the skin, and, 
in fact, in all parts of the body ; they are very liable to enlarge, especially 
those under the chin, as is often the case in children after an attack of 
measles or scarlet fever, or when the child is suffering from eczema ; they are 
frequently called "kernels" by the ignorant; they form a part of the lym- 
phatic system. 

Glass-pock is a familiar name for chicken-pox. 

Glauber's Salts, technically known as sulphate of soda, is a valuable 
purgative, unfortunately gone greatly out of repute. It is contained in sea- 
water, and in most purgative mineral waters. It has been displaced by Epsom 
salts or sulphate of magnesia, but the change has not been altogether for the 
better. Perhaps the best thing to do is to combine the two, a couple of 
drachms of each, which, taken fasting in the morning, will generally be fol- 
lowed shortly after breakfast by a copious loose motion. 

Glaucoma. See Eye, Diseases of. 

Globulin, a substance existing in the serum of the blood, and in some 
other fluids of the body ; it is obtained by passing a stream of carbonic acid 
gas through serum largely diluted with water. See Blood. 



GLO £82 GOU 

Glottis, the upper part of the air-passages, also known as the opening into 
the larynx. 

Glucose is found in many plants, and also in the blood of man, being 
formed to a great extent in the liver. See Grape-sugar. 

Glycerine is a sweet substance, the basis of fats, being combined in them 
with the peculiar fatty acid characteristic of each. Accordingly, when these 
fats are decomposed by the addition of an alkali, as is done in making soap, 
the glycerine is set free, and the new combination of fatty acid and alkali con- 
stitutes soap. It is also obtained by distilling the fats by means of super- 
heated steam. Thus obtained, the glycerine is a sweet liquid, colorless and 
syrupy, oily to the touch, yet mixing readily with water. The solution of it 
in water does not ferment with yeast, and it does not dry up on exposure to 
heat of a moderate temperature. Its properties are very valuable ; it readily 
dissolves many substances, and not drying up readily it constitutes an excel- 
lent basis for applying them to the skin. It is chiefly as an adjunct to lotions 
that glycerine is of use. Lotions containing it do not dry up and so the skin 
is kept soft and moist, and the bad effect of drying in forming scabs is avoided. 
It has been tried internally instead of cod- liver oil, but it is used as a basis 
for some remedies, as gallic acid and tannic acid, when they are applied to the 
throat. In this way, too, borax may be made use of in aphtha? with ad- 
vantage. 

Glycogen, a peculiar substance formed by the liver, and capable of being 
converted into grape-sugar or glucose. See Liver. 

Godfrey's Cordial is a well-known and popular remedy, which if well 
prepared and carefully administered is by no means to be despised in cases of 
griping and irritation in children. It is second only to Dalby's Carminative, 
which of all patent medicines of this sort is the best. 

Goitre. See Derbyshire Neck. 

Golden Ointment, a bright yellow ointment in popular use, made of 
finely-powdered red precipitate and spermaceti ointment. 

Goose-skin is a roughness of the skin which occurs when any one is 
shivering, as in cases of intermittent fever. 

Gout is a disease about which much has been spoken and written, whose 
characters are perfectly well known, and which yet nevertheless retains much 
of its original mystery. The acute portion of the attack generally locates it- 
self in some joint, and is accompanied by great pain and swelling, general 
constitutional disturbance, and especially derangement of the digestive organs. 
It has a very great tendency to recur again and again after intervals at first of 
apparently perfect health, but afterwards of only partial restoration. Most 
frequently it attacks the ball of the great toe ; later also the hands are affected. 
Sometimes, more especially in later attacks, the gout gives some warning of 
its approach. Digestion is impaired, the bowels are out of order, there may 
be some fluttering about the heart, the skin is dry and hot*, and the urine be- 
comes very thick soon after it is passed, with a brick-dust sediment. Usually, 
however, in earlier attacks there is no warning. The victim goes to bed well, 
and is aroused about two or three in the morning with a severe burning pain 
in the great toe, the ankle, or the thumb. There may also be some shivering, 
but the pain gradually subsides as morning advances, and the patient may have 
some sleep. When next observed the toe will be red, excessively painful, and 
still more tender, and more or less swollen. The patient is exceedingly irri- 
table, and more or less depressed. His tongue is coated with a white fur, his 
bowels confined, and his urine scanty, high colored, depositing a red brick-dust 



GOU 283 GOU 

sediment on cooling, or even when passed. Each night the patient is worse 
than during the day, but the attack does not last long ; in about four or five 
days the patient begins to mend, the swelling abates a little, and scurf is left 
behind. Presently complete health is regained, and the patient feels better 
and brighter than he had done for long before the attack. This too often 
induces a return to the mode of life which brought on the previous attack, and 
by and by, after a longer or shorter interval, the gout returns. This occurs 
again and again, the interval becoming shorter and shorter, and less and less 
distinct, until the patient sinks into the condition known as chronic gout. As 
the disease advances, more than one joint is attacked, the small ones having 
the preference, till almost every joint in the body is seized. Round about the 
joints a matter, at first fluid, but afterwards solid and chalky, is deposited. It 
consists of urate of soda, and the deposits are called chalk-stones or tophi. 
Small deposits of the same material are frequently also laid down in the ear. 
These cause' much distortion ; now and again they suppurate and form very 
troublesome open sores. But gout is not alone manifested by what might be 
called gouty inflammation. When the attack comes on it may become what is 
described retrocedent ; that is to say, may leave the limb and attack some in- 
ternal organ, especially the stomach and heart. Application of cold to the 
affected limb is very likely to bring this about, and its occurrence very fre- 
quently means the death of. the patient. So, too, anomalous gout, as it is 
called, may manifest itself in various ways. There is no regular attack, but 
instead there is indigestion with flatulence, heart-burn, and constipation ; the 
heart beats painfully and irregularly; there is pain in various parts of the head ; 
the patient is easily fatigued, and is restless and irritable ; wandering pains fly 
about the body, and any little damp in the atmosphere brings them on at 
once. Frequently in such patients there will be some form of scaly skin dis- 
ease, very itchy and troublesome. Gout is sometimes acquired, but very fre- 
quently the tendency to it is hereditary. Luxurious living and little exercise 
are the two great means of producing gout anew, but in many, with a strongly 
marked hereditary tendency, no amount of sober living will avail in keeping 
off the malady. The foundation seems in all cases to be imperfect metamor- 
phosis of alimentary substances.. They are not burnt up, but remain behind 
in a half-altered condition to poison the system. There is one special form 
which this half-changed material assumes ; that is, uric acid. It is found mainly 
as urate of soda abundantly in the system, especially in the vicinity of joints, 
where it forms Chalk-stones. It is also deposited in the joints themselves, 
where it gives rise to inflammation and other changes in the joints, whereby 
they are bound together. The internal organs, too, are altered for the worse, 
especially the lining membrane of the heart and blood vessels. The kidneys 
are especially affected, being small and granular, and containing deposits of 
urate of soda. During life these alterations are accompanied and indicated 
by changes in the urine. This is usually rather abundant in quantity, of low 
specific gravity, and containing a trace of albumen. As to treatment much 
may be done both during an acute attack and during the interval. The rem- 
edies may be classified under two headings, specific and common or ordinary 
remedies. Of specific medication we have no better example than the use of 
colchicum in gout. This remedy given in full dose has undoubtedly an extraor- 
dinary influence in relieving the gouty paroxysm, but on what principles we 
cannot tell. Thirty drops of the wine is quite enough for the first dose, and 
ten drops every four hours after, until nausea results, when it should be 
stopped. This may be done earlier if the pain abates, and under no circum- 



GOU 234 GRA 

stances should its use be continued over four-and-twenty hours without inter- 
mission. Usually this will stop the attack, but the practice is not without risk, 
and should not be lightly undertaken. A still more powerful remedy, though 
a secret one. is Lavelle's Gout Liquid. Its effects are closely allied to those 
of colchicum, though its constitution is different. Most likely its efficiency is 
due to white or green hellebore. It must be used with great caution and in 
accordance with the rules laid down for colchicum. Though not without 
danger, its efficiency is undoubted, yet men who have used it for years almost 
invariably give it up. Its effects are extreme depression of the heart, with a 
terrible feeling of sinking and prostration, which are far from pleasant. For 
these symptoms the use both of colchicum and Lavelle's liquid are often contra- 
indicated, and recourse must be had to other remedies, which, though less 
speedy, are more likely to do good in the long run. Chief among these are 
laxatives, and those are best which best unload the portal system without 
weakening the patient. For this gentle saline purgatives are best, say a 
double salted seidlitz powder to begin with, and a couple of drachms of sulphate 
of soda and sulphate of magnesia, each with a few drops of dilute sulphuric 
acid, twice or thrice a day. The effervescing form is, however, the best, as 
agreeing better with the irritable stomach. These remedies must not be al- 
lowed to depress the patient, and in some a more comforting draught of senna, 
rhubarb, aloes, and ginger is to be preferred. Pullna water is a good remedy, 
but must not be used too freely. One great object is to get the urine to flow 
freely, and get rid of the half-metamorphosed material in the system. Alkalies 
do good' in both ways ; they tend to increase the flow of urine and they aid 
metamorphosis. It is best to give the bicarbonate of potash or lithia efferves- 
cing with citric or tartaric acid, along with some aromatic spirit of ammonia 
and tincture of lavender. If the pain is very great it is hardly possible to re- 
fuse opiates, though they are to be avoided as far as possible, seeing that they 
tend to aggravate the disease by retarding food and tissue change. If opium 
must be given, then let it be given by the arm, for so less will be required 
than by the mouth. But before having recourse to that it is better to try its 
effects locally. Thus, a warm lotion containing acetate of lead and acetate of 
morphia will often do more good than anything. Extract of belladonna 
rubbed up with water and glycerine and applied warm will often prove of very 
great service. In all cases warmth is the great thing, cold having a tendency 
to drive the gout to some internal organ. Rest must be absolute and the diet 
plain. It must consist only of milk, arrowroot, and the like. All animal food 
should be avoided, even at first, save the strength demands it. Toast and 
water, seltzer water, and the like may be taken freely. After a time fish may 
be given. If there is need of a stimulant, Scotch whisky and water may be 
given, but for a time all stimulants are better avoided. Then come the rules 
as to treatment in the interval. It is by this only the disease can be cured. 
Chief among these is exercise in the open air, sufficient to make rest grate- 
ful, but not to fatigue. Sea-bathing is good, so are early hours, and plain food. 
Claret, ehablis, and hock may be allowed, so may whisky and water. All 
other liquors are forbidden. The bowels are to lie kept open best by Fried- 
richshall or Pullna water, and the urine must be kept right as far as possible 
by alkalies. A visit to a foreign bathing place appropriate to the case is one 
of the best things to have recourse to. Vichy, Ems, Carlsbad, Wiesbaden, 
and Aix la Chapelle are the most appropriate resorts. 

Granulated Preparations of various remedies are now in common use. 
The first granulated preparation introduced was the so-called citrate of mag- 



GRA 285 GRA 

nesia. This might be said to consist of a seidlitz powder, where the acid, the 
alkali, and the purgative salt, along with some sugar, were all rubbed up to- 
gether until they assumed the granulated form. Other substances have since 
been introduced instead of Rochelle salt, and been granulated as before. To 
keep such preparations unchanged, water must be rigidly excluded. The 
moment they touch water they begin to decompose, the tartaric acid attacking 
the bicarbonate of soda and setting free the carbonic acid with effervescence, 
tartrate of soda and whatever other salt has been introduced remaining behind 
in solution. 

Granular Degeneration is a term applied to the appearance which some 
organs assume when undergoing a fatty or fibrous degeneration ; applied to 
the liver it corresponds with cirrhosis, while in the kidney a similar change 
marks a form of chronic Bright's disease. See Cirrhosis and Bright's 
Disease. 

Granulations. On examination of the surface o c a healthy ulcer, or of a 
large wound which has existed for six or seven days, it will be found covered 
at all parts by small and soft nodules of a florid red color. These nodules are 
called granulations, and it is by their development and subsequent changes 
that cicatrization, or scarring of the ulcer or wound, takes place. A wide 
wound on the surface of the body, when free from excessive inflammatory 
action or sloughing about its edges, presents on the fourth day a deposit over 
its surface of a soft, white, and tenacious substance, through which ruddy gran- 
ulations project, forming at first isolated red clots, and afterwards a uniform 
granular surface. The granulations then increase in size, and at the edges of 
the wounds reach, and in some cases project beyond, the surface of the sur- 
rounding skin. The rounded and free extremities of the granulations break 
down into pus, which is discharged from the surface of the wound, while at 
the deeper parts the granulating tissue contracts, and is converted into the 
tough, filamentous substance which subsequently forms the scar. Along the 
edges of the wound a pink or chalk-white line is formed, which presents a 
well-marked border between the moist granulations on the one side and the 
healthy skin on the other. This border increases in width as it encroaches 
upon the surface of the wound ; it is dry and smooth, and is covered by soft 
epidermis. By the shrinking of the deeper parts of the granulations, and by 
the extension of this superficial border of newly-formed epidermis or scarf 
skin, the wound is gradually closed. Granulations are very vascular, and often 
bleed profusely on the slightest touch. They vary much in sensibility; those 
on a superficial wound or ulcer generally give very little pain when touched, 
whilst those lining the mouth or cavity of a healing abscess are extremely 
tender. They possess the power of absorption, and transmit into the system 
any deleterious substance, such as arsenic, opium, carbolic acid, and mercury, 
that may be applied too freely to the raw surface. Granulations frequently 
become diseased, and the wound or ulcer, instead of closing speedily and with- 
out trouble, either remains stationary and becomes painful, or increases more 
or less rapidly in size. These morbid changes are- often due to local irritation, 
caused by dead bone, foreign material, unsuitable dressings, sloughs, etc., and 
the local cause is often assisted by some constitutional disease, or a bad state 
of the system, due to faulty hygienic conditions. See Ulcers. 

Grape-sugar is a substance found in the juice of the grape and many 
other fruits ; it possesses the property, when fermented, of decomposing into 
carbonic acid and alcohol ; this is taken advantage of in making alcoholic 
liquors ; its constituents are carbon, hydrogen, and oxygen. When any 



GRA 28G GRA 

starchy compound, as bread, potatoes, etc., is mixed with the saliva, this fluid 
decomposes the starch into grape-sugar; it is also formed in large quantities in 
the liver (see Liver), and it is present in the blood and urine in cases of 
diabetes. See Diabetes. 

Gravel is the term commonly applied to the small stony concretions formed 
in the kidney, and which, when passed, seem to form a gravelly kind of sedi- 
ment in the urine. Their size varies from that of a grain of sand to the 
largest that will pass by the urinary passages. If this size is exceeded, they 
must remain behind in some part of the track, most probably the bladder, 
until, by their increase of size and the trouble they give rise to, they either 
cause the patient's death or are removed by art. Here we have mainly to do 
with stones formed in the kidney and retained there, or which, in passing, 
give rise to what is called a fit of the gravel. The stone, if it remains in the 
kidney, is sure to grow, and, doing so, gives rise to very troublesome symp- 
toms. There is considerable pain in the back, always increased by jolting, 
and such accidents are usually followed by a well-marked and unmistakable 
flow of blood from the kidney, which may coagulate in the passages or in the 
bladder, and so give rise to very severe suffering. As the stone grows, the 
symptoms become aggravated, and the health fails. Usually there is great 
sympathetic disturbance of the stomach, and digestion is imperfect. Little 
serves to bring on the bleeding, and the bleeding weakens the patient; more- 
over, the pain is severe. The stone, growing gradually, encroaches on the 
substance of the kidney, which withers and may finally altogether disappear ; 
if now, as not unfrequently both kidneys are affected, any slight accident hap- 
pens to disorder the other, life is in great danger, and not unfrequently is thus 
terminated. Sometimes the whole kidney is destroyed and an abscess left, 
which has been opened and the stone removed, the patient recovering; some- 
times it has ulcerated out. More frequently, however, after the stone has had 
time to grow to such a size as to be obstructed in its passage through the 
ureter, it is dislodged, and, carried by the urine, commences its journey towards 
the bladder. If very small, no symptoms are produced ; if very large, it sticks ; 
between the two are all gradations, from momentary uneasiness to weeks of 
suffering ending in death. The symptoms generally begin suddenly, some- 
times with rigors. There is intense pain in the back and loins, extending down 
into the corresponding groin and testis. Very likely there is sickness and 
vomiting, partly from the great pain, partly from reflex irritation. And this 
may go on for days and weeks. Sometimes the urine is suppressed, and death 
by uraemia follows. On the other hand, a few hours' suffering may. end in 
perfect ease, as the stone passes into the bladder, to be followed a few days 
after by a short and sharp attack of pain as the stone passes out of the bladder. 
When the existence of a calculus in the kidney has been made out, everything 
must be done to avoid further increase ; diet must be carefully selected, so as 
to avoid the formation of uric acid in excess, and to this end, too, it ought to 
be well diluted, and so diluent drinks should be freely used. Alkaline aerated 
waters, too, as a rule, will be specially useful, and liquor potassa, which is 
ordinarily well borne, may be given in good large doses. As regards the 
passing of a calculus, — that is to say, a fit of the gravel, — the great thing is 
to relax the passage as much as possible. For this chloroform or a pipe of 
strong tobacco may be employed, till the patient is fairly sick. He should 
also be kept in a warm bath to promote the same object ; the patient must be 
put under the influence of opium, and kept uuder it till the stone passes. The 
opium had better be given by the arm. 



GRA 287 GRO 

Graves's Disease, also known as Basedow's Disease, and perhaps more 
generally nowadays as Exophthalmic Goitre, is a malady ordinarily charac- 
terized by these symptoms : extreme nervousness, protrusion of the eyeballs, 
a projection and pulsation of the thyroid body in front of the windpipe ; the 
heart pulsates violently, and there is often a bruit at its base coincident with 
the first sound. Most writers have overlooked the nervous symptoms, and the 
enlargement of the thyroid body has misled them in detecting an alliance with 
true goitre. With this, beyond the enlargement spoken of, it has not the 
slightest connection, and the remedies which do good in the one are injurious 
in the other. The eyes sometimes project so far that the eyelids cannot close 
over them, and in a few rare cases the eyeball is destroyed from the pressure. 
The thyroid is swollen, but its swelling is rather lhat of a pulsatile tumor than 
the mass of a goitre. The vessels in the neck pulsate violently, and the heart 
beats quickly. Violently, and imperfectly. The health is bad, the bowels are 
deranged, and the patient is easily put out by any little excitement. The sub- 
jects of this disease are almost invariably females, and in them it has often 
come on after a sudden fright. The menstrual functions may or may not be 
affected at the same time. In dealing with such cases the great object is to 
improve the health and diminish the local symptoms. Iron and digitalis are 
the chief remedies. A change of air is good, and especially a stay at one of 
those cheerful, healthful resorts, called hydropathic establishments. Usually 
these cases terminate favorably. 

Green Sickness, also called Chlorosis, is a malady peculiar to young 
females, most frequently, but not always, domestic servants. They become ex- 
cessively anasmic, they suffer from shortness of breath and palpitation. Their 
menstrual functions are either in abeyance or materially altered for the worse. 
In some instances it seems to depend on exclusion from the light, as in towns, 
at all events, domestic servants being for the most part confined to the base- 
ments, the supply of light is there imperfect. That, however, does -not as- 
suredly account for the whole phenomena of the disease. See Chlorosis 
and Anaemia. 

Gregory's Powder, or Compound Rhubarb Powder, consisting of 
rhubarb, magnesia, and ginger, is one of the best and safest of domestic rem- 
edies. It is chiefly given to children as a laxative, when the bowels have 
become out of order from the consumption .of forbidden delicacies of an indi- 
gestible kind. The dose for them is five or ten grains. Among adults it may 
be used for similar purposes, but is not frequently so used ; rather it is given 
combined with some other drug in small doses over a long period, for the sake 
of the beneficial effects of the rhubarb and ginger as stomachics. 

Griffith's Mixture, or the Compound Iron Mixture of the Pharmaco- 
poeia, is one of the most valuable means of prescribing iron for delicate stom- 
achs that we possess. The iron is contained in it as green oxide, and sugar is 
added to prevent the changing into the red oxide, but it does so change in a 
short time. It is the best form of iron for irritable stomachs and for chlorosis. 

Grinder's Asthma, or Grinder's Rot, is a form of consumption com- 
mon in those who are exposed to dust from grinding knives, razors, etc., and 
many suffer from this cause. 

Gripings are painful sensations produced by indigestible food in the in- 
testines, and caused by irregular contractions of the bowels and the passage 
of flatus. 

Grocer's Itch is a form of eczema which occurs in the hands of those who 
work with sugar or other sticky substances. See Eczema. 



GUA 288 GUL 

Guaiacum is a resin obtained from a tree growing in the West Indies and 
Central America. The wood is known as lignum vita?, and is excessively 
hard ; it is employed for various purposes, and the chips and turnings obtained 
in preparing it for these are saved and made use of in medicine. The resin is 
also got by boring a hole in the log, and putting one end of it in the lire ; as 
it burns the resin melts and runs from the hole. More commonly it is ob- 
tained by boiling the chips already referred to in salt and water, when the 
resin floats on the top. The resin is insoluble in water, but soluble in alcohol. 
The preparation commonly employed is the ammoniated tincture, consisting of 
the resin dissolved in aromatic spirit of ammonia. Taken internally the ef- 
fects of guaiacum are not very certain. It is described as stimulant and di- 
aphoretic. It seems to do good in certain maladies, especially of a syphilitic 
taint, which affect the skin, the bones, or their immediate coverings. 

Guinea Worm, an animal parasite infecting man in some parts of Africa. 
See EcTOzo.Y. 

Gullet, Obstruction of. This is. as a rule, of two kinds, simple and 
malignant. Simple obstruction, or stricture, is most frequently due to the 
results of some corrosive poison. The poison may not have proved fatal, but 
may have destroyed the tissues with which it came in contact to some depth, 
and as a consequence, when the parts were cicatrized, contraction of the cicatrix 
has taken place, narrowing the calibre of the tube to such an extent that solids 
cannot pass. The poisons most likely to give rise to such consequences are 
the strong mineral acids and alkalies. The symptoms of obstruction may not 
come on for many months after recovery from the immediate effects of the 
poison. The great tiling to be done in such cases is to guard against the con- 
traction which is almost inevitable. To this end an ordinary gullet tube 
should be passed from time to time till the calibre of the natural passage has 
been attained. Nor should it be forgotten that as soon as the. distending force 
is withdrawn the parts will again tend to contract. Indeed, some have worn 
a tube habitually with very great benefit, and if that is not used a tube must 
be passed at short and regular interval-, or contraction will speedily begin. 
There is probably a variety of stricture of the oesophagus or gullet due to 
syphilis; this, meantime, is not quite certain. True malignant disease of the 
gullet has symptoms which are at first exactly like those of simple stricture, 
only there is no history, of injury to the part. Moreover, it advances more 
rapidly, and there may lie. but not of necessity, pain. The food is swallowed 
as usual, but sticks at the obstruction, and either accumulates for a time or at 
once regurgitates. The vagus nerves being frequently affected, vomiting, 
cough, and hiccup are common symptoms. '1 he patient wastes rapidly, partly 
from the character of the disease, partly from want of food. Death rarely re- 
sults from starvation, as it is wont to do in the other variety of stricture, but 
the disease spreads to some neighboring part, or bleeding follows, or the like. 
Very frequently there is produced a communication between the windpipe and 
gullet. This, too, aggravates the cough. The character of the disease in- 
sures the destruction of life in the long run; the only question is a choice of 
evils. As the disease advances, less and less food can be taken, until the pa- 
tient is threatened with starvation, though surrounded by plenty. This, too, is 
the case in simple stricture, though in that there is much more chance of the 
obstruction being overcome. Under these circumstances we must have re- 
course to nutrient enemata, which may be used as long as possible. At the 
same time the mouth may be washed out with a little water, and kept moist by 
attending to it from time to time. The question remains, Is it right to have 



GUM 289 GUM 

recourse to an incision into the stomach with a view to making a permanent 
opening for cases which cannot otherwise he dealt with ? In malignant dis- 
ease this is merely prolonging torture, supposing the operation to succeed in 
the first instance ; either way the patient must die. Upon the whole, there- 
fore, to make a permanent opening into the stomach through the walls of the 
abdomen in malignant disease of the gullet is not an operation likely to be 
followed with success. The only time when there can be a question of per- 
forming it is when the stricture is a simple one, but as death has followed in 
every instance hitherto the prospect is not an encouraging one. 

Gum Acacia. See Acacia. 

Gumboil, parulis, is the most common form of alveolar abscess, invari- 
ably associated with a decayed tooth causing inflammation of the periosteum 
covering the alveolar process and of the bone itself. The abscess causes great 
pain and discomfort, and frequently considerable constitutional disturbance. 
In the earliest stage, when the formation of pus is threatening rather than 
established, the malady may be cut short by the extraction of a tooth affected, 
or by the removal of the stopping from some decaying tooth. If the extraction 
of such a tooth be undesirable, the gum should be freely leeched, the leeches 
being best applied through a glass tube, or leech glass (see Leeching), a 
brisk purgative administered, and hot fomentations applied to the swelling. 
When pus has formed, and it threatens to " point," the walls of the abscess 
becoming thinned and soft, it should be evacuated by means of a scalpel. Oc- 
casionally, in severe cases, the matter will " point " externally on the cheek. 
The offending tooth must be at once extracted, and a vertical cut be made 
with a scalpel, between the cheek and the jaw, so as to cut across the pus-con- 
taining canal. " In all cases of alveolar abscess, extraction of the diseased or 
dead tooth is the cure ; and there are but two circumstances which peremp- 
torily interdict this mode of treatment. First, where a strongly pronounced 
hemorrhagic diathesis forbids the extraction of teeth altogether; and, secondly, 
where the abscess is associated with the upper incisor teeth of young people in 
whom the jaws have not yet assumed their adult form, and where the perma- 
nent dentition is as yet incomplete." 

Gums, Diseases of. These structures are occasionally affected with 
ulceration in consequence of mercurial salivation. In bad cases. large and very 
fetid sloughs are formed, but usually only redness and superficial excoriation 
of the gums may be observed. The best treatment, perhaps, for small super- 
ficial ulcers of the gums is the local application of solid blue-stone or the use 
of a wash containing alum or borax. In old people the gums frequently be- 
come soft and swollen, and separate from the roots of the teeth. The contact 
of food is painful, and causes bleeding. This condition is often associated with 
disorders of the stomach and liver. The usual treatment consists in washing 
out the mouth with a lotion containing alum and tincture of kino, and in the 
application to the affected gums of tannin and glycerine. Attention should be 
paid at the same time to the digestive organs, and the bowels be freely opened 
with blue-pill or calomel, followed by a black draught. In cases of sea and land 
scurvy, the gums swell and are covered by large spongy outgrowths of a 'dark 
red or purple color, which readily bleed when touched. These outgrowths are 
masses of swollen gum, and generally spring from the small tongues of gum- 
tissue which project between the necks of adjoining teeth. This morbid con- 
dition disappears with the other symptoms of scurvy after the administration 
of a good diet, comprising fresh meat and vegetables. 

Epulis is a firm, painless, and slowly-growing tumor, which appears on the 
19 



GUN 290 GUN 

gums, especially over the sockets of the teeth in the upper jaw. The surface 
of this growth is slightly irregular and tabulated, and resembles in appearance 
perfectly sound gum. It generally grows forward from the free surface of the 
gum. and its root is always connected either with a complete and apparently 
sound tooth or with an imbedded fang. Sometimes the surface of the growth 
becomes ulcerated, and pours out an offensive discharge. The usual treatment 
for epulis is early and complete removal. If the tumor be merely shaved off 
at its insertion into the gum it will almost certainly return. In consequence 
of the origin of the tumor from the fang of a tooth and from the inner part of 
the socket, it is necessary for the surgeon to extract one or both of the dis- 
placed teeth, and at the same time to remove with bone-pliers a portion of the 
corresponding alveolar process of the jaw. 

Gunshot Wounds. The term gunshot wounds implies, of course, in its 
first sense, such injuries as may arise from cannon-shot, splinters of shell, or 
bullets ; but it must be remembered that injuries inflicted by any explosion, 
such as the bursting of a boiler or blasting a rock, for instance, possess the 
same general characters. Ever since the introduction of gunpowder the 
wounds made by its missiles have attracted the minutest attention of surgeons. 
But the immense improvements of late years in artillery and small arms, from 
the fact of such weapons being rifled, have led to changes in severity, and, 
indeed, almost in the nature of gunshot wounds, particularly as regards their 
infliction by small arms. The form of wound is of the lacerated and contused 
character, followed by sloughing and suppuration. Haemorrhage is seldom very 
extensive in cases where there is much crushing, as the vessels thereby become 
twisted and thus closed, although in the case of the puncture that a small 
bullet would make some internal vessels may be wounded and bleed internally, 
while the external wound is very small and no blood flowing from it. Bullets 
frequently lodge. In the instance of a spherical bullet, fired from a smooth- 
bored musket, the aperture of entrance is small, with discolored and inverted 
margins. The aperture of exit is larger than that of entrance, and its margins 
are ragged and everted. If the muzzle of the musket were near to the body 
at the lime of discharge, the aperture of entrance would be lacerated, usually 
containing wadding or clothing, and scorched with the explosion. The appear- 
ance of injuries from the conical bullet of the modern rifles, such as the Snider 
or Martini-Henry, is different from the foregoing in most cases ; the wound is 
more like an incision, and if the ball passes through its apertures of entrance 
and exit are almost similar. It usually splits any bone in its course, owing 
to its velocity of rotation. The course taken by bullets, especially round ones, 
is oftentimes very remarkable, as may be inferred by watching a shot or shell 
strike the water and rebound indefinitely, and instances might be multiplied of 
cases where the apertures of entrance and exit have been exactly in a line, and 
yet the ball has traversed the entire circuit of the trunk. The shock is pro- 
portioned to the extent of injury, the importance of the part affected, and the 
quantity of blood lost. Sometimes fatal injuries are inflicted when there is not 
the slightest sign of an outward bruise, and bones smashed, muscles and arter- 
ies lacerated; this form of injury was formerly called a "wind contusion," but 
it is now well known that such injuries must have been effected by the actual 
contact of the shot. The true extent and danger of wounds inflicted by gunshot, 
in the case of penetration, can hardly be determined until suppuration has been 
set up. Sloughs become detached, particularly at the aperture of entrance, as 
at that point the degree of contusion is greatest, although the aperture of exit 
is always first healed; the suppuration of the slough is usually complete in a 



GUN 291 GUN 

week or ten days. Many formidable accidents are liable to occur, however, such 
as inflammatory fever, gangrene, erysipelas, abscesses, haemorrhage, sloughing, 
phagedena, non-union of fracture, necrosis, caries, hectic, tetanus, and pyaemia. 

Detection of Bullets, etc., in Wounds. It is sometimes difficult to deter- 
mine whether some hard body felt in a wound is a ball or a piece of exposed 
bone, and for the purpose of making a correct diagnosis a probe, carrying a 
small piece of unglazed porcelain at its extremity, is one of the best, as the 
absorbing nature of porcelain allows of a small stain of the metal being carried 
on it on withdrawing it from the track (Nelaton's probe). Kress's probe is a 
very effective instrument ; it consists of a common steel probe, having a conical 
piece of steel at the end, roughened like a file, so that by rotating the instru- 
ment between the finger and thumb some portion of the surface of the body 
reached by the probe is brought away with it. As soon as the injury is in- 
flicted a most careful search should be made for the foreign body, before 
swelling has come on. The best instrument for making an examination is the 
finger, but if that fails to reach the substance a long silver probe which readily 
admits of being bent is required. Bullet forceps, especially made for the pur- 
pose, are needed in many cases, but if the ball be near the surface, common 
incision, with forceps, is sufficient. The external wound must be enlarged in 
cases where neither the finger nor the forceps can be introduced. Gunshot 
wounds of the skull are most unsatisfactory and fatal. In the case of simple 
flesh wounds, if not severe, they will heal under simple dressing and quiet ; if 
the scalp be severely lacerated, suppuration and necrosis of the outer table of 
the skull, and perhaps meningitis, may follow. If severe rigors and head 
symptoms occur in from a fortnight to a month after the injury, it would 
point to the probability of the formation of pus (see Fractures of Skull). 
In cases of fracture with depression of bone, and the usual symptoms of com- 
pression present (see Compression), then the surgeon should trephine. If 
balls or fragments of shell lodge in or penetrate the skull, they are almost 
always fatal. Injuries of the face may be merely superficial, or of consider- 
able importance when the bones are smashed ; care must be taken to relieve 
any deformity which is likely to arise, by adjusting the parts with sutures, and 
removing all spiculos of bone, and applying a light water-dressing. 

Injuries of the Chest. The several kinds of gunshot injury of the chest may 
be conveniently classed as follows, for sake of reference: (1) those in which 
the thoracic cavity has not been opened ; (2) those in which it has ; and a 
further subdivision is to be made of injury and non-injury of -its contents. 
In the first class the danger is small, comparatively ; and in the second it is 
serious, from haemorrhage and its complications. If the ball has lodged in a 
penetrating wound the prognosis is unfavorable. The symptoms of wounded 
lung are great collapse, blanched, anxious face, difficult breathing, and gen- 
erally frothy expectoration, frequently emphysema (see Emphysema), from 
the fact of a rib having been fractured. The patient should be carefully ex- 
amined, to find out in the first place if the ball be in the thoracic cavity, or if 
it has passed out at some counter opening. Splinters of broken ribs must be 
carefully removed, and some light water-dressing be placed over the wound. 
He should be placed on his wounded side, so that the escape of pus may be 
favored and the movements of the ribs quieted. Constitutionally, low diet, 
perfect rest, and the administration of opium, generally suffice. The un- 
favorable symptoms which may arise are pneumonia, pleurisy, or empyema. 

Injuries of the Abdomen may be conveniently divided into non-penetrating 
and penetrating. Non-penetrating flesh wounds merely require the ordinary 



GYM 292 GYM 

treatment of incised wounds. In the case of penetrating wounds the amount 
of fatality is very great. If a ball passes through the abdomen without injuring 
its contents, peritonitis is usually set up. If a large viscus has been wounded, 
great collapse is the first symptom noticed ; if the intestines have been lacer- 
ated or opened there is severe vomiting, great pain, and passage of blood per 
anuin ; the nature of the discharge from the wound is itself a guide to what 
viscus or viscera are implicated. With regard to the treatment of these for- 
midable injuries, the first thing to be done is to endeavor to replace any pro- 
truding contents, avoiding all unnecessary handling, and in the case of a 
wound noticed in any portion of the protruded intestine, its edges should be 
neatly approximated, by what is known as a continuous or Glovers suture. 
Large and frequent doses of opium are needed, to allay pain and overcome the 
peristaltic action of the bowels. Simple flesh wounds of the extremities re- 
quire the ordinary treatment of incised or lacerated wounds; if the bones be 
simply fractured, and there is not much external injury, the limb should be 
put up on a splint, but severe contusion and lesion of surrounding muscles and 
deep structures require amputation. The cases of gunshot wounds of the ex- 
tremities which require removal of the limb are : (1.) Those in which the limb 
has been torn off. (2.) Where there is severe laceration of the superficial tis- 
sues, with injury to the main artery, vein, and nerve. (3.) Severe compound 
or comminuted fractures, with destruction of surrounding tissues. The expe- 
rience of modern army surgeons as to the question of amputation is that when 
necessary it should be primary. 

Gunshot Wounds of Joints are always serious, even though the joint be not 
opened by an external wound, as in such cases the inflammation set up may, 
and generally does, terminate in suppuration. In the treatment of these in- 
juries it usually results either in amputation or excision. In cases where it 
seems that the limb can he saved without risking the life of the sufferer, the 
case may be treated as one of compound fracture, pus being evacuated by free 
incision and constant irrigation by cold water. The treatment of Avounds of 
joints will be found discussed at greater length under the articles Joints and 
Fractures. 

Gymnastics. By gymnastics, we mean at once physical education and 
the use of muscular exercises in the cure of disease, and though these are, 
strictly speaking, totally distinct, it may not be amiss to take them together. 
Physical education has to a very great extent been left, in this country, to 
take care of itself. We are no worshipers of the system which would subor- 
dinate mind to matter, which would make a well-trained boating man or ath- 
lete the most perfect being on earth, but assuredly we do not hold to the other 
view, that men may grow up misshapen, rickety articles, provided only their 
mental powers are developed to the uttermost. Strength of body is necessary 
to strength of mind, and most men of great mental vigor, not necessarily of 
subtlety and l'efinement, are also men of bodily vigor. Here, it may be as 
well to say that physical education does not mean what is sometimes described 
as " hardening" children. You see a miserable little wretch, shivering in the 
cold of winter, only half dressed, and you are told by his parents that they are 
hardening him. It is true the result may be satisfactory, but it may not; 
some live and do well, but a good many die in the process. Physical education 
means taking the material "you have got, however unpromising, and making 
the best of it. To do so, you require good food and clothing, air and exercise, 
and the cleanliness which comes next to godliness. In physical education, the 
object aimed at is the exercise of all the muscles of the body, none assuming 



H^BM 293 H2EM 

an undue preponderance over others. The foundation of all physical training 
is that a part grows by exercising it. The more it is wanted to do, within 
due limits, and provided due nourishment be supplied, the more it will be able 
to do. It grows by exercise ; now the part of exercise which seems to do 
most good is motion. Suppose you move your arms backwards and forwards 
a score of times, these will do the muscles more good than moving backwards 
and forwards, under greater difficulties, ten times ; which leads us to the con- 
clusion, that for training purposes, especially among children, apparatus is of 
little value, save as a means of directing movements. Take the case of dumb- 
bells. They are intended to strengthen the muscles which protrude and draw 
back the arms. But if you use heavy dumb-bells, another thing is called into 
play, namely, the support of their weight, whether close to the chest, or at a 
distance from the body ; that means the use -of another set of muscles, which 
will not be exercised, only strained. So too Indian clubs : first-rate things they 
are for opening out the chest, but if you use them too heavy, you only drag 
and strain the muscles, speedily tiring them out, instead of exercising them. 
But the exercises are easier with clubs than without them ; with them, too, 
you can exercise several muscles you could not without them, and so we pre- 
fer clubs, but light ones. We had almost said, the lighter the better, at all 
events not heavy ones to tire the individual during exercise by weight only. 
It would be useless to enumerate all the various kinds of apparatus used for 
training. In point of fact, we think, with a pair of light wooden clubs you can 
do all you wane. We want to enforce the point that what is required is motion, 
and motion, if possible, of every joint and muscle. There is one caution 
which should not be. overlooked : that is, do things by degrees, never attempt 
violent exercises all at once. The reason is obvious, your muscles may be 
strong and require little training, but a town life almost inevitably throws out 
of good training the heart and lungs, though we do not seem to perceive it 
until we attempt some unusual exertion. Medical gymnastics are totally dif- 
ferent things. Their purpose is to train, not the whole body, but some one 
defective part or organ, to enable it to do its duty aright. Let us take an ex- 
ample : but a few years ago, it was supposed that squinting was due to one 
muscle of the eye pulling more towards one side than its antagonist on the 
opposite side can resist. Then the plan was to cut the muscle which dragged, 
and let the other get fairer play. Now it is well known that squinting is not 
due to any one cause, but is symptomatic of many. It may be a sign of pa- 
ralysis instead of over-exertion, and so requires to be treated in very different 
ways ; stimulation by a galvanic battery, so as to exercise the muscle at fault, 
being one of them. 

H. 

Haematemesis, or Vomiting op Blood, is a symptom of grave impor- 
tance. It occurs under various conditions : sometimes from ulcer of the 
stomach, or from cancer of that organ, or from the mechanical congestion 
caused by disease of the heart or liver, more rarely from the bursting of an 
aneurism into the oesophagus or stomach. It has also been stimulated by 
hysterical patients, and some malingerers have swallowed blood on purpose, 
and then vomited it for the purpose of exciting commiseration ; occasionally, 
haematemesis comes on at the end of renal disease. The blood vomited is 
generally of a coffee-ground color and appearance from being acted upon by 
the gastric juice, but if a large quantity is suddenly poured out from a rup- 



H^EM 294 ' H^EM 

tured vessel and vomited at once, it will have a dark clotted character. If due 
to heart disease, the effused Wood is seldom large in amount ; the capillaries 
and veins of the stomach share in the general congested state of the hody, and 
the coats of some of them become ruptured from over-distension. In such 
cases there will also be dropsy of the legs and abdominal cavity, and the usual 
signs of heart disease. Treatment is of little avail, and death speedily occurs, 
not because of the loss of blood from the stomach, but of the general condition 
of the body, of which the hrematemesis forms only a part. In long-standing 
disease of the kidneys, and more especially in that form which is met with in 
gouty people, haemorrhage from the stomach is often present ; headache, 
bleeding from the nose, sickness, a sallow complexion, and the presence of 
albunien in the urine are generally associated phenomena. The treatment 
consists in avoiding stimulants, keeping up a free action of the skin and bowels 
by promoting perspiration and giving aperients, and in this way relieving the 
kidneys, which are the source of the mischief. Cirrhosis, or contraction of the 
liver (see Cirrhosis), often causes haamatemesis by mechanically obstructing 
the flow of blood. The treatment will consist in keeping the bowels open, so 
as to relieve the liver, giving light and nourishing diet, and making the patient 
lie down quietly. In these cases, as in those depending on heart disease, the 
bleeding ought not to be stopped, as it really relieves the dilated vessels, and 
if it could be stopped in one place it would only break out in another. But 
if the hsematemesis depend on an ulcer or cancer of the stomach, it should be 
put a stop to as soon as possible. Ulcer of the stomach may give rise to 
bleeding, from rupture of some blood-vessel round the margin of the ulcered 
surface. Perfect quiet and rest in a horizontal position should be adopted, in 
this as in all the other cases ; very little food should be taken by the stomach, 
and nourishment may be given by means of .an enema; iced milk should be 
swallowed slowly and in small quantities, and small pieces of ice may be dis- 
solved in the mouth with much benefit. Cancer of the stomach is attended 
by the usual signs of indigestion, great pain over the organ, and constant vom- 
iting; great and rapid emaciation is also noticeable, and a sallow, cachectic 
look; lnematemesis now and then occurs in the course of this disease, and 
hastens its fatal progress; the treatment will be the same as for an ulcered 
stomach. Vomiting is very common in some kinds of hysteria, but there is 
not often any blood present ; when there is it appears in red streaks, and gen- 
erally proceeds from the gums, decayed teeth, or back of the throat ; such 
people do not lose flesh, although they seem to be constantly sick ; they are 
generally young females and are suffering from other signs of hysteria. The 
bleeding is extremely small in quantity, and can do no harm ; the inside of the 
mouth should be examined carefully, as the bleeding may be done on purpose 
by scratching the gums, etc., with a pin or with the linger nails; detecting the 
imposture is the surest way to cure it. A malingerer would be found out by 
the absence of pallor, or general symptoms proportionate to the amount of 
bleeding ; detection would ensue on carefully watching such a patient. Haemafc- 
emesis from the rupture of an aneurism would at once prove fatal. 

Haematocele. The external tunic of the testicle (the tunica vaginalis) 
is sometimes the seat of extravasated blood, generally (he result of injury. 
The scrotum usually shares in the swelling produced, as it is from external 
violence that the disease proceeds. The scrotum and testicle appear enor- 
mously distended, bruised, painful, and tense. In simple cases, rest, a slight 
purgative, and a cold evaporating lotion will be sufficient, but should severe 
inflammation supervene and abscess form, the matter must be evacuated by 
means of an incision. 



HJEM 295 H^5EM 

Haematuria signifies that bloo.d is present in the urine. It is, as a general 
rule, a grave symptom, as it implies that there is some disease going on in the 
kidneys. A common cause is some severe blow on the loins, and may be pro- 
duced by falling backwards, or by a direct blow being given over that part. 
Great pain is at once felt, and is often accompanied by sickness, with a sensa- 
tion of faintness and inability to walk erect. In a few hours the patient finds 
on passing water that there is more or less blood mixed with it, so that it is 
almost the color of porter. He may need to pass water more freemen tly, and 
will most likely have pain extending from the loins down by the groin into 
the thigh. The patient should be at once put to bed and kept at perfect rest. 
To ease the pain, hot flannels, or flannels wrung out of hot water, and put 
across the loins, are very beneficial, and if there is much pain and distension 
of the abdomen they may be applied in front also. Morphia, or some prepa- 
ration of opium, may be given under medical advice. The bowels may be kept 
moderately open, and very plain, simple diet should be given. Nothing should 
be taken to cause any irritation to the kidney ; as the patient will most likely 
be thirsty, and feel sick, iced milk and water is very grateful ; beef-tea, arrow- 
root, tea, and barley-water may be also taken. So long as any blood is pres- 
ent the urine will give a white, heavy, flocculent precipitate of albumen, when 
a small quantity is placed in a glass test-tube and boiled over the flame of a 
spirit-lamp. This is a very simple test, and to insure a good recovery the 
patient ought to be kept to his bed, or at least to his bed-room, until all traces 
of albumen are gone. If any exertion is undergone too soon, the bleeding is 
apt to recur, and may, in fact, lay the foundation of serious mischief in the 
future. For some time the patient will feel weak and will be pale ; to rem- 
edy this, tonics are of great value ; all preparations containing iron are good, 
and are useful in checking the haemorrhage ; when the tongue is clean and 
the invalid feels hungry, solid but light and nutritious food may be given. 
Haamaturia may arise from the presence of a stone in the kidney, and this may 
be induced by severe exercise, such as riding or driving over rough ground. 
If the stone is lying quietly in the kidney, the bleeding may soon go off on 
resting a short time, but if the stone is passing down into the bladder, very 
great pain and distress will be endured until that process has taken place. A 
hot hip-bath is then of great service, and if the pain be very severe the med- 
ical attendant may give a little chloroform to be inhaled. At the same time 
diluent drinks may be given, as barley-water, toast-and-water, tea, and milk. 
Hematuria is very often met with after scarlet fever, and forms part of the 
disease known as " dropsy after scarlet fever." It is often due to a chill be- 
ing taken while the skin is peeling. The urine suddenly becomes bloody 
and rather less than usual is passed ; there may be slight aching pains in the 
loins, but not to any great extent ; there is often with this condition a puffi- 
ness of the eyes and feet, which is caused by an effusion of serum under the 
skin of those parts. When the urine stands a short time, a considerable 
amount of dark brown flocculent sediment is observed, and on boiling, as be- 
fore described, a good deal of albumen will come down. Hot fomentations 
may be applied and the patient placed in a hot bath so as to encourage 
sweating, and to make the skin do the work of the kidneys. The bowels 
should be kept gently open. This disease is most common in children, and 
may often be accompanied with convulsions. Hematuria may occur at the 
very onset of scarlet fever, but is not then a sign of much importance ; it 
is found to occur slightly in nearly every severe case of fever, but in such 
cases rarely calls for treatment. It may come on after taking turpentine or 



HJ1M 296 H^3M 

cantharides (the Spanish fiy) ; these are really poisonous agents, and have 
heen occasionally given for that purpose. They cause a stoppage in the 
amount of urine passed with great pain and vomiting, and often serious results. 
Blood may occasionally appear in the urine from eating indigestible food, 
from over-exertion, and in some people it is met with in very hot weather, 
when all the tissues of the body seem relaxed. In such cases the hematuria 
will last only a few hours, and may be cured by finding out the cause and 
avoiding it. In the diseases known as scurvy and purpura, blood may appear 
in the urine in a similar way to the manner in which blood is effused under 
the skin. More recently the name'* intermittent hematuria " has been given 
to a disease, where, for a few hours, blood will suddenly appear in the urine, 
and as suddenly disappear ; such persons are generally very sallow, and know 
when an attack is coming on by feeling a sh vering fit ; in some, getting out 
of bed and going out into the cold air will bring on an attack at once. Good 
diet, rest, and improving the general health are the chief things to be done 
in such cases. 

Haemoptysis is a term applied to coughing up blood. It comes on in the 
course of many diseases of the lungs and air-passages. Sometimes it is very 
small in quantity, and only streaks of blood are found in the phlegm ; at other 
times the flow of blood is so excessive as to cause sudden death. In pneumo- 
nia or inflammation of the lung, blood is always found in the sputum, giving 
it a rusty or lemon-color look ; in the early stages of consumption, blood is 
frequently coughed up, but never to cause a fatal result; in the later stages of 
this disease, when cavities have formed in the lungs, a large vessel may give 
way and cause haemorrhage which cannot be stopped. The bursting of an 
aneurism into the air-passages, or rupture of the pulmonary artery through 
ulceration of the bronchus, may set up fatal haemoptysis. In many cases of 
heart disease, blood is often found in the sputum during the last few days of 
life. In some forms of bronchitis, haemorrhage occurs, but very rarely, and to 
no great extent. Warty growths, ulcers, and cancerous disease of the larynx 
and trachea or bronchi, may cause the patient to cough up blood ; this symp- 
tom generally accompanies cancer of the lung. The treatment consists in per- 
fect rest in bed, the head and shoulders heing generally propped up, as the pa- 
tient cannot lie down in comfort. Ice broken up and applied in a bladder- to 
the spine or front of the chest is often of service, or small pieces may he slowly 
dissolved in the mouth. No speaking should be allowed, nor any exertion what- 
ever on the part of the patient ; the room should be warm (60°-65° Fahr.), and 
the air rather moist, so that any irritation from external cold may be allayed. 
Inhalation of turpentine vapor is perhaps the most valuable remedy : a jug may 
be nearly filled with boiling water and a tablespoonful of turpentine put into 
it ; the patient should then hold his mouth over the jug and inhale the steam, 
which will cany with it the turpentine vapor ; better still, to use inhalers whiclv 
are manufactured for the purpose, and may be had of any chemist. Various 
astringent medicines have been given internally, as iron, tannin, gallic acid, 
acetate of lead, etc., but they are more useful in cases of haemorrhage from the 
stomach and bowels. Opium is of service in quieting the circulation, and in 
allaying the nervous excitement which is generally associated with ha-moptysis. 
When the bleeding has ceased, rest should, for some days, be carefully en- 
joined, and any exposure to cold or other exciting cause should be avoided. 
There will be anaemia and debility afterwards to a greater or less degree, and 
these must be combated by appropriate tonic medicines. In all cases of hae- 
moptysis, the cause must be clearly made out; in pneumonia, the bleeding will 



H^JM 297 H^IM 

not signify, and it is very small in quantity, and no special treatment is called 
for on that account; again, in heart disease it is of no avail trying to stop the 
haemorrhage from the lungs. In other cases the above remedies should be tried. 
Occasionally, haemoptysis occurs in hysterical females ; of course, in these 
cases it is very small in quantity, and the treatment will consist in attending 
to the general state of the patient, and not to the bleeding. 

Haemorrhage. By haemorrhage is meant an escape of blood from an ar- 
tery or a vein, whether as the result of a wound, or from some pathological 
cause, such as ulceration. Arterial haemorrhage is recognized by the blood 
escaping in jets, per saltum, and being of a bright red color; venous haemor- 
rhage by an oozing of black blood, though in the instance of some of the large 
veins being wounded, and the wound opening superficially, the oozing is con- 
verted into a rushing. In the matter of treatment of haemorrhage from an 
artery, the first indication is obviously to cut off the supply from the heart by 
applying some method of compression between the wound and the heart. (See 
Accidents.) This ma} r be done either by pressure by the finger in the 
course of the vessel (which follows the inner axis of a limb), by a tourniquet, 
or by tying a handkerchief round the limb, with a stone placed in it over the 
artery, and twisting the handkerchief tightly with a stick. This arrests imme- 
diate danger. The surgeon, however, performs the operation of ligature, by 
cutting down upon the wounded vessel in its track, and placing a hempen or 
silken ligature upon it above the seat of injury ; an operation of course de- 
manding considerable' anatomical knowledge and judgment. In the case of 
bleeding from a superficial small artery, if pressure does not control it, it may 
be caught up with a pair of forceps and twisted {torsion), or its end picked up 
and tied, or a needle may be placed underneath it, and a loop of silk applied 
over the ends of the needle, and the inclosed tissue containing the bleed- 
ing vessel (acupressure). In the case of haemorrhage from a vein, ordinarily 
it may be restrained by pressure at the spot, either by a bandage and a gradu- 
ated compress, that is, a pad made of conical shape, applied with its apex 
downward, or by unremitting pressure of the finger, or in very severe cases by 
acupressure, or ligature, as in the case of arterial haemorrhage. 

Hemorrhage from the nose, or epistaxis, may be caused by injury, by gen- 
eral excitement, plethora, or by some excitement of the mucous membrane, 
such as scrofula or phthisis, in which case the bleeding is arterial. Again, it 
may be a passive drainage of venous blood, owing to obstruction of the circula- 
tion in the heart or liver, as in scurvy, purpura, or the last stage of fever. 
With regard to treatment, in some cases a good purge should be administered, 
and quinine and steel exhibited ; or in more protracted cases the patient should 
be sent to bed in a cool room, suck ice, have the nostrils syringed out with 
cold water, or water containing a drop or two of perchloride of iron or a few 
grains of alum or tannin. In cases of great urgency, jthe method of plugging 
the posterior nares must be had recourse to, and this is done as follows : a 
curved catheter or bougie, or an instrument made for the purpose, is passed, 
with a long piece of silk fastened to its end, through the nostril into the phar- 
ynx (remember that the lower border of the nostril is horizontal) ; the end of 
the silk in the pharynx is then brought through the mouth with a forceps, and 
a small piece of sponge is tied to it. Then by pulling the silk back through 
the nose the sponge is drawn through the posterior opening of the nostril, leav- 
ing one end of the string in the mouth ; the anterior nares should then be 
plugged by a fold of lint passed on the end of a probe, and tied in by the 
nasal end of the string. The plugs should be left in for a few days. Haemor- 



UMM 298 H^M 

rhage from the kidneys is the result of disease, such as calculi, or blows, or 
the congestion consequent on scarlatina; from the bladder or prostate gland, 
by clumsy catheterism, stone, or malignant disease. In kidney haemorrhage, 
tinctura ferri perchloridi, or gallic acid are of chief use ; or, if there be in- 
flammatory symptoms, cupping, purging, and the administration of acetate of 
lead. In bladder haemorrhage, a catheter should be passed and tied in, and 
small doses of turpentine administered. 

Haemorrhage from the urethra sometimes occurs as a result of forcible cathe- 
terism, or during chordee ; generally a recumbent position will check it ; if not, 
pressure, far back in the perinaeum, cold, or the injection of tannin or gallic 
acid is of value. 

Haemorrhage from the rectum is caused either by the bursting of a varicose 
vein in piles, or from the vascular surface of internal piles, induced by defeca- 
tion. Should the haemorrhage result from piles, those piles should be operated 
on, and astringent applications, such as bark injections, be used. Internally, 
bark and sulphuric acid, or copaiba. If the haemorrhage be very violent, the 
rectum may be plugged with a cork, having some styptic applied to it, or lint 
or ice be thrust up the cavity. Frequently, haemorrhage from the rectum is an 
evacuation, which affords relief in plethoric individuals, to be combated by ex- 
ercise, temperance, and aperients. 

Secondary haemorrhage is bleeding which comes on some while after the 
receipt of an injury or operation. The most simple form is that which occurs 
after reaction has set in ; thus, after a wound has been dressed, the small ar- 
teries will burst out bleeding. The wound must be opened up again, and 
bleeding vessels tied, and, if necessary, the surfaces sponged with cold water. 
Another form is that which occurs from a wound in an artery (generally of the 
lower extremity), when a ligature has been placed upon it, above the wound, 
although the haemorrhage is controlled for a while ; after the collateral circula- 
tion has been established, the blood will find its way back out of the original 
wound. The blood is generally of a venous, or dark color, and oozes out. 
Again, secondary haemorrhage may occur from sloughing, or from the imper- 
fect closure of an artery at the point of ligature, at the time when this liga- 
ture comes away, which may happen from the roots of the vessel being in a 
diseased condition, or from some constitutional malady which prevents the 
proper adhesion of the coats. The extraction of teeth sometimes sets up very 
severe haemorrhage, which may arise from the dental artery or from the gum. 
A small piece of cotton wool, soaked in perchloride of iron, stuffed into the 
cavity, will generally suffice to stop it, but in obstinate cases a very firm plug 
of lint should be pressed in, with a compress over it, so that by binding the 
jaws together by a bandage considerable pressure is exerted upon the bleeding 
point. 

Haemorrhage, Cerebral, is caused by the rupture of a vessel in the 
brain, in consequence of which blood is poured out into the tissue around ; the 
danger is generally in proportion to the quantity effused, but a small bleeding 
into the medulla or pons, where most important nervous centres are placed, is 
nearly always fatal. The seat of haemorrhage is, as a rule, in or near the 
corpus striatum or optic thalamus, and only one side is affected at a time. 
Very profuse haemorrhage may escape into the ventricles and kill in a few 
hours. The person attacked will then fall down in an apoplectic fit and lie in 
a state of coma; or the bleeding may he confined to a very small area, and 
the patient will recover and find the arm and leg of one side paralyzed. (See 
Hemiplegia.) 



HJ1M 299 H^M 

Haemorrhage, Internal (medical) is caused by a rupture of some vessel 
in an internal organ or tissue of the body. Special names have. been given 
with reference to the seat of the haemorrhage ; when it proceeds from the 
lungs and air-passages and is coughed up, it is called Haemoptysis ; when the 
blood is vomited from the stomach the name Hcematemesis is used ; bleeding 
from the kidney or bladder is called Hematuria, from ihe bowels Melcena ; 
haemorrhage into the skin is called an Ecchymosis, and sometimes Purpura; 
into the brain substance, it is called Cerebral Haemorrhage, and is often found 
in cases of apoplexy. Haemorrhage takes place at regular periods in women 
as a natural process, and is known as the Catamenial Discharge or Menstrual 
Flow ; when this takes place in excess the term Menorrhagia is applied. 

Haemorrhoids or Piles are swellings which are situated in the region of 
the anus, and which by their size and their liability to irritation and inflamma- 
tion cause much trouble and uneasiness, and sometimes intense pain. These 
swellings may be formed either by circumscribed thickening of the skin just 
without the anus, or of enlarged folds of the mucous membrane of the ter- 
minal portion of the gut, which folds are often protruded from the anus. In 
the former case the affection is called external piles, in the latter internal piles. 
External piles consist in a collection just without the margin of the anus of 
rounded hard tumors covered by thickened skin, and of prominent ridges of 
skin. These growths at first cause little or no pain, but after a time one or 
more of them may become irritated and inflamed, and then give rise to very 
acute pain with throbbing and a sense of great heat, and to a constant desire 
to go to stool. These symptoms pass off in the course of three or four days, 
but the attacks are frequently renewed, and the piles gradually enlarge and 
invade the lower portion of the intestine. This affection originates in disten- 
sion of the veins about the anus in consequence of obstruction to the circula- 
tion. It is met with generally in those who follow sedentary employments, 
and those who, in consequence of indulgence in highly-seasoned food and in 
alcoholic drinks, suffer from congestion of the liver. Much horse exercise, 
long-continued standing, and constipation are also causes of external piles. 
The presence within the anus of large rounded and soft tumors covered by red 
mucous membrane is attended with more serious symptoms. These internal 
piles, when large, come down through the anus from time to time, generally 
when the patient is at stool, and become engorged with blood and are very 
painful. Evacuation of the bowels gives rise to a burning or throbbing sensa- 
tion, and as the piles increase in size becomes more and more difficult. A dull 
pain across the loins is complained of ; occasionally the urine cannot be passed 
in consequence of irritation at the neck of the bladder. The most serious 
symptom is bleeding, which occurs during evacuation of the bowels, when the 
piles are protruded and compressed by the anus. The blood is red and arterial, 
and is often passed in considerable quantity. In addition to the discharge of 
blood there is in most cases a constant flow of thick slimy or purulent fluid. 
These growths, like external piles, are sometimes inflamed. Then, in addition 
to intense pain and other severe local symptoms, there is high fever. Inflam- 
mation of internal piles sometimes ends in mortification and in expulsion of 
the mass of abnormal growths from the rectum. The causes of internal are 
similar to those of external piles. Congestion of the liver causing venous 
obstruction in the intestines, and direct irritation of the walls of the intestine, 
are the conditions which most frequently give rise to this affection. The latter 
condition is often due to an immoderate use of strong purgatives, especially 
aloes. The general treatment of piles, both internal and external, consists in 



HAI 300 HAI 

removing congestion of the veins of the liver and intestines, in keeping up 
the strength and health of the patient, and in avoiding or alleviating the re- 
sults of certain conditions favorable to the development of the disease. The 
patient should restrict himself to a carefully regulated and temperate diet, 
and abstain from highly-seasoned dishes, pastry, and spirits ; wine and beer 
ought not be taken except in moderation. Walking exercise is to be recom- 
mended, and, during the summer months, sitting in the open air. Riding on 
horseback or in a jolting vehicle is to be regarded as positively injurious. The 
affected region should be well bathed every morning with cold water, and then 
carefully dried. To external piles may be applied lead lotion or a weak solu- 
tion of alum. For both external and internal piles the compound gall oint- 
ment is a very useful application. When internal piles protrude after every 
evacuation, they should then be sponged over with cold water or a solution of 
alum, or be smeared with gall ointment. The bowels ought to be kept in 
daily action by some mild aperient, as rhubarb in the form of a pill to be 
taken at night, or confection of senna, castor oil, seidlitz or Piillna water, to be 
taken in the morning before breakfast. When a patient with external piles 
complains of almost intolerable pain in one pile, which is found to be swollen, 
teuse, and livid, an incision into this^with the point of a sharp knife will 
often let out a small dark-red clot of blood, and give immediate and total re- 
lief. By these means the bad effects of both external and internal piles may 
be much relieved, or, as occasionally takes place, the disease may be perma- 
nently cured. When, however, the affection increases in extent and intensity, 
it will become necessary to undergo some surgical operation in order to obtain 
permanent relief. External piles are generally treated by excision, the tumors, 
together with the adjacent ridges of thickened skin, being removed with large 
curved scissors. Internal piles have been treated by various operative meth- 
ods ; many surgeons apply a ligature round the base or contracted portion of 
each pile ; other surgeons prefer to cut away the pile and then to apply to the 
raw surface the red hot iron. Fuming nitric acid is often applied to the sur- 
faces of small internal piles. In these operations, but more especialty in those 
consisting in excision or ineision of internal piles, the bleeding is very free, 
and, if it should recur in the absence of a medical man, dangerous to life. 

Hair, Diseases of. The hair is subject to alterations in its growth, cor- 
responding with those through which the body passes. Thus, after fevers or 
exceedingly acute diseases, the hair, which during the period of the disease has 
remained stationary in its growth, generally falls off and a new growth begins, 
which at first frequently differs in its characters from the hair before illness. 
Then, too, it usually grows faster for a time. Ordinarily a good growth of 
strong hair may be taken as a sign of a vigorous constitution. A thin crop 
of sandy, that is, imperfectly colored hair, commonly marks one in whom the 
original force of bodily growth has been deficient. Thinning of the hair may 
take place from a variety of causes, and very often precedes absolute baldness 
(alopecia). Sometimes there is total loss of hair over a limited surface, as the 
result of parasitic disease. Complete less of hair may begin early in life, and 
it may begin in one spot and gradually extend, or commence as thinning onl}\ 
This has been assigned to various causes ; they resolve themselves into this, 
that the power of forming hair ceases, and that present falls. Grief, great 
mental anxiety, or over brain-work, are the most frequent causes of premature 
balduess. That baldness which occurs in the course of years is due to the 
general atrophy of the body, which, beginning at various periods of life, in- 
variably ends in death, supposing the individual is not carried off by some 



HAN 301 HAN 

intercurrent malady. When the hair thins generally all over the head, the 
scalp is commonly seen to be dry and scurfy. Frequently, too, in these cases 
the hair itself alters, splits up at the end, tends to break off, and becomes dry 
and unruly. Both these conditions, though due to local causes, are, through 
these local alterations, dependent on some alteration in the general system, to 
which, and not to the hair, the attention must be directed. This is quite dif- 
ferent in parasitic disease giving rise to baldness ; then the fungus causing the 
destruction of the hair must be dealt with. The baldness of old people is 
generally preceded by alteration in the color of the hair, which becomes gray. 
It generally falls first from the very top of the head, and thence gradually 
spreads. Baldness in young people, arising from parasitic disease, is not pre- 
ceded by alteration in color. Generally there is some local irritation, and in 
this spot the hair begins to fall. This is usually on the side of the head, and 
frequently the hair is broken and stubby round the bald spot. This form of 
baldness is commonly called ringworm (which see). Baldness almost invari- 
ably follows syphilis during the period of secondary eruption. This baldness 
is sometimes sudden and very complete, the hair coming out literally by hand- 
fuls. When hair falls through disturbance of the constitution, it is mostly the 
custom to give arsenic, and frequentljvwhen there is much nervous debility, 
arsenic does good, but not because of its fancied action on the skin ; rather 
because it is a really good, serviceable tonic. Iron, quinine, and strychnine 
will generally do good. If the hair follicles are totally wasted, local measures 
will do no good, but if they are in a condition to respond to stimulation, local 
applications may restore a goodly head of hair. If downy hairs are visible, 
these may usually be made to grow by stimulation ; even if they are entirely ab- 
sent, good may be done if the scalp look at all natural. If white, shiny, and with 
little fat below the skin, there is not much hope. If, too, the scalp be swollen 
or thickened, some local application will be required. The best for this last 
is tincture of iodine, but it must be used with caution. When there is a 
chance of getting the hair to grow again, stimulants may be used. If there 
are downy hairs, let the head be shaved and a blister lightly applied, for of all 
stimulants to the growth of hair Spanish flies (cantharides) are the best. 
These must be used repeatedly if necessary. When the hair is thinned only, 
the first thing is to restore the scalp to a healthy condition. The scurf should 
be got rid of by bathing with tepid water night and morning, and the constant 
application of glycerine and lime-water in the interval. ' No fats or oils are to 
be used at this period, as they are apt to turn rancid and so injure the irritated 
scalp still more, but glycerine and lime-water, or fresh olive-oil and lime-water, 
may be used. A very good compound for gently acting upon the hair follicles 
is to be obtained by adding a few drops of tincture of cantharides to toilet 
vinegar, and gently clamping the scalp after it has been well washed with the 
compound. In short, the principles above laid down are those which must 
guide any individual in dealing with the hairy scalp. Each may apply them 
for himself. 

Hanging. The cause of death by hanging is suffocation, from the pressure 
of the rope upon the trachea preventing the admission of air into the lungs. 
In certain cases of suspension, death takes place very suddenly, and this may 
arise from two causes: from fear, producing syncope,. or from injury to the 
spinal cord, by dislocation of the cervical vertebras, fracture of the odontoid 
process of the axis, or second cervical vertebra, or rupture of the intervertebral 
substance. These injuries to the spine are due to the fall of the body from 
some considerable height, or by a twist given to the body at the time of the 



HAR 302 HAR 

fall ; these details are observed in legal executions, with a view of producing 
death as suddenly as possible. Death from apitoea is next in order of rapidity ; 
and the least rapid, that produced by apoplexy, induced by the pressuie upon 
the great vessels of the neck. The body should be immediately cut down, and 
the knot or loop eased from around the neck. Cold water should be forcibly 
dashed over the face and chest, artificial respiration (see Artificial Respi- 
ration) should be employed. Blood should be taken from the external 
jugular vein, if there be turgidity of the face, and a galvanic current passed 
from the nape of the neck to the pit of the stomach, to excite the diaphragm, 
through the course of the phrenic nerves, that is, just in the hollow ahove the 
collar-bones. It is obvious that in the case of dislocation or fracture of the 
cervical spine these measures are unavailing, but in cases where the hanging 
has taken place very recently, or where there has been a very short fall, such 
measures should be most assiduously applied. 

Hare-lip is a congenital fissure of the upper lip. dependent on an arrest of 
development of the structures forming the upper lip or its bony support. It is 
almost always on one side of the mesial line, though it may be on both. Fis- 
sure of the under lip is sometimes, though rarely, met with. That part of the 
upper jaw-bone which contains the incisor or cutting teeth, and which consti- 
tutes the prae or intermaxillary bone in the human foetus, and in some animals, 
may be ununited on one or both sides, leaving a gap in the alveolar ridge, and 
this may extend so far back along the palate as to present the condition known 
as cleft palate. All possible complications and deformities may occur. The 
existence of a fissure deranges those movements of the lip and face where the 
associated action of the muscles which act upon the lip is called into play. 
When the lower lip alone is affected, the child can neither retain its saliva nor 
learn to speak, except with the greatest impediment : the constant escape of 
the saliva, besides being an annoyance, is found to be detrimental to health, 
for its loss impairs the digestive functions, the patient becomes emaciated, and 
even death would sometimes ensue if the incessant discharge of so necessary a 
fluid in the animal economy were not prevented. It has been observed that 
the sense of smell is defective in these cases, and it seems to be accounted for 
by the want of that mechanical arrangement of the nostril by which, through 
an act of sudden inspiration, a relatively large quantity of odoriferous effluvia 
is forced upon that portion of the pituitary membrane in which the radicles 
of the olfactory nerve are most abundantly distributed. There are two species 
of hare-lip, the simple and complicated. Of the simple, there-are two or three 
varieties. If there is one, it is almost always on one side of the mesial line, 
though it has been observed in the mesial line. If two fissures occur, they are 
usually lateral, and isolate a labial segment ; this segment is sometimes atro- 
phied," sometimes hypertrophied, in either attached directly to the tip of the 
nose or by a short septal pillar. The varieties of complicated hare-lip are : 
(1.) A single fissure of the lip, and a simple fissure of the alveolar margin of 
the jaw, the fissure being either median, or at some one of the lines of junction 
of the intermaxillary and maxillary segments, existing at the time of develop- 
ment; this split in the alveolar ridge corresponds with that in the lip. (2.) A 
single fissure of the lip may be coexistent with a separation of the oppo.sing 
edges of the alveolar cleft, constantly associated with cleft palate. This variety 
is most frequently met with on the left side. (3.) The most frequent variety 
is that in which both lateral segments and the maxillary bone are but imper- 
fectly developed, whilst the intermaxillary attains its normal size and position ; 
a double fissure of the lip is connected with this condition of the jaw ; whilst 



HAR 303 HEA 

the intermediate portion is generally more or less of an oval or rounded shape, 
and, curling upwards towards the nostril, leaves the incisor teeth uncovered 
in so unsightly a manner that this deformity has been called " wolf's jaw." 
(4.) With a double fissure may be entire absence of this intervening lobe, 
and of course absence of the incisive bone. Most modern surgeons agree that 
operative proceedings for the cure or relief of this condition should be had 
recourse to as early after birth as possible. Operations on adults are more 
easy of performance than on children, for the reason that they have command 
over themselves, by the exercise of the will, to keep as still as possible during 
the proceeding. Children should always be etherized. 

Hartshorn. See Ammonia. 

Hay-fever or Hay-asthma, is a peculiar disease to which some people 
are subject in the month of June or July, or during the hay season. It is 
characterized b}' excessive irritation of the eyes, nose, and the whole of the air- 
passages ; producing, in succession, itching of the eyes and nose, much sneez- 
ing occurring in paroxysms, with a copious flow from the nostrils ; pricking- 
sensations in the throat; cough, tightness of the chest, and difficulty of breath- 
ing, with or without mucous expectoration. It affects both sexes, and gener- 
ally occurs in the adult. Various remedies have been suggested, but none of 
them seem very efficacious. Certain sections of the United States are known 
to be exempt from this disease ; notably the White Mountain region, whither 
sufferers from this malady largely resort, and find perfect immunity from it. 

Headache, technically called Crphalalgia, may for the most part be looked 
upon as a symptom, though sometimes also the most important part of the 
disease. Certain pains in the head, not commonly called headache, are rheu- 
matic and neuralgic affections of the scalp, though these are sometimes also 
spoken of as rheumatic and neuralgic forms of headache. Pains from syphilitic 
nodes may usually be distinguished from true headaches by the great tender- 
ness over localized points ; in rheumatism of the scalp, too, there is usually 
some tenderness, but more diffused than in the preceding. The pain of acute in- 
flammation may readily be distinguished by the other and more characteristic, 
features of the malady. Pain in the head is a very constant, but by no means 
invariable symptom of disease of the brain and its membranes. This, if per- 
sistent and accompanied by vomiting, especially if the pupils be affected, is a 
grave sign. Inflammation of the membrane gives rise to more pain than does 
inflammation of the substance of the brain, and it is usually of a sharper de- 
scription in the former than in the latter. Another form of headache is de- 
scribed as congestive or plethoric. It is not unfrequently occasioned from 
over brain-work. It gives rise to a feeling of tightness across the head, and 
a fullness and whizzing behind the ears. It occurs in females of full habit 
of body, in whom the menstrual function is defective or in abeyance, and is 
especially troublesome about the period when this stops, when it not unfre- 
quently leads to that form of headache indicative of brain disease by insen- 
sible gradations. Perhaps the most common form of headache is that con- 
nected with indigestion. It is sometimes called sick headache, sometimes 
bilious headache. It most commonly follows some indiscretion or excess in 
diet, and is generally worst in the morning. The pain is very severe, of a 
throbbing or bursting character, and the sickness is intense. Sometimes this 
sickness ends in vomiting, and then the pain in the head is greatly aggravated 
for a time, but by and by the patient probably falls asleep and awakes re- 
freshed. In point of fact, such headaches seldom last long, and are generally 

these headaches become almost 



HEA 304 HEA 

constant; if so, there is permanent derangement of the digestive organs, 
which must be set right before anything else is done, or before any permanent 
amendment can be secured. There is still another form of headache very 
common. For want of a better name it is called nervous, and is very com- 
mon in women. Not uufrequently this form of headache depends on some 
distant irritation, as decayed teeth, which must be removed before any good is 
done. Headaches are sometimes classified by their site, which will oftentimes 
aid us in determining their origin. Thus, bilious headaches, if slight, are com- 
monly confined to the forehead ; others, especially the nervous forms, are felt 
more on one side than the other. Occipital headaches are perhaps most fre- 
quent in the outset of fevers and such like acute diseases. Patients who have 
resided in marshy districts, and many who as far as we know have not, are sub- 
ject to attacks of headache which recur at definite periods. This, however, is 
not uncommon in pure neuralgia, and so miy have no malarious origin. Hys- 
terical girls are often subject to acute attacks of pain in one particular spot, 
which has been likened to driving a*nail into the head; hence the Latin name 
claims has been given to it. Purely neuralgic pains are more distinctly con- 
fined to the line of certain nerves than are the others. The treatment should 
be the same as that of an acute attack, and of the general condition which 
has given rise to it. For a bilious headache, if known to be due to any error 
in diet or excess in liquor, perhaps the best thing, if the patient can make up 
his mind to it, is an emetic of zinc ami ipecacuanha. Whether this be taken 
or no, the patient must be kept absolutely quiet, with the eyes shut, or in a 
darkened room, and pressure on the temples, so as to arrest the beating of the 
arteries, will often give relief. By and by he will probably fall asleep, how- 
ever severe the pain may seem, and he will generally awake tolerably well. 
A cup of strong black coffee, a walk, and a fast for six or eight hours will gen- 
erally suffice to set everything to rights. When the patient is suffering from 
nervous depression, as often happens, drinking a draught containing a drachm 
of the aromatic spirit of ammonia, with a little gentian, will generally do 
much good. This holds true of the purely nervous headache also. In some 
cases cold is grateful, in others heat. Cold is best applied by means of eau 
de Cologne, or some similar spirit, of course still better by ether ; ice or iced 
water may also be employed. If heat is best borne, let it be applied by heat- 
ing a quantity of salt in a fire shovel, and binding it in a handkerchief round 
the temples. Recently a new remedy called Guarana has been introduced for 
sick headaches. It is undoubtedly successful in a certain number of instances. 
If the headaches be purely neuralgic, recurring at different intervals, a full 
dose of quinine, five grains at least, should be given, as well as a little spirit 
of ammonia. Some sedative should be applied locally, and if necessary some 
should be given subcutaneously. For after-treatment in the bilious form, a 
laxative should be given ; blue pill if there is much tendency to biliousness, 
ipecacuanha and rhubarb if there is not. Podophyllin, which was greatly 
lauded at one time, is very good for relieving congestion of the liver, and 
effectually emptying the gall bladder. A dose of compound rhubarb pow- 
der every morning, or just before dinner in smaller quantities, is a very good 
remedy. Diet too must be regulated ; it must be plain and unstimulating ; 
beer, port, sherry, and spirits should be avoided, but claret and other light 
wines may be taken. Exercise should be taken, especially in the open air, 
and indolent habits should be got rid of. Where the headaches are purely 
nervous and depend on weakness, the remedies used should be strengthening, 
and dux vomica or strychnine is one of the best, especially with nitro-hydro- 



HEA 305 HEA 

chloric acid. If acids do not suit, liquor potassce and compound infusion of 
gentian should be given. Finally, in a considerable number of cases, espe- 
cially in women, no drug does so much good as sal ammoniac (chloride of 
ammonium) ; its mode of action is not quite plain. 

Health Resorts. The places here referred to acquire importance more 
from their atmospheric qualities than from anything else, and many, we fear, 
are hardly in a condition to be called health resorts at all, for the unsanitary 
state of some of them is alike to be dreaded and wondered at. Change of air 
is in many instances the clew to the benefits derived from health resorts. Thus, 
those living in inland places, which are remarkably healthy in every way, are 
often benefited by a visit to the seaside, whilst those living near the sea are 
benefited by a visit to the hills. Then, too, for the inhabitants of large cities, 
the great thing is to get out of town, whether to the country or the seaside. 
Asthmatics, on the contrary, are often better in town than in the country. To 
one set of large city dwellers Long Branch and Newport are the perfection of 
health resorts, to another Saratoga. Notwithstanding all its faults, when 
filled with the crime de la creme, Newport is healthy, and out of the season is 
often an excellent place for a short sojourn. Its climate is. distinctly bracing, 
and during certain portions of the year exposed to east winds, which in spring 
are trying enough, though in late summer they may be pleasant. The air is 
good; so is the water-supply. It is a first-rate place for children and other 
persons suffering from strumous or scrofulous diseases, at the proper period. 
In this country are hundreds of health resorts more or less suited to all con- 
ditions of life. In this work it would hardly be best to describe all in detail. 
Abroad there are also hundreds of noted health resorts, a few of which we 
mention. Ramsgate, England, on the side of the Foreland, is warmer than 
Margate, and more bracing than any place on the south coast. Its season 
corresponds with that of Margate. Next to these comes Brighton, a far more 
aristocratic place, but which possesses similar climate characters to Ramsgate 
during the period of its season, which is in late autumn and early winter. In 
these months it is bracing, later on it is distinctly cold. Nervous patients do 
well here ; so do those whose digestion is out of order, or who are fagged and 
want invigoration. Convalescents from acute disorders do well as a rule, but 
certain patients do badly; those who are called " irritable and plethoric." for 
instance. Between Ramsgate and Brighton lie a multitude of health resorts, 
almost every considerable and inconsiderable town being one. Folkstone is 
one, and a very good place it is too, especially for those who want rest, quiet, 
and good air ; it may be said to have a season on to November ; its air is tonic, 
and is well suited for sufferers from dyspepsia. Sandgate, close by, is milder, 
and even patients with weak chests may venture to spend the winter at it. 
Dover is quite different; it is very cold in winter and spring, and the east winds 
are trying ; at other times of the year its bracing atmosphere attracts to it a 
large number of visitors.; strumous affections, indigestion, and nervous break- 
down do best here. Hastings and St. Leonard's are winter health resorts ; 
they are sheltered from the north by high cliffs, and the soil is dry. Chronic 
bronchitis and rheumatism improve generally. Consumptive patients do not, 
perhaps, greatly benefit, but they do not fall back. Eastbourne is a place 
somewhat similar, but is more bracing. Worthing is another of the mild winter 
climates ; it is well sheltered by the South Downs, and its air is neither too 
sedative nor too bracing. Worthing is consequently a good resort for con- 
valescents in winter, for chest cases and chronic rheumatism. Bournemouth, 
farther west, is also a verv good place in certain months. It is very well 
20 * 



HEA 306 HEA 

screened from the north and northeast, but is quite open to the southwest. 
When it is dry, walking is always practicable, and the walks are good, but it 
often rains. In spring and early summer, fogs are frequent ; in summer it is 
rather too hot; it is best in winter, not being too relaxing, yet mild. Ventnor 
and the Uudercliff of the Isle of Wight are greatly frequented by sufferers 
from the chest. They have a southern exposure and are backed by high cliffs. 
The time for Ventnor does not, however, begin before November ; before then 
it is very relaxing, but between November and May it is, perhaps, the best 
residence for consumptive patients in England ; the air is decidedly bracing, 
and herein lies its superiority over Torquay aud the places further west. 
Torquay must be taken as the type of the western health resorts. Its situa- 
tion is exceedingly sheltered, and its season extends from September to May. 
Early winter is generally very pleasant. Torquay, and most of the neigh- 
boring localities, from which, however, it in many respects differs a good deal, 
is mainly resorted to in winter by patients suffering from consumption or other 
disease of the chest, or rheumatism. Penzance is also a winter residence, but 
is very relaxing. The temperature is very even. It is best for those suffer- 
ing from irritation of the windpipe and air tubes, with little expectoration ; 
where there is much expectoration, both Penzance aud Torquay are to be 
avoided. Ilfracombe is almost entirely a summer resort ; its air is bracing, aud 
the bathing, though inconveniently reached, is very invigorating ; it is a cap- 
ital place to pick up in after hard mental labor. Clifton, though without any 
bathing attractions, has an atmosphere somewhat similar to Ilfracombe, if the 
downs be taken as the type, but the place itself, built lower down, is much 
milder. If the patient can bear the exposure on the downs it does great good 
in convalescence from acute diseases. Wales is chiefly visited in the tourist 
season for an outing. The two most important health resorts are Tenby and 
Llandudno ; both are good bathing places, and to the lover of natural science 
most interesting. Both are good summer places. Malvern is a delightfully 
situated spot, not far from Worcester. Its air is good, and for a convalescent 
or a man broken down from work it promises much, being distinctly bracing. 
Along the coast of Lancashire are several seaside resorts, which in summer 
are crowded by the manufacturing population inland, and hardly suitable for 
invalids. Morecambe Bay we have heard spoken of as a winter residence for 
chest patients, but do not know much of its effects. It is too far north and 
too far west. On the opposite coast of Yorkshire are some of the finest sea- 
side resorts for the summer season, chief among which is Scarborough. Whitby 
and Filey are also frequented. These are extremely bracing, more so than 
any of the others, and out of the season are bleak and cold. They are, there- 
fore, best adapted for those who want sea-bathing and air after the wearing 
effects of city life. Scarborough is too fashionable for a real invalid. Yar- 
mouth possesses some of the characters of Scarborough. Ireland has few 
spots which in the summer time are likely to attract ordinary invalids there 
for a tour. Queenstown is a first-rate spot for many forms of chest affection, 
its climate being exceedingly mild and equable. Scotland, too, though at- 
tracting many tourists, has few places to be called health resorts. Invalids 
generally hurry farther south. The Channel Islands, also, are mainly fre- 
quented by tourists, the sea passage, which is often rough, keeping back many. 
Some of the health resorts in the south of France have already been alluded 
to (see Climate) ; a few words more with regard to them may be added. Pau 
we have mentioned as characterized by calmness. Its climate is soothing and 
sedative, aud so is suited to those w T ho are of an irritable type, but quite un- 



HEA 307 HBA 

suitable for cases requiring stimulation. Then for patients in whom consump- 
tion is for the time quiescent, no climate could be better ; for those recovering 
from most acute diseases it is quite the reverse. Biarritz is a bathing-place not 
very far from Pau, and is a good change for patients in the summer. The 
bathing is not so stimulating as further north, the water being quite warm. 
Montpellier had once a great reputation as a winter station, but that is now 
entirely gone. Its climate is changeable and irritating. Along the south 
coast of France are a great variety of winter stations, now mainly occupied 
by English. Cannes has a climate intermediate between Pau and Nice, being 
less sedative than the former, less stimulant than the latter. It is a very 
good place for a rest, if a man breaks down in winter. Cases of indigestion, 
accompanied by nervous and irritable symptoms, do very well here. Nice has 
not the reputation it once had. It is found to be exposed to dangerous cold 
winds from the east and northeast, which come rushing down gaps in the 
chain of mountains behind it. The climate is not at all favorable to consump- 
tive patients, but is good in many cases of derangement of the womb, and in 
children of a strumous habit of body. Mentone is one of the most sheltered 
of the towns along the coast, and the night temperature is mild, so that win- 
dows can be kept open. The place is one of the best for patients in the earliest 
stages of consumption and in chronic bronchitis. San Remo approaches some- 
what in quality to Mentone. Ansim has hardly come into fashion yet as a 
health resort ; nevertheless it offers some advantages which in time may bring 
it into notice. Ajama is not so stimulating as Mentone, and is somewhat 
warmer. It is the only spot in the island where an English-speaking inva- 
lid could winter. Malaga is, perhaps, the only spot in Spain which could be 
called a true health resort. Its climate is excessively mild and equable, and it 
is neither too moist nor too dry. In winter there is a cold northwest wind 
sometimes, which is distressing. It is best adapted for those cases where in- 
flammation of the lungs threatens to pass into consumption. With regard to 
the cities of Italy they are for the most part to be avoided by the confirmed 
invalid. On the other hand, for a convalescent they are very good, provided 
one is fit to travel from place to place, but few are adapted for a long stay. 
Exception may, perhaps, be made to the Bay of Naples, Ischia, and Capri. 
Patients suffering from kidney diseases often get good there, but the whole 
peninsula is to be avoided by sufferers from consumption. Egypt has recently 
come into repute for sufferers from consumption, owing to its extremely dry 
climate. This is best adapted for the earliest stage of consumption, chronic 
bronchitis, clergyman's sore throat, and such like affections. Algiers affords 
an exceedingly interesting winter residence, and is undoubtedly favorable to 
those suffering from consumption. Madeira used to be the most favorite place 
of resort for consumptives. Now it has in great measure been abandoned, 
the climate being too moist. 

Hearing is interesting, medically, chiefly in its absence, which we term 
deafness, etc. As to the mode in which the ear fulfills its functions, a word or 
two may be said. Sound is the effect of vibrations in the air or in some more 
solid body, and these, for the purposes of hearing, must be transmitted to the 
sentient nerve, called the auditory nerve, as nearly as possible unimpaired. 
To this end they are conducted and reflected from the outer ear inward, and 
strike upon the drum of the ear, as it is called, and through it set in motion 
a chain of jointed bones which communicate with another membrane. Im- 
mediately beyond this is a collection of fluid, which can be set in motion by the 
membrane, and its undulations affect the nerve, which is spread out some- 



HEA 308 HEA 

thing like the keys of a piano. Anything which interferes with the trans- 
mission of vibrations to the nerve gives rise to deafness more or less complete. 
But there is another method whereby the auditory nerve may be reached, that 
is, through the bones of the head, which are capable of conducting the sono- 
rous vibrations. Thus, suppose a man hold in his teeth a tuning-fork while 
vibrating, the sound will be propagated through the bones of the head to the 
nerve of hearing. If now a similar fork be tried just outside the ear and no 
sound be heard, but sound be heard when it is held in the teeth, it is plain that 
it is the conducting apparatus only which is in fault ; whereas if the sound is 
heard in neither situation we are bound to confess that the nerve itself is at 
fault, and the case is hopeless. See Deafness. 

Heart. The heart is a hollow muscular organ, which is the main agent in 
propelling the blood through the numerous vessels of the body. It is situated 
in the chest or thorax, resting on the diaphragm, while its upper border is on 
a level with the junction of the third cartilages with the sternum or breast bone. 
Its shape is roughly triangular, the base being directed upwards, while the apex 
points downwards, forwards, and to the left side ; the apex-beat may be felt in 
the space between the fifth and sixth ribs, and a little within a vertical line drawn 
through the nipple. The weight varies somewhat, being rather more in man 
than in woman ; the average weight in man is between nine and ten ounces, while 
in woman it is between eight and nine ounces ; in disease its weight may become 
enormously increased. The heart lies in a sac made up of a dens-e fibrous 
tissue, and lined within by a very smooth membrane called the pericardium ; this 
membrane is also reflected over the heart itself, so that the movements of the 
heart are attended with the least possible amount of friction; in the cavity thus 
formed a little serous fluid is found, just enough to moisten the opposed surfaces. 
The heart lies between the two lungs, and, for the most part, it is overlapped 
by their anterior edges, but as the left lung has no middle lobe the heart be- 
comes superficial, and appears close to the chest wall. It is divided into four 
cavities, two of which are called the aimcles, and the two others are termed 
ventricles ; each side of the heart is separated from the other by a muscular 
partition wall or septum, so that in health the blood on the right side of the 
heart is quite distinct from the blood on the left side. There is an auricle and 
a ventricle on each side, and the four cavities are therefore named thus : right 
auricle, right ventricle, left auricle, left ventricle. Each auricle is situated behind 
and rather above its corresponding ventricle ; each has a thin muscular wall, 
and their cavities are generally smaller than the ventricular cavities. The au- 
ricles receive blood from the veins and pass it on into the ventricles. The right 
auricle receives the blood from every part of the body by means of two large 
veins, known as the superior and inferior venae cava? ; the former brings back 
the blood from the head, neck, and upper extremities, while the latter performs 
a similar duty for the rest of the bDcly and the lower extremities. This stream 
is venous, and has already passed through the various tissues and organs of the 
body ; it now requires to be oxygenated and to be exposed to the action of the 
oxygen of the air : to do this it must go through the lungs, and the mechanism 
of the process is as follows : the right auricle sends the venous stream through 
an opening, which is called the tricuspid orifice, into the right ventricle, and 
the latter sends the current on to the lungs by a large artery called the pul- 
monary artery, which divides into two branches, one going to each lung ; arriving 
there it breaks up into several main divisions, and these again divide into in- 
numerable small branches, which ramify all through the lung substance and 
spread themselves in a delicate network outside the air cells or the ultimate 



309 




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HEA 311 HEA 

extremities of the bronchial tubes. As these arteries diminish in size, so also 
their coats become thinner, until at length the wall of tlie vessel appears as a 
homogeneous, microscopic membrane, which readily allows of the passage of 
gases to and from the blood. These minute vessels are called capillaries, and 
they differ from the arteries only in their size and in the simple structure of 
their walls ; next, these capillaries join together again and form veins, and these 
uniting one with another form at last four large trunks, which are termed the 
pulmonary veins ; these enter the left auricle, and this stream passes then into 
the left ventricle through an opening called the mitral orifice ; thence it is sent 
into the aorta, a large artery arising from the left ventricle just as the pulmo- 
nary artery does from the right, and then the blood is sent all over the body by 
means of various large branches, which, after dividing again and again, become 
finally so small as to form capillaries ; these again uniting form veins, and at 
length, by trunk after trunk joining to form larger ones, all the blood is brought 
back to the right auricle, once more to pass through the long circle of the cir- 
culation. Arteries carry blood to a part and veins carry it from a part, while 
between the two, but continuous with each, are the capillaries ; and the use of 
the latter is to enable the different tissues to receive nourishment easily and to 
give up their effete products, which could not be done unless the walls were 
very thin, and the blood brought into the closest possible connection with the 
elements of the tissue or organ. Thus everywhere there are intricate mesh- 
works of vessels, some having a close web and some with wider interspaces, 
according to the requirements of the part. This being the course of the cir- 
culation, there remains to be considered the means by which the blood is, so 
long as life lasts, kept in continual motion. Each ventricle will hold four or 
five cubic inches of blood. Each ventricle is made of strong muscular walls, 
the right one being about one eighth of an inch thick, while the left one is about 
half an inch in thickness ; this is because the former has only to send the blood 
to the lungs, while the latter has to propel the blood through all the remaining 
parts of the body. The ventricles are lined, as well as the auricles, with a 
delicate membrane called the endocardium, which is also continuous with the 
lining coat of the vessels which enter into or arise from the heart ; farther, there 
are certain folds or reduplications of this membrane at each orifice which serve 
as valves ; as each ventricle has an entrance and exit, there are therefore four 
sets of valves, two on each side of the heart. The tricuspid valve is formed of 
three folds of the endocardium, and is situated between the right auricle and 
the right ventricle ; it is attached above to a circular fibrous ring round the 
tricuspid orifice and points towards the ventricle, so that when viewed from the 
auricular aspect it looks like a funnel ; as the blood flows through it from the 
auricle to the ventricle, the various segments flap open, while when the flow 
is from the ventricle into the pulmonary artery these segments flap to and 
prevent any backward flow ; they are prevented from being pushed too far back 
by fibrous cords which are attached to muscular prominences on the inner wall 
of the heart, called columnaa carneae on the one side, and to the different cur- 
tains of the valve on the other. These cords are often spoken of as the chordoe 
tendineaa. The pulmonary valves are three semicircular folds of the lining 
membrane which are attached to a fibrous ring at the commencement of the 
pulmonary artery ; they guard this orifice, and while they can readily open to 
allow the passage of blood from the ventricle into the artery they close directly 
afterwards, so as effectually to prevent any of it from returning. The mitral 
valve is formed like the tricuspid, but it has only two curtains instead of three ; 
it guards the mitral orifice or the opening between the left auricle and the left 



HEA 312 HEA 

ventricle. The aortic valves are in shape and size similar to the pulmonary, 
and perform similar work. Both sides of the heart, in health, act in perfect 
unison, and each part has separate duties to perform ; each auricle contracts at 
the same moment, and each ventricle does the same ; the corresponding valves 
also open and shut on each side with the greatest precision. Every minute each 
ventricle contracts some sixty or seventy times, and sometimes a great deal 
oftener ; after the contraction it rests for a short period while it is being refilled, 
and then contracts again. Any one who listens to the heating of the heart will 
hear a sound just at the same moment as he feels the heart beat against the 
chest wall ; this is called the first sound of the heart ; it is followed immediately 
by a second, shorter and sharper, sound, and this is called the second sound of 
the heart ; then comes a short interval or pause before the first sound is heard 
again ; each heart-beat, therefore, is divided into three periods, each of which 
varies slightly in length, although all are very rapidly performed ; it may make 
it simpler to divide each beat into five equal periods, and give the length of each 
sound thus : — 



1st sound. sound. Pause. 

During the first sound both ventricles are contracting, and this is called the 
systole of the ventricles, and the sound is also often called the systolic sound; 
the rest of the time their walls are relaxing, and its state is called the diastole ; 
sometimes the second sound is called a diastolic sound, but this is not quite 
correct, as the diastole lasts three-fifths of a cardiac beat, while the second sound 
only takes one-fifth of the time. Both auricles contract at the end of the pause, 
and therefore they fill the ventricles immediately before the contraction of the 
latter ; the rest of the time they are passive and allowing blood to flow quietly 
in. "When the ventricles contract, the pulmonary artery and aorta become full 
of blood, and their coats, being elastic, are distended ; directly after the systole 
they recoil, and would send some of the blood back again into the ventricle if 
the valves which guard the orifice did not immediately close and prevent it ; the 
effect of the recoil of the vessels is still further to propel the blood onwards, 
while at the same time there is great pressure on the valves which thus shut 
off the blood from the heart while the ventricles are being filled again. This 
closivre of the aortic and pulmonary valves is accompanied by a sharp clicking 
sound, and it is this which is called the second sound of the heart. The mitral 
and tricuspid valves are closed when the other two are open, and are open when 
the other two are closed ; thus, when the left ventricle contracts, the mitral valve 
shuts to prevent any of the blood-current going back to the left auricle whence 
it has just come, while the aortic valves fly open so as to allow the blood-stream 
to enter the artery ; directly afterwards the aortic valves close while the mitral 
valve is open, so that fresh blood may enter the ventricle, in its turn to be 
propelled onwards ; of course similar remarks will apply to the action of the 
corresponding valves on the right side of the heart. During foetal life, that is, 
while the child is in the womb, the circulation is somewhat different; at that 
period of existence no respiration takes place, and therefore there is no need 
for the blood to pass. through the lungs ; so the greater part of the venous stream 
passes directly from the right to the left auricle through an oval opening in the 
septum called the foramen ovale ; there is also a second communication by a 
small vessel, the ductus arteriosus, which joins the pulmonary artery and aorta, 
but which becomes closed soon after birth ; by this means that part of the blood 



HEA 313 HEA 

which in after life passes on to the lungs, takes in the foetus a shorter course, 
and, avoiding the lungs, is at once carried on to the arterial system of the body. 
The foetus derives all its nourishment through the placenta, a complicated 
structure providing for the free interchange of nutrient elements between the 
mother and child. The heart is very liable to disease, and important changes 
may take place both before and after birth. In the former case they generally 
occur as malformations. Sometimes the foramen ovale remains open, and per- 
sons may live a long time without being much inconvenienced by it ; or the 
septum between the two ventricles may be deficient and allow of an intei'com- 
munication between the venous and arterial streams ; this is a serious defect, 
and leads to a deficient circulation, coldness, and blueness of the extremities, 
and shortness of breath. At other times, the large arteries arising from the 
heart may be transposed, or the valves may be deficient or increased in number; 
now and then the heart has been developed outside of the body in certain cases 
of monstrosity. Any defect of development leads to a condition called cyanosis, 
or general blueness or lividity of the skin, specially noticeable in the extremities, 
where the circulation is more feeble than in other parts. (See Cyanosis.) 
Diseases of the heart arise from many causes, as follows : — 

(1.) Traumatic causes, or those caused by external injuries; falling from 
a height or from a horse when hunting has ruptured some of the valves and 
set up heart disease ; a sword wound, or stab, and a pistol shot, would probably 
prove fatal at once; sailors are liable to suffer from aneurism of the aorta, 
or from heart disease, from lying on their chests while furling the sails ; the 
tight stocks of soldiers and the old way of wearing a knapsack tended to dis- 
ease by preventing a ready flow of blood through the vessels. 

(2.) Inflammation may take place in the (a) pericardium, or (b) endocardium, 
or in the (c) muscular wall of the heart. Inflammation of the pericardium, or 
pericarditis, causes an alteration in and a roughness of the smooth lining mem- 
brane above described ; more or less serum is poured out, and the heart's action 
is much interfered with. (See Pericarditis.) Endocarditis is an inflamma- 
tion of the smooth membrane lining the cavities of the heart and forming the 
valves ; this disease is far more common on the left side than on the right side 
of the heart ; it is generally caused by an attack of rheumatic fever, but may 
occur after scarlet fever, and many other blood poisons, as erysipelas, pyaemia, 
etc. The change consists in little beads or warts of fibrine which are formed 
on the valves, and sometimes these form very long and shaggy processes. 
Their presence, of course, impairs the action of the valves affected, and gives 
rise to an alteration in the sounds of the heart called bruits, and these are 
called systolic, diastolic, or presystolic bruits, according as they occur during 
the systole, diastole, or pause. Any change in the valves, whether inflam- 
matory or not, will cause a greater or less mechanical obstruction to the circu- 
lating stream, which may end in dropsy and serious impairment of the affected 
tissues. Each valve has to open and shut, but it may fail in doing one or the 
other, or even in both ; now as there are four valves, they are liable to eight 
different forms of disease : four are called obstructive, when they will not open 
properly, and four are termed incompetent or regurgitant, when they will not 
close properly ; but of these eight, three are by far the most common, namely, 
aortic obstruction, aortic regurgitation, and mitral regurgitation. To show this 
more clearly we may take the latter case ; when the left ventricle contracts, 
the mitral valve ought to close and the aortic valves to open ; then the whole 
amount of blood contained in the cavity (about four or five cubic inches) ought 
to pass into the aorta, but if the disease allows of mitral regurgitation, one or 



HEA 314 HBA 

two inches of the blood will pass back into the left auricle, and the aorta will 
receive less than its share ; it is also obvious that the auricle will be distended, 
and the backward How will meet the column of blood coming from the lungs 
and cause congestion of those organs. Myocarditis or inflammation of the 
substance of the heart may occur in combination with pericarditis and add to 
its danger ; it requires here no detailed notice. 

(.3.) Atheroma of the valves or lining membrane of the aorta may occur ; this 
comes on in old age and in those who have lived hard or been fed badly ; it 
consists of a fatty change, which comes on in the tissues in consequence of 
want of nourishment. 

(4.) Calcification of the valves is often associated with the last change, and 
it consists in the deposit of lime-salts from the blood in parts in which living 
changes have ceased to exist. 

(5.) Fibrous thickening of the valves may occur and cause constriction of 
the orifice, and in that way obstruct the passage of the blood. The symptoms 
common to these four changes are shortness of breath, palpitation of the heart, 
pain in the left side, and inability to run fast or hasten up-stairs. These symp- 
toms may go on for a long time, and if the patient is very careful to live 
quietly, avoid any great exertion, take nourishing food, and avoid bronchitis 
in the winter, life may be prolonged for years. The lungs are liable to con- 
gestion, and so in the winter, or when the east winds are prevalent, bronchitis 
is very apt to come on and increase the mischief. Increased shortness of breath 
is often followed by dropsy of the legs, by a diminution in the quantity of urine 
passed, which is also darker than usual, and deposits much sand on standing. 
There may be also pain over the region of the liver, and a slightly jaundiced 
skin, and at last ascites may come on. (See Ascites and GEdema.) The 
obstruction in the valve of course gives the heart more work to do, and hence 
hypertrophy of the muscular wall takes place so as to overcome the obstacle. 
Sometimes, however, the patient is badly fed and cannot obtain meat and 
nourishing food enough to provide for this increased growth, and then the 
ventricle, unable to withstand the increased pressure, slowly dilates until it 
attains very large dimensions. When dilatation occurs, the apex-beat of the 
heart is much lower than usual, and the heart takes up more space than usual 
in the chest ; thus the lungs, besides being congested, are also much encroached 
upon, and the patient is very short of breath, and unable to lie down ; so at 
this stage he will be propped up in bed by pillows. Hypertrophy of the heart 
is known by the increased impulse felt by the hand when it is placed over the 
region of the heart. Much relief may be given to persons suffering in this 
way by rest in bed, a warm temperature, and light nutrient diet. A belladonna 
plaster placed over the heart (about four square inches in area) and kept on 
for ten days or a fortnight will give much relief. Tonic medicines, as iron and 
quinine, with digitalis, are often of much benefit. There are some other dis- 
eases of the heart, which, however, are of very rare occurrence, and can only 
be merely mentioned here. Hydatids have been met with in this organ, and 
by their rupture have caused sudden death. (See Hydatids.) Rupture of 
the tendinous cords affixed to the mitral and tricuspid valves has been found, 
and of course it has been attended with a fatal result. A clot of fibrine may 
be deposited from the blood in the right auricle and right ventricle, and cause 
death by obstructing the circulation; such a clot is called a thrombus; now 
and then a portion of a clot is carried through the heart into the pulmonary 
artery, and it is then called an embolon. A more common variety is that 
kuown as a fatty heart, where the walls become weak and fragile iu conse- 



HBA 315 HEA 

quence of a fatty change taking place in the muscular fibres ; this change 
usually occurs after middle life and in those addicted to intemperate habits ; 
such persons are liable to fainting and palpitation, and may die suddenly from 
failure of the heart's action. The treatment should consist in nourishing food, 
avoidance of stimulants in excess, or of any great physical exertion, and the 
occasional use of tonic medicine and gentle exercise. 

Heart-burn is a sensation of heat or burning in the region of the stomach, 
due apparently to the presence of excess of acid in the stomach. This excess 
of acid may be due to fermentative change in certain articles of food, or it may 
be due to excessive secretion of acid gastric juice. Thus, many substances of 
a starchy or sugary nature, readily ferment and give rise to acetic and lactic 
acids. With these changes carbonic acid gas is separated, and so there is com- 
monly flatulence; at the same time there is acidity. The other, where there is 
excess of acid secretion, is, as a rule, accompanied by less digestive disturbance 
than is the other, though the fluid so secreted is deficient in digestive power. 
The pain produced by excessive secretion comes on sooner after taking food 
than does the other, and may be induced as readily by a slight stimulus as by 
a greater one. The pain is generally felt behind the breast bone, and is worse 
when the stomach is empty. If at these periods a glass of wine be taken, a 
fit of heart-burn is almost certain to follow, for the gastric juice is induced to 
flow freely by the stimulus of the alcohol, and it has nothing to act on save 
the stomach itself. Food, on the other hand, if subject to fermentative change, 
is as a rule followed by distress. Sometimes the vomiting produced by the 
acidity is very trying, and tends to reduce the patient's strength. As heart- 
burn is due to excess of acid, it is natural to seek relief in the exhibition of an 
alkali, and for the time being this often succeeds, a dose of bicarbonate of 
soda being frequently followed by relief. This is only temporary, and other 
means must be sought. If the acid is due to fermentative changes in the food, 
a drop or two of creasote or carbolic acid will often do good. If excessive 
secretion is at the root of the mischief, nux vomica is the most likely rem- 
edy. In either condition, large doses of bismuth generally give relief. See 
Indigestion. 

Heat and its opposite Cold, which is only less heat, are both excessively 
powerful remedies. Much of their power is due to this, that whereas cold 
causes the vessels to contract, heat causes them to dilate, the one obstructing 
the flow of blood to and through the vessels of a part, the other favoring it. 
Cold is applied in a variety of ways, by means of sponging, washing, etc., with 
cold water, by the use of ice-bags, and again by using artificial means other 
than water for reducing temperature, as sponging with spirit, or the applica- 
tion of ether spray. Heat is applied mainly by means of hot water as a fo- 
mentation, or as a warm bath, but perhaps the most favorable way of apply- 
ing heat and moisture combined is in the form of a poultice (which see). The 
warm bath is at first a pleasant application to the skin, if not too hot; but if 
continued too long, the effects of the heat on the vessels become marked, and 
there is throbbing in the head and temples, and much prostration. Some 
forms of pain are signally relieved by heat. Thus gripes, as they are com- 
monly called, especially if brought on by cold, are better treated by warm 
drinks and applications externally than in any other way ; the turpentine stupe 
is a very good way of applying heat and stimulation at the same time, but a 
cloth wrung out of water as hot as the hands will bear often suffices. There 
is another form of pain from which children frequently suffer, a kind of ner- 
vous pain or earache. Nothing, as a rule, does this so much good as heat, dry 



HEA 316 HEA 

heat from a warming-pan or hot brick, or the like, being best. It is in dis- 
eases somewhat similar in certain respects that the hot bath seems to do most 
good of all. Such are the maladies called a fit of the gravel and a fit of gall- 
stones. Some forms of skin disease benefit greatly by the warm bath. These 
forms are mainly of the scaly kind, and in the acute stage. The water should 
be as soft as possible, if nothing be added as a medicament. Heat receives a 
variety of other applications in medicine, which will be incidentally noticed. 

Heat, Animal. All animals preserve their own natural temperature, ir- 
respective of the medium in which they live. The animal heat of various 
creatures greatly differs. Thus man, birds, reptiles, and fishes have each their 
special temperature. By the action of the skin human beings are enabled to 
endure great variations of external temperature, and yet preserve their own 
animal heat. The proper heat of a human body is 98° Fahr. Any diminu- 
tion of the natural heat of the body denotes disease, and is a symptom worth 
attention. 

Heat Spot is a form of eczema, sometimes produced by exposure to the 
sun on a hot summer's day. Bathing with tepid water or lead lotion and keep- 
ing the patient cool will soon cure it. 

Heat-stroke and Sun-stroke, though closely allied, are not exactly the 
same thing. In typical sun-stroke, the individual, on exposure to the effects 
of the sun's rays, falls down suddenly, and may almost immediately expire. 
In heat-stroke, the onset is more gradual : very likely there is a dry skin, pros- 
tration, and a tumultuous action of the heart ; there may be difficulty of 
breathing and a feeling of restlessness. If the bodily temperature be tested 
by the thermometer it will be found to be far above the normal, perhaps as 
high as 102° or 104° Fahr. This is the typical symptom, and it is this 
which causes the distress and the risk. It must be reduced, or there is no 
safety for the patient. If it is very high, say 105° or 106° Fahr., sharp 
means must be used for reducing the bodily heat to a normal level. Jce must 
be used, either directly to rub the body, or to cool the water in which the body 
is immersed. A bag of pounded ice ought to be applied to the head. If these 
remedies are not at hand, the douche, represented roughly by pails of water, 
may be used, or the patient put under a pump and pumped on. No ceremony 
can be used : it is a matter of life and death. Some stimulant may be neces- 
sary to keep the heart going. Aromatic spirit is the best, but some iced 
brandy or iced brandy and water may be given. The patient, too, should be 
kept absolutely quiet. No exertion of any kind should be permitted, or the 
heart may stop, and a fatal termination of the disease come about. In very 
hot weather it is desirable to alter our habits as well as our dress. The dress 
should be as light and loose as possible, and, as we have always a variable 
climate, flannel should be its material. The head should be covered by some 
light-colored texture, and ventilated well. Sun umbrellas of white material 
should be used if the heat is very great ; if not, an ordinary one will do. The 
heavy meals ought to be taken early in the morning and evening. During 
the middle of the day, exposure to the sun's rays should be avoided. Beer 
should not be taken, nor spirits; light wines freely diluted form the best 
drink. Ice should be used freely with the drinks, and a cold sponge bath 
taken once or twice a day. Ventilation commends itself. 

Hectic Fever. This, as its name expresses, is an habitual or abiding 
febrile disorder. It occurs in connection with certain destructive diseases of 
internal organs, or results from exhausting drains upon the system, either in 
consequence of a greatly increased amount of normal secretion, as in diabetes, 



HBL 317 HEM 

or by profuse and prolonged suppuration, as occurs in death and chronic ulcer- 
ation of bone. Hectic is observed also very frequently in connection with 
progressive angular curvature of the spine, associated with a large abscess ex- 
tending downwards to the groin, and in severe and painful diseases of the hip 
or knee. The most marked symptoms of hectic are rapid loss of flesh, great 
heat of skin, especially of the palms of the hands, occasional chills during the 
day, and towards the end of the day a distinct fit of shivering, followed by 
intense fever, and afterwards, when the patient is in bed, by profuse and ex- 
hausting perspiration. The pulse is quick and very irritable, and is rapidly 
affected by the patient's movements, and by mental excitement or emotion. 
The tongue is moist and clean, and always very red. The skin during the 
day is hot, dry, and rough. During the night it is covered by perspiration. 
The appetite generally remains good. The bowels during the early stages 
of hectic are generally constipated. The mind remains unaffected. If the 
primary cause of hectic fever still persists, the patient sinks in consequence 
of rapidly increasing emaciation and loss of strength. The pulse becomes 
weaker, and the tongue is covered by white patches (aphthae). The ankles 
and afterwards the legs become swollen and dropsical, whilst the skin of the 
arms and body remains thin and shrunken, and is covered by rough branny 
scales. The cold fits become more and more severe, and the nocturnal per- 
spiration more profuse. When the patient is in this condition, bed-sores may 
be formed, the discharge from which, associated with diarrhoea, increases the 
exhaustion of the patient, and hastens a fatal termination. Death takes place 
slowly and quietly. The following are the diseases that most frequently end 
in hectic fever : pulmonary consumption, diabetes, Bright's disease of the 
kidneys, psoas abscess, ulceration of joint cartilages, with death or ulceration 
of subjacent bone. In cases where it is impossible to remove the cause of 
this febrile disorder, the treatment should be directed to supporting the pa- 
tient's strength by tonics, such as quinine and bark, and by a good diet, with 
a free allowance of wine and other alcoholic stimulants. The bed-linen should 
be changed often by reason of the profuse perspiration during the night, and 
in advanced hectic care should be taken to prevent, if possible, the formation 
of bed-sores. 

Hellebore, Black, is not now contained in the Pharmacopoeia, but has 
been used in medicine from time immemorial. The parts used are the under- 
ground stem and rootlets of the Helleborus niger, or Christmas rose, dark ex- 
ternally, white internally. Its taste is first sweet, then acrid and bitter. Its 
powder and tincture have generally been employed in medicine. It acts as a 
powerful drastic purgative. 

Hemeralopia. See Night Blindness. 

Hemicrania, or Brow Ague. See Intermittent Fever. 

Hemidesmus, or Indian Sarsaparilla, is the root of a plant growing 
in India. Its properties are supposed to resemble those of West Indian Sar- 
saparilla ; but as this last is now out of favor and but little used, so its Indian 
substitute has correspondingly decreased in estimation. It was used in skin 
eruptions, especially in those of a syphilitic nature, and was supposed to do 
good in some diseases of the kidney. 

Hemiplegia signifies paralysis of the arm and leg on one side of the body. 
The loss of sensation is generally very slight, if at all marked, but the loss of 
motion is most particularly noticeable ; this may be partial or complete. The 
seat of mischief may occasionally be in the spinal cord, but, as a rule, it is 
always in the brain, and on the opposite side to the paralysis; thus, if there be 



HEM 318 HEM 

hemiplegia of the right arm and leg, the disease will he on the left side of the 
brain. Any influence which interferes with the due supply of blood to a cer- 
tain area of the brain will. cause hemiplegia ; white softening, cerebral haemor- 
rhage, a clot of f brine obstructing the vessels, disease of the coats of the ves- 
sels from fatty change, and epileptic attacks will cause this form of paralysis. 
Hemiplegia may come on suddenly without any coma or insensibility, as when 
it is caused by a very small clot ; more generally the two symptoms are pres- 
ent, and when sensibility returns the patient finds he has lost the use of his 
arm and leg. In most cases the limbs lie useless and flaccid, and, if raised up, 
drop at once when left unsup ported. Improvement may be known by the 
patient being able to perforin simple movements or raise the limb a short dis- 
tance from the side. When the individual has recovered from the shock, fric- 
tion may he used to the extremities, or a galvanic current or rubbing with 
rough towels after a stream of cold water has been applied ; this should not be 
done until three or four weeks after the disease has begun, and then only when 
the patient is in a fit state for it. In every case the treatment and chance of 
recovery must depend in a great measure upon the nature of the injury. See 
Apoplexy. 

Hemlock (Conium maculatum) is a plant which grows wild in this coun- 
try. The fresh leaves and young branches, collected just when the fruit be- 
gins to form, and the dried ripe fruit, are the parts used. They contain a 
peculiar substance or alkaloid, called conia. This is volatile, and is easily set 
free by means of an alkali like caustic potass, with which, when the suhstance 
is rubbed, a peculiar and characteristic mousy odor is observed. The best 
preparation for use is the succus conii, or hemlock juice, got by expressing the 
juice from the fresh leaves, and adding a little spirit to make it keep. Hem- 
lock in large doses seems to paralyze the animals to which it is given, mainly 
by acting on their motor nerves. It is chiefly of use, apparently, in thus con- 
trolling violent muscular movements, as in some forms of chorea, but as yet 
it has received no very extensive therapeutic application. One great obstacle 
in the way is the uncertainty of its preparation, the only tolerably stable one 
being the succus conii. 

Hemp, Indian, consists of the dried flowering tops of the common hemp- 
plant grown under the tropical sun of India. The female plant is to be used, 
and it should be carefully noted that the resin is still present. The tops are 
usually found together in bundles a few inches long, have a greenish color, 
and exhale a peculiar odor. In India it is used in various forms. The resin- 
ous exudation of the leaves and flowers gathered into masses is called churrus. 
The plant itself, gathered complete and packed in long bundles, is called 
gun j ah, whilst the leaves and fruit, without the stalk, constitute what is 
called bang. It is the resin, developed by the great heat and powerful sun, 
which gives its value to the Indian plant This may be readily dissolved out 
by alcohol or ether, but the addition of water causes its precipitation. The 
solution in spirit evaporated to a paste constitutes the extract of hemp. The 
effects of Indian hemp are very wonderful. The resin of the plant gives rise 
to a peculiar form of intoxication ; this is always attended with exuberance of 
spirits, and, if the individual sleeps, is attended by dreams of a pleasing kind. 
It relieves pain, and in many cases occasions sleep, and its after-effects are 
not unpleasant. There is little languor, and no loss of appetite, neither does 
it constipate the bowels. Indian hemp is seldom given to allay pain purely ; 
but in certain cases of painful menstruation it does great good. It is best 
given until the patients begin to feel light in the head, after which the pain or- 



HEN 319 HEP 

dinarily ceases. In cases, too, where the menstrual flow is excessively pro- 
fuse, it ordinarily arrests this excess. It has been given in many diseases — 
in whooping-cough, in asthma, and in spasmodic diseases of a nervous origin ; 
but it seldom does the good expected, partly because the preparations of the 
drug are often worthless. As a rule, it may be said that if the drug does 
not produce its peculiar physiological properties, especially lightness in the 
head, it will not affect the pain. The dose of the tincture should be from ten 
to twenty drops, and it is best given in aromatic spirit of ammonia, — spirits 
of sal volatile. 

Henbane, also called IIyoscyamus, consists of the leaves of the Hyoscy- 
amus niger, gathered when about two-thirds of the flowers are expanded. The 
plant is of two years' growth, flowering the second year, and the flowering or 
second year's growth should be selected. It grows wild, but it is also cul- 
tivated ; and the cultivated plant, although not the best, is most commonly 
made use of. The leaves are wooly, underneath especially, and have a strong 
and peculiar odor. The preparations mainly employed are the extract and the 
tincture. As to its action, it seems allied to that of belladonna and stramonium, 
but is milder. It has the power of dilating the pupil, and it has distinctly a power 
of soothing irritable conditions of the system, and of preventing the griping 
action of certain purgatives. Its main use is as a sedative where opium can- 
not be given for other of its effects, as when the lungs are congested. Hyo- 
scyamus is also used to relieve irritability of the bladder. In large doses its 
effects are dilatation of the pupil, dryness of the mouth and throat, slight delir- 
ium, and partial loss of power. The dose of the tincture is from ten to thirty 
drops. 

Hepatic disorders or derangements. See Liver. 

Hepatitis, or inflammation of the liver, is a disease which is exceedingly 
common in tropical regions, especially in Americans and Europeans living 
there who are careless in their mode of life. We shall speak here solely of 
the form of inflammation which tends to end in softening and the formation 
of an abscess. Other forms of liver disease are sometimes spoken of as inflam- 
mations, but they have nothing of the nature of that process. The disease 
would seem to be caused sometimes by free living in unhealthy climates, ex- 
posure to marsh or jungle miasms, and very frequently it is due to dysentery. 
The onset of the disease is marked by pain and fullness of the side, with 
some degree of tenderness, especially on pointed pressure. Then there is fe- 
ver, the skin is hot, the temperature high ; there is much thirst, and the urine 
is scanty. The pain in the right side is often severe, but sometimes absent. 
It is much worse on lying on the left side, or on coughing. There may be a 
slight tinge of jaundice, but not much. Usually, too, there is a peculiar pain 
in the right shoulder, especially about the collar-bone. More rarely the left 
shoulder is affected. If the inflammation go on to the formation of an abscess, 
as it commonly does, the occurrence of suppuration is commonly marked by 
shivering; there is increased pain, and tenderness very often, especially if the 
abscess be on the upper part of the liver, a dry cough, and a feeling of weight 
and dragging in the right side ; the muscles forming the wall of the belly on 
that side, too, are tense, and kept tight, as if to protect the sensitive organs 
beneath. Sometimes it may be distinctly made out that the liver is enlarged,. 
but often this is not the case, and as time wears on the patient suffers from hec- 
tic fever, there is great prostration, and most frequently diarrhoea or dysentery. 
Inflammation of the liver may abate, and the patient get well without any 
abscess being formed ; but generally, when an abscess has been produced, its 



HER 320 HER 

contents must be got rid of, or the patient will die. The escape may be nat- 
ural or artificial, but it is always dangerous. Sometimes they burst into the 
cavity of the abdomen ; if so, death is almost certain, for inflammation is set 
up and a fatal termination is not far off. Sometimes they open into the bile- 
ducts or gall-bladder, and so their contents may escape into and through the 
gut. Most frequently, as the abscess nears the surface of the liver, an inflam- 
mation of its covering is set up, and thus it is glued to the neighboring parts ; 
if to the wall of the abdomen, an opening may be made in it. and so the pus 
escape externally. It may also adhere to the intestines, and an opening be 
made in them, and the fluid escape that way. The same may occur by way of 
the stomach. 

The treatment of hepatitis consists in a considerable measure in letting the 
patient alone. The bowels ought to be kept open, but not loose. If confined, 
and the tongue is brown, and there is much fever, rhubarb and alkalies are 
likely to do good. If they are too loose, and there is a tendency to dysentery, 
astringents must be used, especially in combination with ipecacuanha, in full 
doses. When suppuration has fairly taken place, good nourishing food must 
be given, probably also tonics ; and we must wait. If there is much restless- 
ness and pain, small doses of chloral or morphia subcntaneously will be best. 
If the abscess has fairly declared itself as likely to burst on the surface, the 
fluid may be withdrawn by aspiration, or that may be attempted beforehand. 
After that a stimulant and supporting treatment is solely needed. 

Hermaphrodite, an individual combining both sexes in the same or- 
ganism. 

Hernia. By the term hernia is meant any protrusion of the contents of a 
cavity through its walls. But in general the, term is applied to the protrusion 
of the abdominal viscera, constituting rupture. The predisposing cause of 
hernia is a weakness in the walls of the abdomen. The exciting cause is 
compression of the contents of the abdomen by the surrounding muscles, which 
are very powerful, and are brought into violent action by rowing, lifting 
weights, pulling, etc. Hernia is divided into the following varieties : reducible, 
irreducible, and strangulated. 

By reducible hernia is meant one returnable into the abdominal cavity, and 
its symptoms are the existence of a compressible tumor in the abdominal walls, 
which lessens in size if the patient lies down, or disappears altogether, receives 
an impulse on coughing, or on any exertion being made, and can be readily 
returned by pressure. This form of hernia can be treated either palliatively 
or radically ; the first by means of trusses, and the second by operation for the 
closure of the aperture through which the rupture passes. A truss consists of 
a ring of steel, to the extremities of which are attached pads, one of which 
presses upon the aperture and retains the hernia within the abdominal cavity. 
There are many forms of trusses, but the measurements to be taken in writing 
for any form recommended are the same ; thus, if an inguinal or femoral truss 
be required, the circumference of the body at the hips should be stated, mid- 
way between the spine of the ilium and the trochanter. In Coles's truss there 
is a spiral spring acting on the pad; the Moc-Main lever truss dispenses with 
the usual circular spring, and the pressure upon the rupture is gained by a 
strap passing under the thigh and acting on a spring lever attached to the pad. 
Salmon and Ody's self-adjusting truss has a pad revolving on a ball and socket. 
The best form of truss, however, in modern use is Wood's. In this truss a 
flat and level pressure is applied at the sides of the hernial opening instead of 
at the axis. The part of the skin upon which the pad presses should be regu- 



HER 321 HER 

larJy washed and bathed with eau de Cologne or spirit, or dusted with violet 
powder or fuller's earth. In children, an india-rubber band and pad answers 
generally. 

Umbilical Hernia, or exomphalos, is most frequent in newly-born children, 
and presents itself as a protrusion at the navel ; a flat disc of metal, or even a 
penny piece, retained against the protrusion with a strap of plaster, will retain 
the hernia. 

Ventral Hernia, is a protrusion of bowel through the abdominal walls in the 
mesial line, or through any parts of the parietes which are not usually the seat 
of otherwise named hernise. There are several other forms of hernias in which 
there are protrusions through those natural openings in the pelvic or abdom- 
inal walls which serve to transmit muscles, vessels, and nerves to the limbs, 
or which may be the result of arrested development or of injury, and which 
can hardly be mentioned except by name, such as perineal, vaginal, labial, 
obturator, ischiatic, and diaphragmatic, and for which the reader is referred to 
special works on surgery. 

Strangulated Hernia. By the term strangulated hernia is meant that, a por- 
tion of intestine being protruded, there is a total stoppage of its contents, so 
that they cannot be propelled towards their natural outlet, and, moreover, that 
the structure of the bowel itself is so constricted that it is itself strangulated. 
The symptoms of this condition are : firstly, those of obstruction of the bowels ; 
secondly, those of inflammation. The individual has flatulency, tightness over 
the belly, a desire to evacuate the bowels, and an inability to do so. Next, 
vomiting supervenes ; in the first place, of the contents of the stomach, of 
bilious matter, and then of matters smelling strongly of fasces, in consequence 
of the ingesta being detained in the intestinal circuit. In this state of things 
operative interference is necessary, and that at once, although, until such aid 
is at hand, some assistance is to be derived from what is termed taxis, from 
which, even in unprofessional hands, if properly directed, good results may 
ensue. The patient should be placed in a warm bath, and both the thighs be 
raised towards the belly and placed close to each other, as a means of relaxing 
all the muscles and ligaments connected with the abdomen ; he should be en- 
gaged, if possible, in conversation, so as to relax the respiratory muscles. 
Next, the visible tumor should be grasped gently with one hand, to empty it 
as far as possible, and with the other the neck of the tumor should be kneaded, 
with a motion towards the abdomen. This operation should be continued for 
some time, a quarter of an hour or so, if no great pain is produced by so doing, 
at the end of which time, if the proceeding be successful, a slight gurgling- 
sound will intimate the return of at least a portion of the tissues. In some 
instances, when mere taxis has failed, raising the pelvis and lowering the 
shoulders have proved effectual. Chloroform is a great aid in the reduction 
of such a hernia ; so is a hot bath (96°-100° Fahr.), a large dose of opium, an 
enema of tobacco, a drachm to a pint of boiling water; or cold, in the form 
of ice, or of a freezing mixture, in a pig's bladder, applied over the swelling. 
In the event of these milder remedies failing, a surgeon must perform an 
operation to relieve the constriction. Hernise passing over Poupart's liga- 
ment are called inguinal, either direct or indirect, external or internal, as they 
take the course of the spermatic cord or not, or are external or internal to 
the deep epigastric artery ; scrotal or pudendal, if they descend into the scro- 
tum or pudenda; femoral or crural, if they pass under the above-named 
ligament. 

Irreducible Hernia. By the term irreducible is meant that form of rupture 
21 



HER 322 HIP 

where, from some impediment in the canal through which it passes, it cannot 
be replaced in the abdominal cavity. If an irreducible hernia be neglected, it 
produces many inconveniences, abdominal pains, vomiting, and general intes- 
tinal disturbance, and the contents of the bowel may be obstructed in their 
natural passage, causing colic and constipation, and, moreover, the chance of 
the bowel becoming strangulated at that point is greatly enhanced. With re- 
gard to treatment, it is either palliative or radical, the palliative measures 
being the application of a bag truss ; and all violent exertion or excess in diet 
should be avoided. The radical proceedings, which have been before alluded 
to, are of course only to be attempted by an experienced surgeon. 

Herpes is a skin eruption, made up of clusters of small vesicles or blisters, 
surrounded by a pink or red areola. It generally occurs on the upper lip in 
cases of ordinary cold, and it often is found there in those suffering from 
pneumonia; it is then called herpes labialis. It is caused by the irritation of 
the nasal discharge, and commences with tingling pain and itching and slight 
redness. A little cold cream applied night and morning, or simple zinc oint- 
ment, will suffice for a cure. There is another variety, named herpes zoster or 
shingles, the peculiarity of which is that it only affects one-half of the body; it 
is oftenest met with on the right side of the chest, but may occur anywhere; 
clusters of vesicles with red margins are found along the course of the cuta- 
neous nerves. The eruption commences with pain along the nerves, and in 
two or three days a copious rash will appear ; it may occur at any age, and is 
perfectly harmless in its nature. Bathing with warm water or Goulard's ex- 
tract, or smearing on a little zinc ointment, is all the treatment required, and 
a cure will take place naturally in a few days. 

Hiccough. See Hiccup. 

Hiccup consists of a short, abrupt contraction of the diaphragm, and a 
sudden jerking, imperfect ejection of the breath. Most frequently it is purely 
emotional, and brought on no one knows how ; and very often it may be got 
rid of in the same way, by frightening the individual, by exciting the curiosity, 
and so removing the attention from the hiccup. A draught of cold water or 
sucking a piece of ice will generally get rid of this nervous form of the affec- 
tion. A variety of it is not uncommon in hysteria, when it may continue for 
a very long time, apparently resisting every remedy. The application of the 
galvanic battery to the region of the diaphragm will in most cases put a stop to 
this hysterical kind. There is a form of very grave origin, however, when 
gangrene of any part sets in, but especially gangrene or mortification of the 
gut ; this proves very troublesome, and in most instances it is a fatal symptom. 

Hiera Picra, better known as hickory-pickory, consists of a mixture of 
equal parts of canella bark and aloes. The canella bark is an excellent 
stomachic tonic, possessing a warm and spicy taste, which is agreeable and 
comforting. The laxative effects of this remedy are due to the aloes which it 
contains, and its properties mainly approximate to the properties of that drug. 
See Aloks. 

Hip-joint Disease. The hipjoiut is liable to the following injuries and 
diseases : dislocation (which see) and a peculiar form of disease known as 
morbus coxee, or coxalgia. It most frequently attacks children between the 
ages of seven and fourteen, although no age is exempt, and generally prevails 
in cold, moist climates. The first symptom noticeable in a child is the fact of 
its dragging the affected limb after the sound one, a flattening of the natural 
fold of the buttocks, and pain referred at first to the knee; and in standing 
the patient advances the foot a little, slightly everting the toe, and does not 



HOA 323 HOP 

rest his weight upon it. After a while pain comes on in the hip-joint itself, 
and generally continues chronic for several months. At length the symptoms 
may disappear and become far more serious ; thus the affected limb becomes 
shorter than the sound one, the motion in the joint being impaired or 
destroyed, and permanent dislocation taking place. Matter now forms in the 
region of the hip and makes its way to the surface, and then, after a tedious 
illness, the patient either becomes hectic and dies, or recovers with a stiff 
anchylosed joint and a wasted, useless limb (Syme). The treatment in the 
earliest stage consists in maintaining the limb at perfect rest in the straight 
posture, and this is best effected by placing sand bags on each side of the limb, 
the external one reaching as high as the arm-pit, and the body and legs kept 
fixed straight by a stout sheet drawn tightly over them and fastened to the 
bedstead. Counter irritation by means of small blisters around the hip, and 
the internal administration of cod-liver oil and tonics, with resort to sea air, 
is the best method of treatment to be depended on. In advanced cases, when 
there is extensive disease of the bone, operative measures, such as removal 
of dead bone, either partially or by the operation of excision of the head of 
the femur, must be resorted to. 

Hoarseness, a common term for Aphonia, or loss of voice. See Apho- 
nia. 

Hob-nailed Liver, so called because in cirrhosis the surface of that or- 
gan is rough and uneven. See Cirrhosis. 

Homoeopathy. A theory of medicine opposed to that commonly known 
as Allopathy, and introduced by Dr. Hahnemann, a German physician, about 
the year 1810. The main principle of the practice of this theory is that 
" like cures like," and the motto " similia similibus curantur " is adopted by 
Hahnemann and treated of in his works. Homoeopathy professes to cure dis- 
eases by the employment of remedies which, if given to a healthy person, 
would produce symptoms of a disease' similar to the one to be treated. The 
three points o:i which the fabric of homoeopathy may be said to rest are, first, 
that like cures like ; second, that the curative power of drugs is increased in 
proportion to their minute subdivision ; and third, as a consequence, that in- 
finitesimal doses of medicine are the proper treatment of all diseases. By 
degrees most people learn that attention to diet, general habits, exercise, and 
rest have more to do with the cure of disease than the absolute medicine swal- 
lowed, and it is thus doubtless that homoeopathy has secured its present 
amount of popularity. 

Honey is the sweet juice of plants and flowers elaborated by the bee, and 
deposited in waxen cells in the form of liquid sugar. The quality of honey, 
both in flavor and richness, depends greatly on the character of the country 
over which the bees roam for food. Honey is used in medicine as an emul- 
sion, expectorant and laxative, and is often combined with vinegar and squills 
to make a simple remedy for colds, coughs, and hoarseness. 

Hooping-cough. See Whooping-cough. 

Hops are the flowers of the female hop plant collected and dried. The 
flowers consist of scales inclosing a quantity of powder to which they owe 
their peculiar effects. This powder may be separated by sifting, and is then 
called lupulin. Various preparations of hops are in use — the tincture, the 
extract, and the infusion ; the best is, however, bitter beer. The hops them- 
selves are supposed to be slightly narcotic, and a pillow of hops has been used 
to give sleep, but there is no evidence whatever to show that any preparation 
of hops has this particular effect. Hops are besides bitter, stomachic, and 



HOR 324 HOS 

tonic, and this wholesome bitter in good bitter ale in often invaluable. Much 
of the beer used, however, owes its bitter to something else than the hop, and 
in many instances that something is not quite so wholesome. 

Hordeolum, commonly called a stye, is a small, hard, painful boil devel- 
oped in the margin of the eyelid. It is of slow growth; the suppuration 
proceeds imperfectly, and as it iucreases in size it presses on and produces ob- 
struction of some of the ducts of the Meibomian glands. (See Eyelid.) 
Suppuration should be promoted by the frequent application of warm fomen- 
tations, such as a hot soft sponge, wrung out in boiling water, applied to 
the eye, and a hot bread-and-milk poultice applied over night. When the 
pus " points " a very slight puncture may be made, and the warm applica- 
tions continued. If the margin of the eyelid remains thickened and painful, 
and the tissues immediately adjacent be indurated, a little citrine ointment 
should be applied along the margin of the lid. Aperients, and afterwards 
tonics and alteratives, are always necessary, as the complaint is traceable to 
debilitated conditions. Those affected with scrofulous habits, or who often 
suffer from chronic ophthalmia, are peculiarly liable to be attacked with stye, 
and they then occur one or two together or in succession, plainly indicating- 
something wrong in the general health. When stye occurs frequently in re- 
lapses in scrofulous children it is readily cured by the administration of qui- 
nine. If it occurs in persons of full habit, spare diet and gentle aperients are 
indicated. If the tumor remains indolent, some stimulating ointment, such as 
iodine or citrine ointment, or nitrate of silver, proves very efficacious in dis- 
persing it. 

Horehound (the Marrubium vtdgnre), a plant belonging to the Labiate 
family, has long been used in domestic practice. Its uses are ill-defined, but 
it was supposed to act as a tonic and expectorant, and so was generally used 
for coughs and colds. 

Horse-radish ( Cochharia armordcia) is a plant well known for its culi- 
nary virtues, though not much can be said for its medicinal properties. It is 
sharply pungent, and will act as a stimulant to the How of saliva, probably also 
to that of gastric juice. Its only officinal preparation is a compound spirit. 
which is rarely if ever used. It is best taken scraped, with roast sirloin of 
beef. 

Hospital Gangrene. Under this term have been included several gan- 
grenous apd ulcerative processes which attack wounds and stumps after ampu- 
tation, when the patients are collected together in great numbers, and are 
placed under faulty hygienic conditions. Hospital gangrene in all its forms 
is both contagious and infectious, and seems in some instances to be due to 
epidemic influences. It is very prevalent among armies during military opera- 
tions, and when large numbers of wounded soldiers are collected together in 
buildings unsuitable in size and internal arrangements for hospital purposes. 
The disease has often made its appearance without any known cause in hospi- 
tals. It attacks small as well as large wounds, and even blisters and leech- 
bites, but is never met with in perfectly sound individuals. In the most severe 
form of hospital gangrene a small livid spot or bleb makes its appearance on 
a stump, or near the margins of a wound, which had previously been closing 
favorably. This bleb increases rapidly in size, and converts the extremity of 
the stump or the whole of the wound, with the surrounding healthy skin, into a 
black and swollen gangrenous mass. The disease spreads rapidly, and is asso- 
ciated with constitutional symptoms of a low typhoid character. At other times 
a stump swells and becomes hard and very pale, and its surface is marked by 



HOS 325 HOS 

large blue veins. This form is also attended with severe general symptoms 
and much pain. Like the preceding one, it is generally fatal. In the less 
severe forms the surface of a wound is covered by a thick, yellow, and adher- 
ent crust, which increases rapidly both in depth and superficial extent. This 
disease has been met with chiefly in Europe, and is there known by the name 
of diphtheria of wounds. The constitutional symptoms are not so severe as 
those of the strictly gangrenous forms, and the fever, if it be present, is us- 
ually high and of an inflammatory kind. The general treatment should con- 
sist in supporting the strength of the patient by tonics, stimulants, and nour- 
ishing diet. In the diphtheritic form, however, the diet should be moderate, 
so long as there is high fever, and alcoholic drinks should not be given freely. 
The local treatment is generally directed towards arresting the spread of the 
gangrene by the application of nitric acid or the red-hot iron. The affected 
parts should be frequently cleansed by lotions containing carbolic acid, Condy's 
fluid, or tincture of iodine, and after the application of a caustic agent be cov- 
ered by yeast or charcoal poultices. 

Hospitalism. The aggregation of living beings in well-filled habitations 
is undoubtedly a cause of disease and a high death-rate. M. Rossignol, in his 
Treatise on Military Hygiene, states that the mortality among the French 
cavalry horses, which, previous to 1836, varied from 180 to 197 per 1000 per 
annum, was reduced in the following ten years, after enlargement of stables, 
to 68 per 1000. In man the effects of extensive aggregation, and of the con- 
ditions usually associated with aggregation, are fraught with danger to health 
and life. At the present day, in spite of improvements in building and a 
more extended knowledge of hygiene, the death-rate of large cities far ex- 
ceeds that of country districts, and the average mortality of a place bears an 
almost direct proportion to the aggregation of the residing population. In 
some remarks on the subject of habitations, Professor Parkes states that 
" barracks have been in our army, and in many armies of Europe still are, a 
fertile source of illness and loss of service. At all times the greatest care is 
necessary to counteract the injurious effects of compressing a number of per- 
sons into a restricted space." That the residence in large hospitals of persons 
in a state of good health is prejudicial to life has been indicated in a recent re- 
port of the Scotch Lunacy Commissioners. In Scotland chronic and harmless 
lunatics are either lodged in lunatic wards attached to poor-houses, or are 
boarded with peasants in private dwellings. From the year 1861 to 1867 in- 
clusive, the average annual mortality of chronic lunatics living in lunatic 
wards was 8.6 per cent., and that of lunatics living in private dwellings 5.6 
per cent., or, as it was put by Sir James Simpson : — 

Of the chronic lunatics resident in private dwellings 56 in 1000 die annually. 
Of those chronic lunatics resident in lunatic wards 86 in 1000 die annually. 

There seems, then, to be no doubt as to the prejudicial influence of close aggre- 
gation on healthy individuals residing in large and badly-ventilated dwellings. 
For several years past this subject has been supplemented by the important 
and serious question whether the present system of constructing large hospi- 
tals and of collecting several patients in spacious wards is not a grave hygienic 
mistake, and whether the sick and injured who apply to those institutions for 
relief are not submitted to risks which they would certainly have escaped had 
they remained at home. The subject was first brought under the notice of the 
medical profession in 1848 by Sir (then Dr.) James Simpson, of Edinburgh, 
who then held that a total change in the system of hospital practice would 



HOS 326 HOS 

much contribute to save surgical and obstetric patients from inflammation of 
the veins and other analogous disorders, and that a great saving of human life 
would be effected if hospitals were changed from being crowded palaces into 
villages or cottages, with one or at most two patients in each room. He advo- 
cated the use of iron in the construction of such a village, so that this might 
be removed and rebuilt every few years. Nothing further was written on this 
subject until the year 1864, when the interest of the profession was aroused 
by the discussions concerning the best site for the new St. Thomas's Hospital, 
by a prolonged debate in the French Academy of Medicine on the compara- 
tive mortality of surgical patients in the hospitals of London and Paris, and 
chiefly by a remarkable work by Miss Florence Nightingale called Notes on 
Hospitals, which had been published in the previous year. In the preface to 
this work the following passage occurs : " It may seem a very strange prin- 
ciple to enunciate as the very first requirement in a hospital that it should do 
the sick no harm. It is quite necessary, nevertheless, to lay down such a 
principle, because the actual mortality in hospitals, especially in those of larger 
crowded cities, is very much higher than any calculation founded on the mor- 
tality of the same class of diseases amongst patients treated out of hospital 
would lead us to expect." 

In the year 1867 Sir James Simpson again brought forward this subject, 
and in an inaugural address as president of the Public Health Section of the 
Social Science Association, which had met at Belfast, propounded the question, 
'•To what extent are hospitals, as in general at present constituted, banes or 
blessings ; and how can they be changed so as to convert them from the 
former to the latter ? " In conclusion, he suggested that hospitals, in order to 
be made as healthy and useful as possible, should be changed " from wards 
into rooms, from stately mansions into simple cottages, from stone and marble 
palaces into wooden or brick or iron villages." In the spring of 1869 Sir 
James Simpson again returned to the charge, and published in the Edinburgh 
Medical Journal some important articles under the title of Hospitalism, by 
which he implied the prejudicial influences of large hospital buildings upon 
sick residents. In order to obtain sufficient data on which he might base his 
objections to the construction of large and palatial edifices for hospitals, Sir 
James had collected figures showing the comparative mortality of amputations 
through the bones of the upper and lower extremities in rural private practice 
and in large and metropolitan hospitals. The total number of cases of amputa- 
tion in rural practice was 2098 ; of cases of amputation in large hospitals 2089. 

Out of the 2098 amputations in country practice 226 died, or 1 in 9.2. 
Out of the 2089 amputations in hospital practice 855 died, or 1 in 2.4. 

Sir James also found from his statistics that 

In fatal country amputations 5 in 100 die of pyaemia. 
In fatal hospital amputations 50 in 100 die of pyaemia. 

In the 2098 cases reported to Sir James Simpson by medical practitioners of 
the country the patients in not more than half a dozen instances belonged to 
the upper classes. In eight or ten per cent, the patients belonged to the middle 
classes ; but in the great majority of cases they were artisans, laborers, farm 
servants, masons, quarrymen, etc., or some members of their families. The 
house accommodation of the best class was reported in most instances as " being 
bad, and not such as most hospital surgeons would have deemed eligible." The 
country returns indicated to Sir James that limb amputations become more 
and more successful in the hands of rural and provincial practitioners in ac- 



HOS 327 HOS 

cord an ce with the experience which they have had of the operation, so that 
had the skill and experience of the country operator been equal to the skill 
and experience of hospital surgeons, a still higher rate of success would have 
been obtained by the former. Sir James also collected the statistics of eighty- 
two amputations performed in private practice in Norway. These confirmed 
the conclusion that the average death-rate after amputation of the limbs in 
private country practice is about one in nine. 

]n August, 1869, Sir James Simpson further extended his arguments in a 
series of articles, styled Some Propositions on Hospitalism, which were pub- 
lished in the Lancet in answer to some adverse criticisms from Mr. Timothy 
Holmes. Further statistics, including some of the surgical practice of provin- 
cial hospitals, had been collected, and the following comprehensive table was 
formed in order to show that the mortality of limb amputations is regulated 
by the size of hospitals, and the degree in which patients are aggregated or 
isolated : — 

SIZE OF HOSPITAL, ETC. DEATH-RATE. 

1st Series. — In large and metropolitan British hospitals, chiefly contain- 
ing from 300 to 500 beds or upwards, out of 2089 limb 
amputations 855 died, or 1 in 2.4. 

2d Series. — In provincial hospitals, containing from 201 to 300 beds, out 

of 803 limb amputations 228 died, or 1 in 3.5. 

3d Series. — In provincial hospitals, containing from 101 to 200 beds, out 

of 1370 limb amputations 301 died, or 1 in 4.4. 

4th Series. — In provincial hospitals, containing from 26 to 100 beds, 

out of 761 limb amputations 134 died, or 1 in 5.6. 

5th Series. — In provincial hospitals, containing 25 beds or under, out of 

143 limb amputations 20 died, or 1 in 7.1. 

6th Series. — In British private country practice, with the patients oper- 
ated on in single or isolated rooms, out of 2098 limb am- 
putations 226 died, or 1 in 9.2. 

" In the Propositions on Hospitalism, Sir James Simpson endeavored to 
show that the high death-rate after limb amputations in large hospitals as com- 
pared with that after similar operations in country and private practice was 
due not to the greater number of deaths by shock in hospital practice, but was 
the 'result of pyaemia and those congener affections which are the natural conse- 
quences of defective hospital hygiene.' In propositions XIX. and XX. it is 
stated that — 

" Surgical patients in surgical wards seem sometimes to have pyaemia or 
surgical fever, induced by the accidental inoculation of the morbific secretions 
formed in the bodies of other patients previously affected. 

" The air breathed by patients aggregated in surgical wards becomes some- 
times morbific and dangerous by its containing various inorganic and organic 
materials, and by the inmates mutually vitiating it more or less by the exhala- 
tions and excretions from their wounded, ulcerating, and sick bodies." 

In conclusion Sir James Simpson advocated the modification of existing 
large hospitals by adopting Sir Sydney Waterlow's plan in regard to dwellings 
for London workmen. According to this plan each flat of the dwelling is so 
divided that there is no other communication between it and the flats above 
and below, except a staircase perfectly open to the external air. Sir James 
believed that by building up the doors and other entrances from the wards into 
the hospital stair-landings, and by making all the wards and flats accessible 
from without by new external staircases, and by covered balconies placed upon 
the outer wall of the ward, perfect isolation and ventilation of individual wards 
could be thus effected. 



HOS 328 HOS 

Views so original as those propounded by Sir James Simpson, and which 
involved such grave accusations against an old established system of hospital 
relief, were not long permitted to remain unchallenged. In answer to Miss 
Nightingale's remarks on the general mortality of hospitals, and her conclu- 
sions from the tables of the Registrar-General, it was urged by Dr. Guy that the 
class of cases treated in the different hospitals varied to such an extent that 
any collection of figures treating them as homologous units failed in the very 
essence of its assumption. Sir James Simpson's statements, however, con- 
cerning the prejudicial effects of large hospitals, being based upon a profusion 
of figures and more extended information, and indicating the necessity of such 
radical change, attracted increased attention both from the profession and the 
general public, and were soon submitted to severe criticism. Some surgical 
critics disputed the correctness of the figures showing the results of amputa- 
tions in hospital and private practice ; others, while granting the accuracy of 
the statistics, opposed the deductions made by Sir James ; and others, follow- 
ing Mr. Jonathan Hutchinson, objected to a sweeping condemnation of hospi- 
tals on account of the facts supplied by the study of any special class of injury 
or disease ; these hold that a great majority of cases, medical as well as sur- 
gical, are cases in which there is no risk of contamination, and that the case of 
amputations and capital surgical operations, like that of confinements, was 
quite a special one, which might be efficiently controlled by isolation, without 
having recourse to costly changes and a general disturbance of the present 
hospital system. It was held by many critics that the lower death-rate in 
country practice, after amputations of the limbs, was no proof of the unheal th- 
iness of large hospitals, but rather indicated a difference in the constitution of 
the patients, being more debilitated, more frequently the subjects of chronic 
alcoholism, and, for those reasons, more likely to sink from shock or to con- 
tract phlebitis, surgical fever, and pyaemia. Among the most formidable and 
able critics of Sir James's views concerning hospitalism was Mr. Timothy 
Holmes, who was the better entitled to give an opinion on this subject as he, 
in connection with Dr. Bristowe, of St. Thomas's Hospital, had drawn up an 
elaborate and valuable report on the hospitals of the United Kingdom, which 
was published in 1862 in the sixth report of the Medical Officer of the Privy 
Council. 

The following is a brief statement of the arguments adduced by Mr. Holmes 
in his articles on Hospitalism, published in the Lancet of 1869 : In the 
first place it was denied that the figures showing the mortality after amputa- 
tions in the country, collected in such manner as they had been by Sir James, 
could faithfully represent a normal and actual average. He believed, too, that 
these returns furnished a small sample of the mass of country amputations, 
considering the period comprised in these statistics (twenty years), and the 
great number of amputations that must be performed by country surgeons. 
Under the third head Mr. Holmes states that amputation is not an entity which 
can be submitted to a numerical method of reasoning, like cattle or inanimate 
objects, but is obviously a process, a step in the treatment of a surgical case, 
upon the nature of which case the failure or success of the amputation very 
commonly depends. The errors were not balanced or diminished by the large 
numbers of Sir James Simpson, but rather increased, as these errors depended 
on essential differences between the two classes of cases compared. Four re- 
turns, taken from Sir James's statistics, show 125 amputations of all the limbs 
for injury (the thigh having quite its fair proportion) occurring in the practice 
of four surgeons, aud comprising their entire experience, without a single death. 



HOS 329 HOS 

This, says Mr. Holmes, occurring in the unselected hospital practice of four 
surgeons, would be nothing short of miraculous, because in so many of the 
amputations in hospitals for injury the operation is performed in desperate 
injuries, or on patients whose decrepit or diseased condition has prostrated 
attempts at conservative surgery. Granting that secondary surgical affections 
(erysipelas, pyaemia, phagedena, tetanus) are rarely met with in country dis- 
tricts, this is no proof of the greater advantage of treating surgical cases in 
urban residences than in large hospitals. " Secondary surgical affections," 
asserts Mr. Holmes, " are met with in town practice amongst every class of 
population; the nobleman in his palace and the artisan in his narrow lodging 
suffer from erysipelas and pyaemia, as well as the hospital patient." Mr. Holmes 
next discusses the alterations in hospital arrangements suggested by Sir James 
Simpson, and questions whether the balance of deaths would be redressed, and 
the contemplated change prove really a benefit. If it were possible to allow 
to each surgical patient a separate, well-ventilated room and a skilled nurse, 
although the chances of recovery in each case might be increased, such im- 
provement would not protect an urban population from the ravages of erysip- 
elas and pyaemia. To transform a palatial hospital into a series of iron sheds 
would not produce much change in the condition of the wards, " except that 
the walls would be," Mr. Holmes supposes, " more pervious to the weather, 
the floors nearer the soil, and the sheds more easily removed. We should, 
after all, come back to a hospital ward again, liable to overcrowding as now, 
liable to contamination of its atmosphere by the exhalations from wounded and 
diseased surfaces as now, liable to the effects of contamination from careless 
nursing as now; in fact, equally liable to all admitted aud proved sources of 
unhealthiuess, and free only from those which, for anything that has yet been 
shown, are imaginary." In conclusion Mr. Holmes observes that the alleged 
greater salubrity of cottage hospitals, or of small city hospitals, as compared 
with large ones, rests on no evidence whatever. There are great drawbacks 
in treating the poor in their own homes, such as badly-ventilated rooms, dirt, 
want of nursing, and general discomfort; and it cannot be admitted that grave 
surgical cases can be safely treated at home, in the circumstances of the London 
poor. 

Another series of articles from Mr. Holmes, in answer to Sir James Simp- 
son's Propositions on Hospitalism, appeared in the Lancet of 1871. The au- 
thor agreed with Sir James in believing that there was a lamentable waste of 
life amongst hospital patients, and that hospital practice, including operative 
surgery, was not so successful as it might have been and ought to have been ; 
but he differed in attributing a large share in this result, not to the ventilation 
of hospital buildings, but to the low vitality of the patients in London hos- 
pitals, and the late stage of the disease in which hospital surgeons are often 
consulted. 

No further facts or arguments of any great importance have been brought 
forward, either in support of or against the views of the late Sir James Simp- 
son, concerning this subject of hospitalism. It still remains a very doubtful 
question whether the high mortality attending surgical practice, especially 
operations, be principally due to influences which patieuts might escape if they 
were treated in isolated buildings ; and it seems to be a question which it is 
impossible to determine satisfactorily. There is without doubt a very great 
difference in constitution and bodily strength and vigor between the inhab- 
itants of country districts and those of large cities, who on account of injury 
and disease resort for treatment to large hospitals. It is well known to London 



HOS 330 HOS 

surgeons that in out-patient practice injuries even of a slight kind frequently 
do badly. One would imagine that children were no less amenable to the bad 
effects of hospitalism than adults, but still operations performed upon patients 
under ten or fifteen years of age are quite as successful in the hospitals of 
London, and of other large cities, as they are in the country. The difference in 
the mortality of the operations in town and country is met with in dealing with 
patients of middle and advanced life, when it might be supposed that harder 
work, less regular habits, and worse hygienic conditions had told unfavorably 
upon the laboring urban population. On the other hand, it is clear that sec- 
ondary surgical affections, as inflammation of veins, erysipelas, hospital gan- 
grene, and pyaemia are evils inseparable from the present hospital system, 
which, however, may be reduced in severity and extent by improvements in 
the construction of hospital buildings, by good ventilation, and by efforts on 
the part of managing authorities to procure at any price the services of an 
abundant staff of experienced and intelligent nurses. 

Hospitals being buildings intended for special purposes, special rules have 
to be applied to their construction. Where practicable, the selection of a site 
should be governed by the same laws as hold good with regard to ordinary 
inhabited houses (see Houses), but this is seldom attainable. Hospitals are 
intended for the relief of the sick and injured poor, and where these are con- 
gregated together there must the hospitals be also. Nowadays, however, the 
work of hospitals in towns is largely supplemented by convalescent hospitals 
in the country, and to these the rules for selecting a site apply with all their 
strictness. Even the outline of a site must be dependent on circumstances in 
towns. Nevertheless, even in towns there are neighborhoods which can be 
avoided, such as those where unhealthy trades are carried on, and very low 
and damp situations should be strenuously avoided. The size of a hospital 
must of course be governed by circumstances, but it has been found by expe- 
dience that one of between two and three hundred beds is most economical, 
fewer servants being required proportionally for this than any other size. The 
material must of course vary with the part of the country ; in America it is 
usually good sound brick, and there can be none better. Portland cement 
on the outside may be used if desired; on the inside parian, if not too ex- 
pensive, might be used. The drains are always trying in a hospital, for if the 
drainage is not good the place soon becomes a hot-bed of disease instead of 
one for its relief and cure. Where there is a system ot drainage, stoneware 
pipes, well protected, should be used. These should be laid, if possible, in 
such situations as to be easily come at if required ; they should be ventilated 
by shafts reaching to the highest point in the building. Cesspools should be 
avoided. If such a thing is possible, and it generally is in the country, the 
dry-earth system should be used for the wards, the liquid portion of the evac- 
uations and slops being run off and used for irrigation. The water supply is 
a matter of extreme importance ; usually it comes from pumps or from the 
general town supply. In either case, whatever is used for drinking purposes 
should be purified by filtration. Rain-water may be collected for washing 
purposes, but must not be used for any other. What are called the silicated car- 
bon filters are perhaps the best for all ordinary purposes. The shape of the 
hospital must depend in great measure on its site. The number of floors must 
likewise be dependent on the size desired and the size available ; perhaps three 
floors — two, that is, above the level of the ground floor — are most convenient. 
Sometimes after these the best attics are used as separation wards. Elevators 
should always be used ; they save an enormous amount of labor, and provide 



331 




Fig. t. 






Fig. l 



J 



mm 



few: 



E 






I 



Fig. liv. 





HOS 333 HOS 

prompt means of removing as well as bringing up the patients' meals, etc. 
The elevators are best managed on the endless rope system where water-power 
cannot be applied. The size of the ward is a matter of very considerable 
importance ; still more so is its shape. The ward should never contain more 
than thirty patients, and frequently half that number will be found enough. 
The shape of the ward should be oblong, and there should be no projections 
to interfere with ventilation or harbor dust. The simpler the outline of the 
room, the better. On either side of it should be windows for through-and- 
through ventilation, which is best attained by opposite windows, and should 
always be sought for. The windows should be arranged so that a bed inter- 
venes between each. It is better that the windows should be high than that 
they should be wide ; they should not come quite so low as the patient's head 
when he is asleep. There should not be — as unfortunately there is in some 
hospitals — a perforated wall extending along the middle of the room, thus 
dividing it into two separate wards; this is a very bad system. In height 
the ward should be about fifteen feet ; in width it should be such as to con- 
tain a row of beds on each side wall, a central table with all necessary con- 
veniences, and room between these and the beds for students, if intended for 
clinical purposes. The walls may be partly painted, partly whitewashed ; 
either way they must be re-coated from time to time, the whole of the old 
coating having first been removed : this is of the first necessity. The flooring 
is very important ; it must be impervious to soakage of any kind. Two plans 
are available for dealing with it : either the floor is to be varnished and pol- 
ished, or it must be scrubbed daily. The substance of the flooring may be 
either oak or parquet, but well-scrubbed deal does very well. In some of our 
hospitals the flooring has been scrubbed quite thin in the course of years. 
Flooring of brick or stone is to be avoided; it is very uncomfortable for the 
patients in winter. The ward furniture need not be very grand ; polished 
deal varnished looks best, and costs least. Of course the bed is the main 
thing; the bedsteads should always be iron, and it is desirable that they should 
not be too low. In some recently constructed hospitals they are, on the other 
hand, too high. This, though convenient for the physician or surgeon, is not 
convenient for the patient to get in and out, even when he is convalescent. 
The bottom of the bed is commonly stout canvas ; this of course does not spoil 
easily, and is fairly elastic. We have seen various others introduced and tried, 
but none have as yet so well stood the test of time and use. Over these should 
be a good mattress of hair ; no other material should be used. Feather beds 
are an abomination, and spring mattresses do not last. Besides, with wet or 
dirty patients, such as constantly occur, the horsehair can easily be purified, 
and is at once as good as new again. By the side of the bed should be a re- 
ceptacle for the patient's necessaries and a seat for him when he is able to sit 
up. Sometimes the lower end of the bed sustains a sliding box for holding 
his clothes. Day-rooms are seldom found except in convalescent hospitals ; 
there they are of great use. The baths of a hospital will probably continue 
to assume a greater and greater importance. There is the fixed bath, through 
which each patient should pass before being admitted to the wards, provided 
there is no reason against it ; and there are the movable baths, which can be 
brought along-side a patient's bed. Baths are being more used now in the 
treatment of disease, and these movable baths are absolutely necessary. The 
fixed baths are best made of zinc or enameled earthenware ; this last is best, 
but many patients do not like it ; they should always be cased in wood. 
Warming and ventilation are two of the great vexed questions in hospital con- 



HOU 334 HOU 

struction. In this country we have a very strong prejudice in favor of the 
open fire-place, and ventilation by the doors and windows. Abroad some form 
of stove is generally used for heating. Where corridors are in use hot-water 
pipes are very convenient means of keeping them warm, but one or two fire- 
places should be added. The open fire-place is moreover of service in various 
other ways, but it hums much more fuel. A coil of hot-water pipes and an 
open fire-place will warm a ward at much less cost than will most systems, 
whilst the place receives the advantages of hoth. There are artificial systems 
of ventilation by the score — clever contrivances for letting out the foul air 
and admitting the fresh. There is only one objection to them : they won't 
act; the wrong current will perversely select the wrong orifice. Air-shafts 
connected with the wards, and having the air impelled through them by heat, 
are used in many hospitals with advantage as auxiliaries, but our main trust 
should be in the doors, windows, and fire-places. Sash windows are best, as 
by them we can easily regulate the quantity of air admitted. It is especially 
important to see that the ventilation of water-closets be independent of the 
wards, and that these are never ventilated through the water-closets, as some- 
times unfortunately happens. Of the internal management of a hospital this 
is hardly the place to speak. On the whole, it is desirable that there should 
be an independent medical officer at its head, but as clearly such an appoint- 
ment should be temporary, or mischief is sure to result. The best mode of 
nursing a hospital is a difficult question. In many hospitals, now, nursing sis- 
terhoods are employed ; these do well on the whole, but very often they pre- 
sume on their position, and follow their own ideas. This of course cannot be 
tolerated, and usually discomfort is the result. Where two medical officers — 
as not unfrequently happens — entertain different religious views, things are 
apt not to go quite smoothly. Perhaps, on the whole, the best plan is for each 
hospital to be independent, to have a good head and a good staff of nurses, 
with probationers under them. Such a system is less costly, more easily worked, 
and generally more satisfactory. On the other hand, where religious feeling 
predominates, a sisterhood is a very efficient instrument, but it must be worked 
with care. The block or pavilion system is now generally adopted for hos- 
pitals ; in this system a building containing one or more wards on each floor is 
isolated from all its neighbors, and the blocks are multiplied according to the 
accommodation required. In this way a block containing infectious diseases 
may be kept quite apart from all the rest. In the centre or most convenient 
spot is the administrative department, containing cooking arrangements, offices, 
rooms for officers, etc. ; each block has its own domestic utensils, bath-rooms, 
etc. That is the foundation of the system; of course its application varies 
with the ground at the disposal of the authorities and the accommodation 
required. 

Housemaid's Knee is a familiar term applied to enlargement of the large 
bursa mucosa (see Burs.e), situated in front of the knee cap or patella, and 
of the tendon immediately below it (Ugamentum patdlce). It is often noticed 
in those whose daily occupation necessitates much kneeling, as household ser- 
vants, carpenters, plumbers, carpet-layers, etc. Enlarged bursas of the patella 
are frequently attacked by inflammation and suppuration, and usually there is 
extensive inflammation of the surrounding cellular tissue. Sometimes, troub- 
lesome burrowing ulcers remain after these abscesses, which are singularly 
obstinate, attended with fungous growths, the surrounding skin being dark and 
unhealthy, with deep burrowings under the integuments of the knee, and a 
foul offensive discharge. In severe instances the bone (patella) may become 



HOU 335 HOU 

necrosed. (See Necrosis.) The treatment consists in the first place of com- 
plete rest, and a well-fitting splint must be applied, and all motion of the joint 
prevented. If a recent enlargement, a stimulating lotion of acetic acid and 
hydrochlorate of ammonia, or a small blister, will often cause it to subside. If 
there is considerable thickening, as there always is if the tumor has been of 
long duration, evacuation of the sac and subsequent counter-irritants will often 
effect a cure. Some surgeons use a seton (see Seton), composed of a few 
threads of silk passed through the cyst, and by setting up suppuration and the 
consequent contraction and granulation the cavity becomes obliterated. When 
the tumor has become a solid, gristly mass, there is no other treatment than 
dissecting it completely out. In the cases most commonly brought under ob- 
servation, rest, leeching, hot fomentations and purgatives, and failing these a 
free incision, usually effect a cure. 

Houses and their construction are of the very greatest importance from a 
sanitary point of view. Often the health of families is completely lost, very 
frequently death itself ensues, from defects in household construction. If a 
man sets to work to build or select for himself a house on sound principles, 
the first thing he has to satisfy himself about is the site in which it is to be or 
has been built. We do not, of course, refer to beauty of situation, which will 
always speak for itself; but rather with regard to the nature of the soil. 
There are two kinds of sites, — the natural and artificial. Artificial founda- 
tions, except they be carefully prepared, are to be strenuously avoided. It is 
quite true that in a damp soil a good sound artificial foundation is a very great 
improvement ; but then it must be carefully prepared, not made of materials 
heaped together at random. As far as site is concerned, the possibility of good 
drainage ought to be carefully kept in view. A house with damp foundations 
is an artificial hot-bed for rheumatism, with all its dangers to health and life ; 
and so a situation below the high-water mark of rivers is to be avoided. A 
point much studied in selecting a building site, and yet often on wholly erro- 
neous principles, is the nature of the soil. Thus a gravelly soil is commonly 
supposed to be far superior to a clayey soil, on which to build a house ; so 
it is, other things being equal, which is precisely what, as a rule, they are not. 
A gravelly soil is good, or not, according to the nature of the subsoil and the 
direction of the water-shed. If there is a considerable depth of sand or gravel, 
aud a distinct water-shed away from it, no better site could be selected ; on 
the other hand, it is quite possible for a gravelly site to be the very worst site 
possible. If, as very often happens, the subsoil be gravel or clay, the water 
which falls on the gravel will sink through it till it reaches the clay, and no 
further, for the clay is not permeable by water. Having reached the level, it 
must flow away as it would from a clay surface, only percolating through the 
soil, instead of running above it until it reaches the lowest level in a stream or 
otherwise. But if it does not flow away, if there is no water-shed, it will ac- 
cumulate in the soil, just as it might in a reservoir on its surface, and, rising 
higher and higher, at length reach the foundations of the house, and sap the 
timbers of its flooring. Such a condition of things is most likely to occur un- 
der the following conditions : Suppose, by the agency of the great forces at 
the disposal of nature, a huge basin has been hollowed out of the clay and sub- 
sequently filled with gravel. This, we know, not unfrequently occurs. Out 
of this basin there is no escape for the ground water, unless it overflows the 
clay banks of the basin, and so it rises and falls according to the season. 
Such a gravelly soil would be the very worst site for building purposes it 
would be possible to select. But if now in this sea of gravel there was a little 



HOU 336 HOU 

island of clay, that would be subject to no such variations in the rise and fall 
of its ground water. "When rain fell it would run off its surface into the 
gravel beyond ; its own ground water would be invariable. If, therefore, un- 
derneath the gravel there is a water-shed which will allow of the free escape 
of the ground water, no site could he drier or healthier; if not, no site could 
be worse. The nature of the ground site having been settled, the next thing 
perhaps, especially in the country, is to consider the direction and nature of the 
prevalent winds. " If possible, the house should have its greatest exposure to 
the direction whence come the driest winds, and have the best exposure to the 
sun. Thus each district and each situation must be considered by itself : 
protection from the worst winds and exposure to the most favorable being 
sought in every case. This, perhaps, is hardly a proper place to speak of 
the kind of trees which should be planted round a house with a view to pro- 
tection ; but such should be carefully selected with a view to shade in summer 
and protection in winter. It should not be left to hap-hazard. The materials 
of the house itself also merit consideration. Every one may not be able to 
tell the difference between good brick and bad brick, but there are people who 
can ; and it is better to pay for such skill than to have one's house constructed 
of bad material. In districts where stone is used, this too requires to be se- 
lected. Of the wood used little need be said, beyond the necessity to provide 
for future comfort by having nothing but seasoned timber ; otherwise, imper- 
fectly fitting doors and' window-sashes'will try tempers and give rise to draughts. 
As to plan or elevation, each may suit his own fancy ; but from the health 
point of view there are certain broad rules to be observed. Simplicity of de- 
sign should as far as possible be aimed at. Again, the rooms should be well 
balanced. The living-rooms should correspond to the size of the family, and 
as a rule the bed-rooms should be larger than the sitting-rooms. We consume 
a very great portion of our time in bed, not less, usually, than one-third, and 
during that period most people have their windows shut, so that the air can 
chan °e only by the chimnev, and that too is often closed, and no chinks left 
in the walls or doors. It is' desirable, therefore, that the sleeping-rooms should 
be so large that the total quantity of air they contain cannot become very 
greatly fouled, even supposing it is not changed during the period devoted to 
sleep. There can be no doubt that breathing the same air over and over 
again is unhealthy. Houses should always be built, be the plan what it may, 
so as to admit of through-and-through ventilation. In some hirge cities 
abroad a horrid plan prevails of building houses back to back, so that the 
back wall suffices for two streets. Nothing could be more pernicious to health 
than this, for it is impossible, however desirable, to obtain sufficient ventila- 
tion. As for the rooms themselves the best system of ventilation is the natu- 
ral one, that is to say, by the doors, windows, and grates. All artificial sys- 
tems of ventilation have hitherto proved failures. The perfection of ventila- 
tion is where a room is kept constantly sweet and fresh by an insensible change 
of air. The open fire-place is undoubtedly of great service in ventilation, and 
Americans will not willingly see it superseded ; yet it occasions great waste 
of fuel, and has the disadvantage of not keeping up an even temperature. 
The open grate draws upwards the cold air which has entered the room, heats 
it, and causes it to ascend the chimney ; in this way a constant current is kept 
up. Often, however, grates have this great disadvantage, in bed-rooms which 
are also sick-rooms, that it is hardly possible with them to keep up an equable 
temperature for the four and twenty hours. If a good fire is lighted at bed- 
time, i' warms the room to begin with ; but as moraing advances, and the tern- 



HUM 337 HYD 

perature outside sinks lower and lower, so too the fire sinks, and it goes out just 
when it is most wanted, that is in the early morning hours. This is the time 
which is most trying to those who are subjects of chest affections ; it is then 
when coughs most become troublesome. Certain kinds of stoves are free from 
this inconvenience ; but they necessitate ventilation by artificial means. But 
besides air, houses should admit plenty of light. Hence big windows should 
be provided, if possible ; if the light proves troublesome by its excess, it is 
easily shut out. Too many creepers should not be trained against the house ; 
they are picturesque, but they harbor damp. There is nothing more important 
in the ordering of a house than the water-alosets and drains. In the country, 
where there is little water-power, and no means of getting rid of sewage, there 
is but one thing or course compatible with safety, namely, avoid water-closets 
altogether. Even in towns they are hardly tolerable ; in the country they are 
intolerable. It has been clearly proved that many diseases are spread by 
their means, if they do not indeed arise from them originally, and these 
diseases are very fatal : typhoid fever is a good instance. Even in towns the 
closets should be as far from the living and sleeping portions of the house as 
possible, and the drains" ought not to ventilate through it. The drains should 
be ventilated by a shaft reaching above the top of the house, and having its 
basis in the drains. The closet is best kept sweet by carbolic and disinfect- 
ing powder, or by a teaspoonful of carbolic acid in a gallon of water. In the 
country earth-closets alone should be allowed in the house, and outside the 
same dry-earth system ought to be employed ; closer attention to this rule 
would prevent many a case of typhoid fever. Previous to building a house, 
it is now very common to have the drinking-water analyzed. This is a very 
good rule, for bad drinking-water is a sure source of diseases. As a rule a 
water which contains much nitrate and chloride is to be avoided. The storage 
of the water in the house should be attended to. Lead cisterns used to be the 
rule ; now galvanized iron ones are coming into use. The lead is dangerous 
with soft water, if it stands long and is not run off. This risk is avoided by 
the other. N The cistern should always be kept covered, so as to prevent rats, 
mice, and the like from getting drowned in it, and thus remaining to flavor 
the water. Moreover the cistern should be readily accessible, so as to be 
easily cleaned. Finally, the drains should be earthenware pipes. It is well 
to understand the mechanism of the traps, so as to know if they are in work- 
ing order. A very little attention to this slight detail will often save much 
inconvenience, and guard against detriment to health. 

Humidity. The air is never free from moisture under ordinary condi- 
tions ; for from the surface of the earth, and from rivers, lakes, seas, etc., 
evaporation is going on constantly ; this aqueous vapor, ascending into the 
higher and cooler regions of the atmosphere, forms clouds ; and this vapor 
descends to the earth again as rain, snow, or hail. The amount of evaporation 
varies much at different seasons of the year, being much greater in summer 
than in winter. The hotter the air, the more aqueous vapor will it hold. It 
is to the presence of humidity or moisture in the air that the deposition of dew 
can take place. Instruments, called hygrometers, have been devised to find 
out the amount of watery vapor in the air at any temperature and at any time. 
Hot and damp air generally has a relaxing effect on the constitution, while 
cold and damp air is unsuited for those who suffer from chest affections, and 
who are liable every winter to bronchitis and winter cough. 

Hydatids are cysts formed by the ova of the Tcenia echmococcus or tape- 
worm of the dog. In the article Entozoa it is shown how tape-worms occur 
22 



HYD 338 HYD 

in man ; the ova, however, of those tape-worms which infest the human sub- 
ject will not produce in him the mature worm at once, but it is developed in 
some other animal as a cysticercus ; so in the case of the worm met with in 
the dog or wolf, the ova passing into man do not develop a worm, but a cysti- 
cercus or hydatid. These bodies, minute at first, pass from the alimentary 
canal into the system and may be carried by the circulation into the nearest 
organ. The liver is the organ which is most commonly their seat ; but they 
have been found in the lungs, heart, brain, kidney, pelvis, and bones, etc. 
When they are deposited in an organ a fibrous cyst (the ectocyst) is formed 
around, and within this is the endgcyst, a clear, gelatinous membrane which 
lines the former, and itself incloses a large collection of watery fluid holding 
in solution some common salt and phosphates. These cysts vary in size, from 
a marble to a child's head. They tend to grow larger and larger, and they 
may at length burst ; in this way they have escaped into the heart, pleura, 
peritoneum, intestinal canal, etc., and nearly always with a rapidly fatal result. 
No medicines are of any avail in checking their growth, or in causing the ab- 
sorption of the fluid. Various methods have been adopted to empty the cyst 
by drawing off the fluid, and in a great many cases this is done with excellent 
results. Now and then inflammation of the cyst takes place, and the contents 
become purulent ; the only chance then for the patient is to have a free open- 
ing made and let the matter out. Still more rarely the cyst dies early ; the 
contents become of a cheesy consistence and the cyst may remain in the body 
for years without giving rise to any symptoms whatever. 

Hydragog'ies are remedies of the purgative class, which produce copious 
watery stools. Some seem to give rise to fluid specially, apart or in excess of 
their purgative effects ; others seem to do so only incidentally. Elaterium is a 
remedy of this kind, so are most of the purgative salts. Gamboge, too, pro- 
duces very watery stools. Compound jalap powder is a remedy much used in 
this way ; so too is compound scammony powder, Ilydragogue purgatives are 
employed mainly to get rid of excessive fluids, as in dropsies, especially of the 
cardiac kind, or in the earlier and acuter stages of renal dropsies. 

Hydrocele. When there is a collection of serum in the external or serous 
covering of the testicle (tunica vaginalis), the tumor so formed is called hydro- 
cele, or dropsy of the. testicle. It commences in the lower part of the scrotum, 
and grows upwards ; it is fluctuating on pressure, painless, interfering with the 
patient's comfort only from its size and position. It does not receive an im- 
pulse on coughing, as in the case of a rupture, and the flame of a lighted 
candle held on one side of it can be discerned through it. It occasionally 
attains an e:iormous size. It frequently arises without any local cause, 
although sometimes it is dependent apparently on injury or is due to syphilis. 
The method of treatment consists in evacuating the contents of the tumor by 
means of a small trocar and catmla. The tumor being grasped with the left 
hand, the trocar is entered below, and pointing upwards; then the trocar is 
withdrawn and the canula left in the cavity, allowing the fluid to escape. To 
insure cure, or at all events to give a chance of the cyst not refilling, an astrin- 
gent injection should be introduced into the cavity to set up inflammation. 
Tincture of iodine is the injection commonly used by surgeons. 

Hydrocephalus is a disease of which the main feature is an accumulation 
of fluid in the central cavities of the brain. Sometimes the child is born in 
that condition, and then the dangers of delivery are considerably increased ; 
more generally the symptoms appear after birth, and become more marked in 
the second and third years of life. At first, and before the child can walk, 



HYD 339 HYD 

nothing particular may be noticed, except that it has a large head. But as it 
grows older it will be found that the child is not so sharp as others of the 
same age, that it walks with difficulty, that its teeth are backward in appear- 
ing, and that the size of the head is out of all proportion to the rest of the 
body ; the upper part of the skull enlarges so that the face appears much 
dwarfed; the anterior fontauelle remains open; the eyes are very apt to roll 
about, and there is inability to look upwards ; the skin over the scalp is smooth 
and tense, and often marked with the superficial veins. The rest of the body 
is generally badly nourished, and the legs are often bowed if the child has 
walked too early, and the wrists and ankles are enlarged. Such children are 
more liable than others to catch infantile disorders, such as whooping-cough, 
convulsions, measles, scarlet fever, etc. When the mischief is but slight the 
child may grow up to adult life ; but when far advanced death generally takes 
place before the child has reached five years of age. The treatment will con- 
sist in giving nourishing food and tonic medicines ; bathing with cold water or 
sea-water may do good. Bandaging the head has been recommended, and 
various preparations of mercury have been rubbed in, but very little in this 
way can be done. This disease is often called chronic hydrocephalus to dis- 
tinguish it from acute hydrocephalus, an affection of quite a different charac- 
ter, and which is described under the head of Tubercular Meningitis. 

Hydrochloric Acid, also known as muriatic acid or spirit of salt, is a 
waste product in the manufacture of common washing soda. It is often im- 
pure, and requires to be carefully purified to get rid of arsenic and other sub- 
stances with which it is commingled. The strong acid is not used in medicine. 
In the dilute form, given in doses of from g ten to twenty drops well diluted in 
water, it may be found useful, given immediately after food, in aiding diges- 
tion. It is the natural acid secreted by the stomach for the purpose of diges- 
tion, and itself has, at the temperature of the body, considerable power in dis- 
solving meat or solid white of egg. It is also of some use as a gargle diluted 
with water, but it is best given along with chlorate of potass for this purpose, 
when it has the power of setting free a substance allied to chlorine. This 
certainly has a beneficial effect in foul ulceration of the throat, and in diph- 
theria where sloughs are formed and tend to decompose, still further poisoning 
the system. It has also been given as a remedy in typhoid fever, but perhaps 
the disease is better treated without the remedy. 

Hydrogen, Sulphuretted, is not itself used in medicine, but mineral 
waters which contain it free and in the form of sulphides of the alkalies are of 
very great value. The smell of this gas, from the simple substance or the gas- 
eous, resembles rotten eggs ; and the same is true of the so-called sulphurous 
waters. The baths containing sulphur are exceedingly useful in certain dis- 
eases of the skin, chronic gout and rheumatism, and chronic lead poisoning. 
A preparation for destroying the itch animalcule is made by boiling sulphur 
and quicklime together. This is very efficacious. Given internally, either as 
mineral water or as sulphides, this substance is said to benefit scrofulous ulcers 
very greatly. Small doses of the sulphides seem to relax the bowels, as sul- 
phur itself does. 

Hydrogen is one of the gases contained in water, and is notable for its 
extreme lightness ; as far as we know, however, it possesses no remedial ac- 
tion. A compound of it, called peroxide of hydrogen, has been tried. It 
possesses the property of freely giving off the oxygen it contains, and so may 
be useful in certain conditions. Applied to the skin it whitens or bleaches it, 
and has been used to favor the healing of sores. 



HYD 340 HYD 

Hydro-nephrosis is a peculiar condition of the kidney, induced commonly 
by some obstruction to the flow of urine from it. This condition is commonly 
present on one side only, and the obstruction may arise in various ways. The 
tube conducting the urine from the kidney, and which is called the ureter, may 
be constricted as by an irregular blood-vessel ; it may be compressed by 
tumors, or obstructed by calculi or deposits of various kinds. Sometimes both 
kidneys are affected. Occasionally the condition is present from birth. The 
obstruction, however caused, prevents the flow of urine from the kidney, so 
that it accumulates in the sacculated portion of that organ. With increasing 
distension this portion increases in capacity until at last the secreting portion 
of the kidney may only constitute a portion of the wall of a vast cyst. When 
this is the case the pressure of the sac itself upon the ureter is sufficient to 
keep up obstruction ; but in certain cases, after this has existed for a time, 
the pressure becomes great enough to overcome all resistance, and an enor- 
mous flow of water takes place. Once emptied, however, the cyst tends to 
fill up again until the pressure becomes as great as before. These causes of 
hydro-nephrosis will probably depend on some peculiarity of the ureter at its 
origin in the kidney, or its course to the bladder, which renders it liable to be 
pressed upon or otherwise obstructed. In some cases these tumors have been 
tapped, and enormous quantities of fluid removed. The point of greatest prac- 
tical interest about hydronephrosis is its liability to be mistaken for ovarian 
tumors. Double hydro-nephrosis is not very likely to occur : sometimes we 
do see the ureters enlarged on both sides, when there has been very long- 
standing stricture of the urethra, but not very often ; even then it is doubtful 
if the kidneys could become very much distended without causing death. 

Hydropathy, also known as the Water Cure, is a system of dealing with 
disease invented by a German named Priessnitz. His doctrine was that plain 
water outside and inside was all that was necessary to cure disease. Un- 
doubtedly he committed grievous errors, but he was not like a consu ting sur- 
geon or physician ; he had his patients under his thumb, and could diet them 
and manage them as he liked. Undoubtedly, too, he introduced a very potent 
means of dealing with some disorders which has been too much overlooked by 
the regular faculty, chiefly on account of its antecedents, and because too 
much Was claimed for it. Now, however, things seem to have reached their 
proper level, and many practitioners are glad to send their patients to hydro- 
pathic establishments provided they can rely on their instructions being car- 
ried out, Hydropathic establishments are generally situated in places of great 
natural beauty, which induces the patients to exercise. The diet at them is 
usually plain and wholesome, and early hours are insisted on. I he baths 
mainly used are the shallow bath, in which the individual sits immersed up to 
the hips, is well laved, and finally has a bucket of cold water thrown over 
him ; the sitz-bath, where the water plays on the lower portion of the body ; 
the rain-bath, where every portion of the body is acted upon in the same way ; 
the shower-bath, where the rain comes only from above ; the douche-bath, 
where a column of water of varying weight and force is made to play on dif- 
ferent parts of the body. Then there is the Roman or Turkish bath, where 
hot air is used to induce sweating. The b<v is well kneaded, and the perspi- 
ration abruptly stopped by a douche or plunge-bath. But one of the chief 
means for dealing with disease is the wet pack. This is a very valuable 
means of reducing the temperature and getting the skin to act. lhe patient 
must be in good heat. He is stripped naked, laid on a wet sheet, and packed 
in it like a mummy; then follow blankets in the same way, with a feather-bed 



HYD 341 HYD 

over all ; a wet towel is applied to the head, and the patient is left, usually 
to sleep. Presently the cold gives way to heat, the skin is enveloped in one 
vast poultice, and if there be much irritation of it the relief is magical. A 
cold douche or plunge or rain-bath ends the process, which should not last 
much over half an hour. 

Hydro-pericardium means a passive effusion of serum into the sac of 
the pericardium, or membrane inclosing the heart ; it occurs in many cases 
where dropsy of other parts is present, as in diseases of the heart, lungs, and 
kidneys. 

Hydrophobia is the term applied to the conditions which occur in the 
human being after the inoculation of the saliva of a rabid animal, most fre- 
quently of dogs or cats. The term in its derivative sense is not always ap- 
plicable, as the " dread of water " is not always present either in the patient 
or in the animal inflicting the injury. Mr. Youatt in his treatise on canine 
madness thus describes the symptoms of this disease in dogs, from whom the 
disease is most generally derived : "The disease manifests itself under two 
forms: the furious form, characterized by augmented activity of the sensorial 
and locomotive systems, a disposition to bite, and a continued peculiar bark. 
The animal becomes altered in habits and disposition, has an inclination to lick 
or carry inedible substances, is restless, and snaps in the air, but is still obe- 
dient and attached. Soon there is loss of appetite and thirst, the mouth and 
tongue swollen, the eyes red, dull, and half closed, the skin of the forehead 
wrinkled ; the coat rough and staring ; the gait unsteady and staggering ; thero 
is a periodic disposition to bite; the animal in approaching is often quiet and 
friendly, and then snaps ; latterly there is paralysis in the extremities, the 
breathing and deglutition become affected by spasms ; the external surface 
irritable, and the sensorial functions increased in activity and perverted ; con- 
vulsions may occur. These symptoms are paroxysmal; they remit and inter- 
mit, and are often excited by sight, hearing, or touch. The sullen form is 
characterized by shyness and depression, in which there is no disposition to 
bite and no fear of fluids. The dog appears to be unusually quiet, is melan- 
choly ; and has depression of spirit ; although he has no fear of water, he does 
not drink, he makes no attempt to bite, and seems haggard and suspicious, 
avoiding society, and refusing food. The breathing is labored, and the bark 
is harsh, rough, and altered in tone ; the mouth is open from the dropping of 
the jaw ; the tongue protrudes, and the saliva is constantly flowing. The 
breathing soon becomes more difficult and laborious ; there are tremors and 
vomiting and convulsions." A knowledge of the periods at which madness 
attacks dogs is of great importance, and with this object the Council of Hy- 
giene of Bordeaux issued the following instructions : " (1.) A short time after 
the madness has seized the dog, he becomes agitated and restless and turns 
himself continually in his kennel. If he be at liberty, he goes and comes, and 
seems to be sucking something ; then he remains motionless, as if waiting ; he 
starts, bites the air, seems as if he would catch a fly, and dashes himself, bark- 
ing and howling, against the wall. The voice of the master dissipates thesa 
hallucinations ; the dog obeys, but slowly, with hesitation, as if with regret. 
(2.) He does not try to bite, he is gentle, even affectionate, and he eats and 
drinks ; but he gnaws his litter, the ends of the curtains, the padding of tho 
cushions, the coverlid of beds, the carpets, etc. (3.) By the movement of his 
paws about the sides of his open mouth, one might think he was wishing to 
free his throat of a bone. (4.) His voice has undergone such a change that 
it is impossible not to be struck with it. (5.) The dog begins to fight with 



HYD 342 HYD 

other dogs.'' When the disease has attacked the human being, we find strik- 
ing points of resemblance to those already quoted as occurring in the dog, but 
at the same time several points of difference. At first no symptoms manifest 
themselves, and it is usually not until some weeks afterwards that the effects of 
the introduction of the poison into the system appear. The first symptoms are 
general, and are those of general malaise, nausea, loss of appetite, and restless- 
ness. The peculiar or special symptoms, however, which set in later, comprise 
an irritation in the locality of the bite, simulating neuralgia. The cicatrix be- 
comes red and swollen, and discharges a thin unhealthy pus. The actions and 
affections are changed ; children, if the objects of the injury, become shy ; 
adults, depressed, lonely, anxious, and melancholic, and anticipatory of result- 
ing danger Some, on the contrary, are usually irritable and ill-tempered. 
There is a characteristic anxiety, with a sense of weight and pressure in the 
chest, disturbed sleep, and frightful dreams. These symptoms, with complica- 
tions, constitute what may be regarded as the first or primary stage of the 
disease. The second stage is ushered in with stiffness of the muscles of the 
throat, jaws, and tongue, pain in the pit of the stomach, with chills, and drow- 
siness, convulsive spasm of the muscles of deglutition, causing swallowing to be 
difficult or impossible. There is great dryness of the mouth, with burning 
thirst, there is spasm of the muscles of the larynx, causing the peculiar hawk- 
ing or barking noise in the attempts to expel the secretions of the mouth and 
fauces. There are convulsive paroxysms, and the sight or sound of fluids pro- 
duces aggravation of them ; the mind becomes in a state 'of agitation, inspired 
with a dreadful feeling of despair. Sometimes the mental disturbance may be 
slight, but generally it is the reverse, bordering on maniacal fury. The third 
stage, or stage of decline, is attended with rapid depression and nervous ex- 
haustion, with incoherency and delirium, and death takes place either from 
choking, or during a convulsive attack, or from exhaustion. The duration of 
the disease varies from seventy-four hours to six or seven days, and there are 
cases on record which have lasted for two or three weeks." 

The treatment, in the first instance, on the receipt of the bite, must be im- 
mediate, and the injured part should be at once destroyed by some powerful 
escharotic, which must be used unsparingly over the whole surface and depth 
of the bite. Thus, nitrate of silver, caustic potash, nitric acid, sulphuric acid, 
arsenical paste, chloride of zinc, the actual cautery (hot iron), boiling oil, etc., 
are all of use. In the absence of these means, the bitten spot should be cut 
out at once. As drugs, stimulants and other anti spasmoclics, anodynes or 
narcotics, and tonics are frequently indicated. Thirst should be alleviated by 
ice. The course of the disease, however, is usually fatal. 

Hydrcthorax, or, as the name signifies, water in the chest, is met with in 
cases of disease of the heart and kidney. Either from an alteration in the 
quantity of the blood or from a change in its quality, serum is poured out into 
the pleural cavity, and generally both sides are affected, although not equally 
so. It is attended by no pain, and its chief result is to cause an increase in the 
difficulty of breathing, with which such patients are mostly troubled ; this is 
the case in consequence of the lungs being compressed by the effused fluid, and 
so there is less room for the air to enter. The treatment will consist in the 
use of purgatives, so as to remove the fluid by the bowels, by the action of 
sedatives, if the heart's action be very tumultuous, and by rest in bed and 
nourishing food; any special treatment must be decided upon according to the 
particular form of mischief in the heart or kidney, and upon the state of the 
patient. 



HYD 



343 



HYG 



Hydruria means an excessive secretion of limpid, watery urine. 

Hygrometer. A hygrometer is an instrument for observing the dew- 
point, or the amount of moisture in the air, and various kinds have been made 
for the purpose. Daniell's dew-point hygrometer consisted of two glass bulbs, 
communicating with each other by a glass tube ; this tube is bent twice at 
right angles, but in such a way that one arm is longer than the other ; a 
wooden stand supports the centre of the horizontal portion of the tube, so that 
the arrangement has something of a T shape, but one bulb must be lower 
than the other. The apparatus contains ether which is boiled, so as to expel 
the air in the tube, and the instrument is hermetically sealed while the ether 
is boiling. A sensitive thermometer is placed in the long limb of the tube, and 
its lower end ought to dip into the ether in the bulb; the lower bulb (b) is also 
made of black glass, so that any moisture on its surface can be more readily 
observed. The other bulb (a) should be covered with muslin. When the 
hygrometer is to be used all the ether is driven into (b) by inverting the in- 
strument, and warming the bulb (a) with the hand. On allowing a few drops 
of ether to fall on the muslin, the vapour within the ball (a) is condensed by 
the reduction of temperature occasioned by the rapid evaporation thus produced 
on its outer surface; fresh vapor rises from the surface of the ether in the 
blackened bulb from the diminished elasticity of the vapor above it ; the tem- 
perature of this ether and of the bulb in contact with it is lowered, and a de- 
posit of dew commences on the surface of the black bulb in the form of a ring, 
which coincides with the level of the ether. Directly this occurs, the tempera- 
ture, marked by the included thermometer, is noted. The temperature of the 
atmosphere at the time is observed by means of another thermometer close at 
hand, or attached to the wooden stand of the apparatus. In making the ob- 
servation, the hygrometer should be placed at an open window, and a screen 
should be placed between the two bulbs, so as to prevent the vapor of the 
ether on the muslin from extending to the atmosphere around the blackened 
bulb. The rate of evaporation varies at different seasons, being greatest in 
summer and least in winter. The wet-bulb hygrometer is another form of in- 
strument adapted to determine the quantity of moisture present in the atmos- 
phere. It consists of two similar thermometers placed side by side on a ver- 
tical stand ; the bulbs of both are covered with muslin, and one of them is kept 
constantly moist by the capillary action of a few fibres of cotton, which connect 
it with a small vessel containing water. The dew-point may be ascertained by 
multiplying the difference between the temperature of the dry and the wet bulb 
by a number depending upon the temperature of the air at the time of obser- 
vation. Mr. Glaisher gives the following numbers from observations made at 
the Greenwich Observatory : — 



Dry Bulb, 
Temperature of. 


Multiplier. 


Dry Bulb, 
Temperature of. 


Multiplier. 


Dry Bulb, 
Temperature of. 


Multiplier. 


Below 24 


8.5 


31 to 32 


3.6 


55 to 60 


1.8 


24 to 25 


7.3 


32 to 33 


3.1 ■ 


60 to 65 


1.8 


25 to 26 


6.4 


33 to 34 


5.8 


65 to 70 


1.7 


26 to 27 


6.1 


34 to 35 


2.6 


70 to 75 


1.5 


27 to 28 


5.9 


35 to 40 


2.5 


75 to 80 


1.5 


28 to 29 


5.7 


40 to 45 


2.3 


80 to 85 


1.0 


29 to 30 


5.0 


45 to 50 


2.1 






30 to 31 


4.6 


50 to 55 


2.0 







HYP 844 HYP 

Hyperaemia is a technical term for increase in the quantity of blood in a 
part ; it comes on in every case of mechanical obstruction to the circulation, 
and precedes inflammation of a tissue. 

Hyperpyrexia is a term applied when the temperature of the body is very 
high, as in some cases of rheumatic fever, when 107° or 110° Fahr. may be 
reached, and a fatal result may be expected; the only relief at present known 
is by cooling the patient down by means of a cold bath, or by packing in sheets 
wrung out of ice-cold water. 

Hypertrophy is a term applied to an increase of a healthy tissue without 
any change in the quality of its component parts ; thus a muscle is said to be- 
come hypertrophied when it is increased in size by using it, as in the arms of a 
blacksmith or athlete. 

Hypochondria. See Abdomen. 

Hypochondriasis, also known by the old English equivalent of the Va- 
pors, seems to be the correlative in the male sex for what in the female we call 
hysteria. The conditions have long been well known, though very various 
causes have been assigned to it, the favorite being for mauy years the formation 
and circulation of " black bile," for melancholia means this exactly. Nowadays 
we assign to it a nervous origin, and though there may be no actual disease, the 
condition is one very hard to get rid of. Most frequently there is functional 
derangement of some part, generally of the stomach, though sometimes there 
is really alteration in structure. The chief characteristic of hypochondriasis is 
a morbid self-consciousness similar in some respects to that of hysteria, but 
generally taking a different direction. The hypochondriac commonly fancies 
himself the subject of all the ills that flesh is heir to. There is usually a 
great dread of death, and the patient resents being told that there is nothing 
the matter with him. Such a man always has something the matter with him, 
generally a most obstinate indigestion ; and if that be cured the patient is in 
a fair way to be relieved of his mental symptoms. Frequently this malady 
assumes the character of insanity, some member of the body being supposed to 
be lost, or so altered as to be useless, or worse than useless. Hypochon- 
driasis seldom occurs in those who lead an active, healthy life in the open air. 
It is most frequent among those who, living well, take little exercise, and whose 
lives are what is termed sluggish. Such individuals will often be subject to 
short attacks of a malady of this kind, which a little laxative medicine and 
exercise in the open air will soon carry off. It is very frequent, too, among 
those who, having led an active life, retire to comparatively early rest and 
quiet, as they think. Such, having seldom any internal resources in the way of 
education and cultivation, have recourse to morbid retrospection, their own 
feelings, desires, and aims are their only company, and each uncomfortable 
sensation is pondered over until some comparatively slight ailment becomes a 
thing of the first magnitude. Those who have long had their minds strained 
by over-work are liable to a somewhat similar form of disturbance. In them, 
however, the bodily condition is less the subject of notice — it is the mental ; 
it is those which suffer most. They become miserable objects for the time 
being ; they lose their nervous energy, grow weak and wretched ; they fear to 
cross the streets ; they live in constant dread of having done something wrong, 
or of having wrong attributed to them; they are the shadows of their former 
selves. Hard students are frequently so troubled. We have already hinted 
at the causes of this malady. These are essentially the continued use of one 
part of the system, the other being left without due exercise. In one set of 
cases mentioned above, exercise for the head is wanted ; in another, exercise for 



HYP 345 HYS 

the body. For the retired man of business something is wanted to keep his 
mind engaged, and this may often be supplied by the affairs of the city or 
township in which he may be placed. To the other set of patients mental work 
is already too severe a burden ; they ought to have more relaxation, and this 
relaxation ought to be devoted to bodily exercise. The selection of the kind 
of exercise may in great measure be left to each individual. But this is to be 
borne in mind, that extremely violent exercise for a few moments will not 
answer the. same purpose that moderate exercise for a longer period will. So, 
too, violent exercise one day and quiet the next will not answer : the great tiling 
is to keep the system equable. Such men as desire to excel in mental work 
should not attempt to vie with an athlete. The two things are very seldom 
compatible. These things are, however, rather to be looked upon as means of 
maintaining health in all these circumstances, or in getting rid of slight attacks 
of the malady. They will not suffice for more serious ones. When a man is 
fairly " hypped," as it is called, there is only one satisfactory remedy, a total 
change of scene and pursuits. Often we have seen a new lease of life gained 
by a short rest and change of scene. After these the general rules above laid 
down are to be duly observed ; especially is the digestion to be looked after, 
but only by proper food and appropriate exercise, not by medicines, if they 
can be avoided. There is but one final caution we desire to enforce, and we 
do this very earnestly. As a rule, hypochondriacs sleep badly ; often those, 
especially, who have too much mental and too little bodily work are troubled 
with frightful dreams and restless nights. To these we say, Avoid opium or 
other sedative ; if the bowels are not open, try a blue pill and a black draught. 

Hypodermic Injection. This is a procedure which has been adopted of 
late years, by which medicines may be inserted under the skin, and absorbed 
into the blood, without having first to enter the stomach. Thus there are cases 
where the patient can take very little food, and opium or morphia swallowed 
in medicine will bring on sickness and distress ; but if a smaller quantity be 
inserted under the skin, the stomach will be at rest, the pain relieved, and no 
disagreeable effects follow. The fluid, which is concentrated, so that five or ten 
drops will suffice, is placed in a small glass syringe so graduated that one can 
easily see the exact amount to be injected. To the lower end of the syringe is 
attached a fine and hollow needle, so that the skin can be readily pierced and 
the fluid introduced. The syringe should be kept very clean and dry, and the 
injection should be made while the point is held downwards, so that no bubbles 
of air enter the skin with the fluid. Very slight pain attends the operation, 
but it should not be adopted without medical advice, as poisonous effects might 
follow its use. Morphia is generally injected in cases of great pain, as after 
an injury, and in cases of inflammation, cancer, neuralgia, etc. ; but other sub- 
stances have been used as well. 

Hypospadias, a malformation sometimes occurring in the under surface 
of the penis and bladder. 

Hysteria is a malady chiefly confined to women, but by no means neces- 
sarily so, though if it does occur in the male it is in the weak, imperfect crea- 
tures who approximate to women mentally and morally, if they do not phys- 
ically. It is apparently connected with, if not due to, an imperfectly balanced 
mental and moral system. The controlling faculty is either in abeyance or 
imperfectly developed, whilst the susceptibility of suspension is often morbid. 
It is most common in young women who are unmarried after the age of 
puberty up to a very variable period, this period depending in great measure 
on the time when hope of marriage becomes faint. It is much less frequent in 



HYS 346 HYS 

married women who have children, hut in married women who have none it is 
perhaps most common of all. The hysterical tendency manifests itself in very 
many ways ; sometimes it assumes the form of a regular stereotyped kind of fit. 
In others it may simulate any disease under the sun, and frequently it appears 
in the most anomalous shapes it is well possible to conceive. The true hyster- 
ical fit or paroxysm commences in various ways ; most frequently the patient 
is observed for a second or two staring before her with her eyes wide open, 
and then falls to the ground. Here she may lie quiet for a moment, as if 
dead, then suddenly begin all sorts of shrieks, screams, beating of the breast 
with clenched fists, tearing the hair or garments, seizing and scratching any- 
thing near at hand. Sometimes the limbs seem convulsed and the arms rigid. 
Presently the patient will be quiet, and suddenly break out into a fit of laugh- 
ter, beating the ground with her heels ; this, again, will cease ; she will sob 
till you think she is heart-broken, and this goes on till she is exhausted, when 
presently she will come to herself with a very imperfect recollection of all that 
has taken place. Usually there is presently a profuse discharge of limpid 
urine, which occasionally indeed is discharged during the attack, but this is 
only one phase in the numberless forms assumed by the malady. These at- 
tacks sometimes closely simulate those of epilepsy, and consequently it is of 
the greatest importance to be able to tell which is which, the chances of recov- 
ery or the reverse being so very much greater in the one than the other. In 
epilepsy there is complete insensibility; during the attack in hysteria there 
hardly ever is. Moreover, the breathing is not interrupted and the heart beat 
is not greatly altered; the pupil of the eye always responds to the stimulus of 
light ; and the mode of termination is different. Epilepsy generally ends in 
cases of deep sleep, and the patient is completely unconscious of everything ; 
not so in hysteria, as already said. One thing on which we are wont greatly 
to rely is the state of the tongue. In epilepsy the muscles of the tongue are 
convulsed, as are most of the others. Accordingly the tongue is thrust for- 
ward, whilst the jaws are ground together, so that it is rare in a case of well- 
marked epilepsy for the tongue to escape laceration ; it is just as rare, or even 
more so, to find it affected in hysteria. There are two things very common in 
hysteria : a choking feeling in the throat, and stitches of pain in various parts 
of the body. The choking sensation seems often due to a ball, and hence is 
termed the globus hystericus ; the sharp pain, especially as it affects the head, 
often goes by the name of claims hystericus. This pain is often of a very 
serious character, and there may be increased tenderness of the part; but as a 
rule, a slight stratagem will serve to divert the patient's attention, when both 
pain and tenderness will disappear. It is the opposite condition to this which 
sometimes enables hysterical women to appear perfectly insensible to all pain 
or injury to certain parts of the body, and has rendered efficient service fro va- 
rious kinds of impostors. Akin to this is a tendency on the part of some 
hysterical females to attract to themselves public attention, and so deprive 
themselves of food in order that they may seem to exist without it. Such 
usually take to bed, and, as they undergo no exertion, an exceedingly small 
quantity of nutriment will suffice to keep them alive. Such a case was once 
known as that of the Welsh fasting girl, where the unfortunate creature was 
allowed to die instead of being made to swallow her food. If carefully watched 
and deprived of the small quantity of food they require, and which they man- 
age to secure unseen, they are bound, as would be any living thing, to perish. 
There is but a step from this to the shamming of disease, and there is hardly a 
disease under the sun which may not and has not been simulated by hysterical 



ICE 347 ICT 

women. But there are some which are hardly feigned ; chief among these are 
cough and shortness of breath or breathlessness ; hiccup, too, is another thing 
commonly assumed, as is yawning and sobbing, but it is very hard to say 
where the voluntary and the involuntary impulses begin and end. For it is use- 
less to look upon hysteria as other than a real disease, tormenting alike to the 
patient and to the patient's friends, and to suppose its assumption is entirely 
voluntary on the part of the female is a great mistake. True, the symptoms 
can be got rid of by powerful mental influences, and not unfrequently are so 
got rid of, but the disease is not cured except the patient be at the same time 
removed from the mode of life which has led to the loss of controlling power ; 
the malady is sure to return. Still worse policy is it to yield to such patients 
one single iota. There is one rule, and one rule only, " kindness and firm- 
ness ; " the judicious use of these will overcome the most troublesome cases. 
The treatment of hysteria resolves itself into management during an acute at- 
tack, and management during an interval. Suppose the patient has a fit and 
struggles about, the best thing to be done is to remove all tight fastenings 
about the body, surround her by cool air, and prevent her from hurting her- 
self. If the attack seems likely to continue too long, we must try and stop it 
by using sharp but not brutal remedies. Cold water plentifully applied to the 
head and face usually does most good ; strong smelling-salts held to the nose 
are also beneficial. Above all, the patient should be kept quiet ; everybody 
should be removed save a nurse and the medical attendant, and then let her 
know that her case is understood and that she will gain no sympathy. But 
the worst of these attacks must be allowed to wear themselves out, for it is in 
the interval that the physician must aid. The most important thing is to ob- 
tain moral control over the patient. To this end it is not necessary to be 
brusque or hard, but it is necessary to be unyielding. Such patients always 
have ill health, and this must be seen to. Nervine tonics, like nux vomica and 
c-xide of zinc, usually do good, and as the menstrual function is generally dis- 
ordered, iron and aloes may be prescribed with advantage. Cold baths and a 
healthy, quiet mode of life are of the greatest service ; early hours should be 
the rule ; and whilst the patient should be treated kindly at home, anything 
like weakness in dealing with her is worse than folly, is criminal. The food 
should be good and plain; anything like fancy in articles of diet should be dis- 
couraged ; change of air and scene is almost always beneficial, as assuredly is 
amusement without excitement, and an occupation in life. 

I. 

Ice is the name given to water when it is cooled down below 32° Fahr. 
Its properties and appearance are too well known for description. 

Ice-bags are made generally of india rubber, into which pounded ice is 
placed and applied to the desired spot; it is equally advantageous to break 
ice into small pieces and put them into a bladder 

Iceland Moss is not, strictly speaking, a moss, but a lichen or liverwort 
named Cetraria islandica. It is collected in large quantities in Iceland, and is 
used as food by the natives of Iceland and Lapland. The moss contains a 
bitter principle, of acid character, which has been called cetraric acid. The 
decoction is the preparation used in medicine. It is slightly tonic and demul- 
cent, but has no well-marked property. 

Icterus is the medical name for jaundice ; icterus neonatorum, or yellow 



ICT 348 ILL 

gum, comes on sometimes in infants soon after birth, but disappears of itself in 
a few days, when the natural functions of the body are properly established. 
Jaundice. 

Icthyosis occurs in two forms. It is met with as a dryness of the skin in 
both children and adults. It is usually congenital, and occurs in many mem- 
bers of the same family. The skin is dry, harsh, and rough, and it appears as 
if it were too tight for the body. The epidermis often peels off; on the neck 
it is rough and horny, and in the rest of the body the cracks of the epidermis 
correspond with the lines in the skin. In the other form dry and hard gray- 
ish or slate-colored scales appear on different parts of the body, unaccompa- 
nied by any redness or heat of skin. Its most frequent seat is on the extrem- 
ities, and especially on their outer aspect. True icthyosis is often hered- 
itary. Alkaline baths will remove the thicker scales, but they are speedily 
re-formed ; so also with castor oil. Patients who are affected with this dis- 
ease generally do not enjoy good health. Treatment may relieve, but will not 
cure it; the part affected may be rubbed with oil, and cod-liver oil and tonic 
medicines may be taken internally to improve the general health. 

Idiocy might be defined as that form of insanity where the mind from the 
first is imperfectly developed, and remains permanently in this undeveloped 
state. This imperfect state of the mind seems due to imperfect development 
of the brain itself, and this not unfrequently is accompanied by defects in other 
parts of the body. A distinction which on the whole is useful is commonly 
drawn between idiocy and imbecility : an idiot being considered one in whom 
mental or moral powers can hardly be said to exist, imbecility the condition 
where these exist but are defective. Very often the one is confounded with 
the other. The idiot is distinguished \ery frequently by peculiarities of coun- 
tenance, and still more commonly by peculiarity of gait and speech. Not- 
withstanding the defects of these unfortunate beings, much improvement may 
be effected in their condition by careful training, and to this end more than 
one asylum is now specially devoted. The brains of idiots, when examined 
and weighed, generally speaking, present marked deficiencies. Some of the 
parts, too, may be wanting. Two very important points need to be borne in 
mind with regard to idiocy : one is that some idiots have been known to at- 
tain considerable mental powers, especially after injury to the head. The 
other is still more important. It is a fact finally ascertained that intermar- 
riage in the same family tends inevitably to lower the intellect, and finally, if 
the process be not arrested, to produce hopeless idiots. 

Idiopathic is a term of no distinct meaning, often used to veil ignorance, 
and is given as the cause of a disease when nothing else is known to give rise 
to it. 

Idiosyncrasy is really the professional term for that condition of mind or 
body which is commonly known as antipathy. Some persons are peculiarly 
affected by certain smells, sights, or noises, and these we call their idiosyn- 
crasies. The smallest possible dose of a particular drug will, in some cases, 
produce the most violent and peculiar effects, — some articles of ordinary diet, 
likewise ; one man cannot eat any shell-fish without breaking out in an erup- 
tion all over his skin ; another cannot bear the smell of flowers without faint- 
ness : and these results are technically called idiosyncrasies. 

Ileus is a term applied to those cases, whether inflammatory or not, in 
which, owing to an obstruction in the intestines, the food passes back into the 
stomach, and is then vomited. 

Illusions are sensations without corresponding external objects ; when the 



IMP 349 IMP 

eye is the seat of the sensation, it is spoken of as a spectral illusion, phantom, 
or hallucination ; and illusion means a mockery, false show, or counterfeit ap- 
pearance, and is opposed to delusion, which is a chimerical thought. An illu- 
sion of the senses, if believed to be a reality, becomes a delusion of the mind. 

Impetigo. This skin disease is most frequently met with in children : it 
begins as small pustules, slightly raised above the surface, and surrounded by 
an angry red blush ; the pustule is about the size of a pin's point, and of a 
yellowish-green color, so that if pricked a minute quantity of matter will exude. 
They are at first separate from each other, but as the child picks them they 
run together and form a bleeding surface covered with scabs : this condition 
is similar to what is met with in eczema, and has been termed porrigo. (See 
Porrigo.) The angles of the mouth, chin, and cheeks are the parts chiefly 
affected, and this disease has a great tendency to spread, because the matter 
exuding from the pustules is so acrid and irritating that if any other part is 
touched with it another spot rapidly develops. The treatment consists in 
preventing the child from picking or rubbing the spots, so as to prevent their 
spread as far as possible ; the eruption should be washed twice a day with oat- 
meal and hot water, and not with soap ; zinc ointment should be applied night 
and morning, and the child's health should be improved by a careful diet and 
steel wine twice a day ; the bowels may be kept open by Gregory's powder, 
and every day exercise should be taken in the open air : by this method a cure 
may soon be effected. 

Impotence, deficient or absent sexual power, is a subject which, in a vol- 
ume like the present, requires to be handled with delicacy. Nor indeed would 
it be touched upon at all were it not that the plan of systematically ignoring 
it has produced disastrous consequences. There are few things which have 
given rise to so much mental torture as the idea of the want of sexual power, 
and perhaps there are few faculties so seldom absent, though being peculiarly 
subject to nervous influence, it may be for the time in abeyance ; then, too, 
the idea of impotence tends to perpetuate the condition. So, too, still more 
do efforts to overcome it, until at last the unfortunate individual is sometimes 
driven to acts of the rashest self-violence. For such individuals there is noth- 
ing like peace of mind and rest of body. In all probability the condition will 
depart of its own accord in due time. Meantime interference is sure to do 
harm. Rigid continence and chastity in thought, word, and deed should be 
practiced for the time being, until a more healthy condition of things comes 
ahout. This refers especially to individuals who have led healthy lives ; but 
there is, however, another class who have had themselves in part to blame for 
their condition, real or fancied. Such are often subject to exhausting dis- 
charges, which will not, we are assured, cease until the mind and body both be- 
come healthier. To both of these classes we very earnestly desire to speak. 
We counsel them, if they love their own peace of mind and future comfort, to 
have nothing to do with the class of advertising impostors who prey on such 
unfortunates. Let them apply to the best and most respectable medical prac- 
titioner within reach, fearing nothing, for these things are well known and 
carefully studied among such. Above all, let them have no fear that their con- 
fidence will be divulged ; but from a quack expect ignorance, avarice, and 
devilish malice. 

Impure Air may be caused by several conditions : (1.) Carbonic acid gas 
may accumulate in the air from people living in too small a room, or in an ill- 
ventilated apartment; or from the same cause the proper amount of oxygen 
may be diminished. (See Ventilation.) (2.) Various fever poisons are 



INA 350 INC 

supposed to be conveyed by tbe air ; such is the case in scarlet fever, measles, 
and small-pox, in cholera and influenza, etc. (See Fevers.) (3.) Emana- 
tions from chimneys, manufactories, and gas-works render tbe air impure. 
In many of our large towns the smoke hangs over the place, in a dense cloud. 
Tins, although disagreeable, is not hurtful, ;is in those cases where fumes of 
sulphuretted hydrogen or arsenic are given off, as in smelting furnaces ; in 
some parts no vegetation can grow for some considerable distance around, and 
where vegetation cannot exist it is injurious for man to live. (4.) Smells 
may exist in the air without causing mischief, although they may render the 
neighborhood disagreeable to some people. Tan-yards, gas-works, and tallow- 
chandling are well known to render the air odoriferous in their neighborhood, 
but they cause no injury to health. Again, air may contain all the germs of 
a fever and yet produce no smell, although its effects may be dangerous, or , 
even fatal to life, so that there is no relation whatever between the smell of 
the air and the danger arising from breathing it ; yet, in some cases, the two 
are combined, as in cases of decomposing animal and vegetable matter, and 
then the smell, like the Davy lamp to the miner, is the signal to warn us when 
danger is near, but is not the danger itself. The impure air along the bank 
of a liver where there is rank and decomposing vegetation is very injurious ; 
while in the marshes in Italy and on the Mediterranean shores, and in the 
low-lying valleys of India, malarious emanations are very common, and pro- 
duce intermittent and remittent forms of fever. For further information the 
reader must refer to articles on Am and Ventilation*. 

Inanition is the condition brought about by bad feeding, or by food which 
is deficient in quantity or in quality, or in both respects. It is a too fre- 
quent cause of death in infant life; the child gradually loses flesh and "wastes 
to a skeleton," until finally death takes place by exhaustion. 

Incisions. Divisions of the several tissues of the body, whether made by 
knives, scissors, or saws, are called incisions, although the term is generally 
applicable to such as are made by a sharp cutting edge. In surgery, rules are 
laid down for the various incisions requisite in performing operations. Such 
incisions must be made with some definite purpose, with determination and 
steadiness, so that the operator neither injures his patient nor his assistants. In 
all incisions the integuments only should be first divided, and all other struct- 
ures, as much as possible, in the line of their natural direction ; and in making 
incisions in situations where vessels or nerves abound, great caution is neces- 
sary, the overlying tissues being divided seriatim on a director, and if possible 
in the direction of such vessels. In any region of the body, where the result- 
ing scar would be noticeable, care should be taken to make such incisions in 
the line of some natural fold or wrinkle, or in some place from which the hair 
can be shorn, and subsequently grow up to cover it. Incisions may be straight, 
curved, semilunar, circular, V, L, T, H shaped, crucial, or stellar. The in- 
strument must be perfectly clean and sharp (the keenest edge examined with 
a lens is serrated or saw-like.) All incisions should be made promptly ; a 
clean cut depends upon the tension of the parts the edge is acting on, and it 
will be found as a rule that the blade of any instrument should be perpendicu- 
lar to the tissue acted on. In using scissors, care must be taken that the cut- 
ting edges meet in the same plane, thus giving the hand greater power over 
them, and causing less liability to the deviation of the blades. 

Incompatibles are remedies which, when mixed together, destroy each 
other's effects, or materially alter them. It was at one time the universal 
custom to order several substances in the same prescription, one of which, if 



INC 351 IND 

care was not taken, might neutralize or destroy the effects of the others. This, 
of course, had to be guarded against, and so lists of incompatibles used to.be 
given with each remedy. Nowadays we tend more to give remedies singly, 
and so incompatibles are of less consequence. Incompatibility mainly depends 
on chemical reaction ; physiological incompatibility has been but little studied, 
though it certainly does exist. But as examples of incompatibles, we might 
cite iron and all substances containing tannin or gallic acid. Either of these 
acids, with an iron salt, strikes a black-like ink, and the medicine is thus ren- 
dered unpleasant ; but it by no means follows that it is inert. Some incompat- 
ibles are, however, more serious. Many of our vegetable remedies owe their 
efficiency in great measure to the presence of some alkaloid, and if that is 
thrown down the mixture becomes useless. There is another form of incom- 
patibility, however, which men do not sufficiently study ; that is, incompatibility 
with water. Resinous substances mixed with water promptly solidify, and fall 
down, except the substance also contains some gum, as does gamboge, or gum 
is added to the mixture to suspend it. Take the ammoniated tincture of gua- 
iacum ; that, if added to water, is immediately precipitated ; if an alkali be 
added it remains in solution. This is only an example ; but there are many 
other remedies which a few drops of ammonia would keep all right. 

Incontinence of Urine is a troublesome symptom, occurring at different 
ages from various causes. In children it may arise from bad training, or from 
some irritation in the penis or bladder ; such children should be made to pass 
water just before going to bed, and may be even roused in the night for the 
same purpose ; if punishment be of no avail, search should be made for a 
cause, and sometimes, when proper training will not cure it, some tonic, as iron 
wine combined with belladonna, will do good; if it is due to any abnormal 
condition of the penis, a surgical operation may have to be performed. In 
adults, it may come on from paralysis of the bladder, as in cases of paraplegia, 
where, from over-distension, the urine dribbles away.; the treatment will con- 
sist in drawing off the urine night and morning with the catheter, and in keep- 
ing the patient dry and clean so as to prevent the formation of bed-sores. In 
young hysterical women it sometimes occurs, and the best thing for them is 
cold bathing, change of air and scene, healthy and useful occupations, daily 
exercise, and avoidance of hot and overcrowded rooms, late hours, and morbid 
mental excitement. In old people this symptom may come on from an enlarged 
prostate, or irritable bladder, and for this condition very little can be done 
except daily catheterism. In those also who suffer from a fistulous opening 
into the rectum or vagina, or in those who have a false opening in the urethra, 
this condition may prove very distressing from the constant flow of urine ; 
perfect cleanliness must be enjoined, and a piece of sponge may be so ad- 
justed as to catch any fluid that dribbles away : if a stricture of the urethra 
is the cause, surgical interference must be resorted to. 

Indigestion, or Dyspepsia, as it is also commonly called, is in one group 
mainly due to what is termed atony, that is, simple derangement of the pow- 
ers of digestion, without any eventual change in its organs. This derange- 
ment is dependent on weakness ; but the source of the weakness may be local, 
that is, confined to the stomach ; or general, that is, due to something which 
affects the whole system. To this group, too, belong the changes which take 
place in the digestive organs in old age. Another large group of indigestions 
are connected with inflammatory changes in the stomach. These changes may 
depend on various causes; very frequently improper food — improper, that is, 
in quantity or quality — is at the root of the mischief. Yet another form of 



IND 352 IND 

indigestion is due to nervous influence ; witness the effects of anxiety, fear, and 
the like emotions in completely averting not only appetite, but digestion. 

A brief word as to the relative functions of various organs concerned in 
digestion is necessary to a clear understanding of those defects which consti- 
tute dyspepsia. Our food may be taken to consist mainly of three kinds of 
substances, which are represented to a different degree in almost every article 
of diet, yet are present in some form or other in most dietaries. These sub- 
stances are starch, or sugar which can be derived from starch ; oil, or fat ; and 
albumen, or white of egg, which may be taken as the type of all kinds of meat. 
The object of digestion is to convert these several elements into a material 
fitted for the nourishment of the body. The first secretion encountered which 
has any influence on the food as prepared and ready for swallowing is the sa- 
liva. This speedily converts the starch of the food, especially if that starch 
have been cooled, into sugar similar to that found in fruits, and called grape 
sugar. But the food does not remain long enough in the mouth to undergo 
this change in its entirety ; it is swallowed, and passes on into the stomach, 
where the saliva ceases for the time being to act. 

In the stomach the albuminous element in the food is converted by the 
gastric juice into a substance which can more readily pass through animal 
membranes than itself can, and all kinds of albuminous food are reduced 
nearly to the same chemical substance. 

When stomach digestion has finished, that part of the food which has not 
been absorbed by the vessels in the inner surface of the stomach passes on into 
the small intestine. There it encounters the secretion of the liver, called the 
bile, which promptly puts a stop to all further change such as has been going 
on in the stomach. Here, too, is poured out the secretion of the pancreas, or 
sweet-bread, which enters the intestine along with the bile. These, too, are 
powerfully alkaline, and neutralize the acidity of the gastric juice, so that now 
the change in the starch can begin again. Another substance, too, remains 
unacted on, that is, the fat contained in the food ; these two substances act 
upon it, and finally by converting it into a kind of soap, partly by suspending 
it, the fat becomes ready for absorption, and is taken up by special vessels ac- 
cordingly. The pancreatic juice has a further influence on albuminous sub- 
stances. These it alters something in the same way as does gastric juice, and 
renders them more easily taken up by the absorbing vessels. The refuse of 
the food is ejected together with certain other waste products. The signs that 
tell us something is wrong with the stomach are partly such as the patient alone 
is cognizant of, partly such as are appreciable by the skilled practitioner. There 
are certain special signs which tell us something is wrong with the stomach, 
such as flatulence, acidity, or heart-burn, acid eructations, and perhaps vomiting. 

The tongue used to be taken as a certain guide to the condition of the stom- 
ach and other digestive organs, and so the indications afforded by it were care- 
fully studied. Though of less value than was supposed, still the signs afforded 
by the tongue are not to be neglected. The " fur," as it is called, is formed 
from the scaly covering of the lips and cheeks, as well as from the tongue 
itself. This is agglutinated by the saliva drying, and so gives rise to the furred 
appearance spoken of. Some people sleep with their mouths open ; these have 
almost invariably an accumulation of fur on the tongue in the morning. This 
may mean nothing. Again, any irritation of the mouth may give rise to an 
unusually copious production of this substance, and so the tongue be furred. 
This fur often decays and produces putrid gases, which cannot fail to be prej- 
udicial to health. When the fur is due to stomach mischief, that is generally 



353 





Fit). LVII 



Fig. ox. 




Fig. IX. 




Fig. lxl 



PLATE XII. 



IND 355 IND 

of a semi-inflammatory character, and thus the appearance of the tongue and 
mouth affords not only valuable means for making out the nature of the dis- 
ease, but also helps us to some clew to its treatment. The alternations in hun- 
ger and thirst are often of value in enabling us to come to a conclusion as to 
the existence and nature of stomachic derangement. There may be loss of 
appetite (anorexia) with dyspepsia; if so, the malady is generally inflamma- 
tory, and rather acute in its nature. The opposite condition (boulimia, or 
voracious appetite) is hardly a sign of dyspepsia, though it does occur. More 
frequently it is associated with such a malady as diabetes or the presence of tape- 
worms. This is different from the craving or sinking feeling often experienced. 
Eating food repugnant to ordinary appetites (pica) is more a sign of hysteria 
than dyspepsia. Thirst is most common in irritative states of the stomach, 
and then mostly manifests itself some hours after a meal. Of all the symptoms 
derivable from such sources, thirst and loss of appetite are the most valuable. 

Flatulence is a very important symptom of indigestion. It is due either to 
accumulation of gas in the stomach and bowels, or it may be formed there. 
That gas which gives rise to flatulent distension (which is called, if excessive, 
tympanitis and meteorismus) is commonly derived from fermentative changes 
in the food swallowed. The formation of gases from food will certainly occur 
when substances already fermenting are swallowed, when too much food to 
be digested is swallowed, or the food is of a kind exceedingly prone to fermen- 
tation, and when the secretions which are required to digest the food are de- 
ficient in quantity or altered in their characters. Especially, it would Seem 
that when these peculiar secretions are deficient, the ordinary mucus secretion 
becomes excessive in quantity, and perhaps altered in quality, so that it is 
very prone to set up fermentative instead of digestive changes ; in the course 
of these changes carbonic acid, carburetted hydrogen, and sulphuretted hydro- 
gen are generated. 

Acidity is another important symptom of indigestion. It arises from two 
causes, over-formation and fermentative change. The latter occurs under the 
same circumstances as does the flatulence produced in like manner ; for the 
fermentation which sets free the gas above referred to produces acids, acetic, 
butyric,- and lactic, when starchy or saccharine substances and milk become 
altered. But another cause of acidity must be admitted in excessive secretion 
of acid gastric juice. Perhaps more frequently, however, if there be excessive 
secretion on the part of the stomach, it is of an alkaline mucus, rather than of 
acid gastric juice. This is especially the case in inflammatory conditions of the 
stomach. 

Heartburn, as it is called, is usually present, whether the excessive secretion 
be acid or alkaline, perhaps even more in the latter, though then it may be due 
to fermentative changes in the food. The sensation is one of burning at the 
entrance to the stomach, with a desire to bring up something, which commonly 
ends in a hot burning fluid regurgitating to the back of the throat and some- 
times being ejected. Pain is not constant in acidity. If the acidify be due 
to fermentation, the pain is longer in coming on, and often ends in colicky 
pains. The pain produced by over-secretion, on the other hand, very com- 
monly occurs when the stomach is empty, and is very readily set going by a 
stimulant, such as a glass of hot spirits and water. Both forms of acidity, if 
not checked, may give rise to dangerous symptoms. Fermentative change, 
as interfering more with digestion in the bowel, is perhaps more dangerous 
than the other, but both seriously undermine health by the exhaustion to which 
they may give rise. The vomiting of pregnancy illustrates the danger, for 



IND 



356 IND 



though due to different causes, it is sometimes so severe, and the exhaustion 
occasioned by it so profound, as to endanger life, or even prove fatal. _ 

Pain in the stomach may be due to irritating substances in its interior, de- 
rived from without, or perverted secretions derived from within. It may be 
dne to profound alterations in its texture, or to those imperceptible alterations 
which we ascribe to altered nerve-power. The question how far this pain may 
depend on altered nerve-power is not easily answered. Usually this is accom- 
panied by some alteration in the secretions. Perhaps, too, there may be a 
kind of cramp or spasmodic contraction of the stomach, which may give rise to 
acute pain. Undoubtedly, too, there is a neuralgia of the stomach. In these 
cases of purely nervous pain, digestion may go on well enough during the inter- 
vals of ease. . . . 

Vomitino- is mainly produced by the compression of the stomach against the 
diaphragm & by means' of the abdominal muscles ; but the walls of the stomach 
and various other parts participate in the action. It may be induced by irri- 
tating the nerves, either at their centres in the brain, or where they end, in the 
stomach and neighboring organs. Consequently we have vomiting in head at- 
fections as well as in affections of the stomach and neighboring organs. As a 
means of diagnosis it may be said that vomiting arising from irritation of the 
stomach is attended with more or less pain, the tongue is furred, and there is 
a feeling of heaviness and nausea preceding the act. These are rare when 
the vomiting is due to cerebral symptoms. As to the causes of dyspepsia, the 
first we shall deal with is unsuitability of food, and the food may be unsuitable 
both in quantity and in quality. 

The human digestive organs, from the teeth downwards, are fitted tor a 
mixed diet, partly animal, partly vegetable. An undue preponderance of either 
of these, therefore, is likely to lead to injurious consequences if long continued. 
The excess of saccharine material gives rise to an undue secretion of acid in 
the stomach, which is not reabsorbed, and disorders digestion lower down m 
the alimentary canal. Excess of starchy food seems altogether incapable of 
being digested under ordinary circumstances, and so passes into ferment and 
undergoes the changes which give rise to flatulence. Again, a certain amount 
of indigestible material is mingled with all our food. It does good by distend- 
ing the" bowels and so inducing in them the movements needful to carry the re- 
mains of the food, digested or undigested, out of the body. If, therefore, the 
food is too nutritious, as in those who live highly, there is not enough of this 
'material in it, and so the bowels become confined. On the other hand, very 
poor diet, containing little nutriment, is apt to irritate the bowels, and to give 
rise to indigestion and perhaps diarrhoea. Certain, indeed most articles of food 
undergo in" course of time changes which render them unfit for human use. 
This takes place under almost any condition, but is more likely to take place 
under some than others. Thus putrid meat or fish, sour bread, and imperfectly 
or excessively fermented beer give rise to irritation of the stomach, or even to 
worse consequences. One of the most potent causes of dyspepsia is deficient 
mastication. Again, from various causes, people nowadays lose their teetn 
earlier than they were wont, and this loss sadly interferes with the due pulping 
of the food. The remedy for this is a good false set. When from any cause the 
saliva becomes altered, as it sometimes does, its action on starch may be en- 
tirely prevented. This may occur when the secretion of the mouth itselt is 
acid' Such conditions are exceedingly liable, if starch be much used in food, 
to <nve rise to flatulent indigestion. The quantity of food is quite as important 
as its quality. It is notorious that excessive quantities of food, excessive, that 



IND 357 IND 

is to sny, as regards the powers of -the stomach, are in a certain class the most 
prominent cause of dyspepsia. The stomach seems in most cases only to secrete 
enough gastric juice to digest the food necessary to the wants of the system ; 
the rest is passed on to ferment or putrefy in the bowel, and so give rise to the 
tortures of dyspepsia. When the digestion is good, and this surplus food is 
digested, obesity results ; or the food so taken into the system is only imper- 
fectly consumed, is not readily extruded, and so the phenomena of gout ensue.. 

Irregularity in taking food is a great drawback to perfect digestion. And 
this must be remembered, that if a man is working hard in the open air, he can 
digest twice as much food, and many times more of some kinds of food, as one 
who lives a habitually sedentary life. 

Deficiency of food, accompanied as this almost invariably is by unsuitable 
food, is a serious cause of dyspepsia among the poorer classes. 

Certain causes of dyspepsia are located in the stomach itself, and these may 
be mainly referred to such conditions as obstruct the passage of food through 
it, or to alterations in its secretions. The stomach, like other portions of the 
alimentary canal, has the power of expelling its contents in due time. But 
these movements may be impaired, as when the stomach is atrophied and di- 
lated. So, too, indigestion may result from obstruction at the intestinal end 
of the stomach ; but that being of a cancerous kind, or of some other new 
formation, withdraws it from the realm of dyspepsia pure and simple. Adhe- 
sions of the stomach to surrounding organs, interfering with its movements, and 
not likely to be discovered save through the signs of indigestion it gives rise 
to, may be referred to here, but only referred to. 

Hypertrophy, or excessive growth of the muscular tissue of the stomach, is 
mentioned as being one of the causes of hastening food too rapidly through the 
stomach and into the intestines, and so giving rise to dyspepsia, but we confess 
this is hard to understand. 

As to altered secretions, these being two in number, deficiency of the active 
one, that is, the true gastric juice, is often accompanied by an excess of the 
other, which is mucus, and that is worse than useless. The secretions are un- 
doubtedly influenced by changes in the blood itself, as is well seen in B right's 
disease. 

The precise mode in which the nervous system influences gastric secretion is 
not very plain, but that such an influence exists is patent to all, as witnessed 
in the manifestations of anxiety, sorrow, fear, and even joy. Most probably 
this takes effect through the sympathetic nerves. There are certain forms of 
the malady, too, which depend on what has been called reflex irritation. Thus 
constipation is to many, especially to those not habitually its subjects, one of 
the surest causes of a temporary indigestion or loss of appetite; but it is just 
possible that the same cause which in these has produced the constipation may 
also produce the indigestion; more distinctly if this reflex character is the indi- 
gestion due to the presence of worms. The three main varieties of indigestion, 
then, are the atonic, the nervous, and the inflammatory. The atonic form is 
almost invariably chronic, rarely attended by fever or pain, but indicated by 
a dull sense of weight, uneasiness, and languor, especially after taking food. 
Very generally, too, there is depression of mind — hypochondriasis in the 
male, or hysteria in the female. 

Weakness of digestion is very often accompanied by weakness of other or- 
gans besides the stomach, — weakness, too, of a hereditary origin. In aged 
people this form of indigestion is almost habitual, and on that account easily 
made worse by any indiscretion of diet, a sub-inflammatory form being thus 



IND 358 IND 

induced. The digestion in these cases is excessively slow, and frequently con- 
tinues from one meal to another. There is also a feeling not amounting to 
pain, except in hysterical women, but apparently giving rise to imperfect res- 
piration or want of breath, or a feeling as if something had stuck in the 
throat. There is flatulence, and very likely eructations of acid, or more 
likely undigested or half-digested food. Frequently the eructations are offen- 
sive or acid, and these occur some hours after food. The flatulence is not con- 
fined to the stomach, but affects the bowels also, giving rise to troublesome 
distension. The appetite, as a rule, is impaired, and certain forms of nutri- 
ment, as soups and broths, indeed most kinds of fluid, markedly disagree. The 
tongue is pale and flabby, marked by the teeth at the edges ; there are marks 
of general relaxation hi the mouth and throat, especially about the uvula, 
which the patient commonly attempts to relieve by hawking. The bowels are 
usually constipated, and the gases passing along them give rise to unpleasant 
noises, though there may be no sensation of them. Frequently the bowels 
become distended at one particular spot by accumulations, and this is not re- 
lieved by purgatives. The breath in these cases is ordinarily offensive. The 
evacuations are usually hard and deficient in bile, but in a good many cases 
this alternates witli the opposite condition. In these cases, too, the pulse is 
slow and weak, but readily raised, so that if the patient be examined immedi- 
ately after exertion he would seem to have an unnaturally fast pulse ; palpita- 
tion, too, is frequently present ; and these two frequently lead the subjects of 
the complaint to fancy themselves affected with heart disease. There are no 
marks of fever about the patient: the skin is soft, flabby, and moist. The ex- 
tremities, too, are cold, especially after meals. The color of the skin is bad, 
generally sallow or muddy. For the same reasons the nervous system is 
affected, and there is languor and lassitude, and a sense of weariness in the 
limbs. Sick headache is frequently present from time to time, and the men- 
tal faculties are dulled and incapable of prolonged exertion. 

In fever, as is well known, there is an almost complete arrest of appetite 
and digestion. This is due in part to changes in the secreting structures, simi- 
lar to what take place in other structures of the body. These various changes 
are, some of them, such that thev hold out a good prospect of recovery ; but 
some, especially those of old age, are well-nigh hopeless. The treatment to 
be adopted for atonic dyspepsia must have a twofold end : there must be an 
endeavor to improve what is called the general tone of the system, and special 
pains must be taken to enable the stomach to do its duty aright. It is espe- 
cially in cases like the present that due attention to food and drink is neces- 
sary, and hence the treatment resolves itself into dietetic and medicinal. As 
regards diet, we have already pointed out that in a very considerable number 
of instances the indigestion has been brought on by overtaxing the powers ot 
the stomach by too frequent and too copious meals. It is, therefore, necessary 
here to beat back, so to speak, to find the least quantity of nutriment which is 
required by the system, and the greatest which can be digested by the stom- 
ach in comfort. Here the conditions of the patient's life must be borne ui 
mind, for there is a great difference in the amount of food which will suffice 
for a listless invalid and that required by one habitually undergoing powerful 
bodily exertion. . 

Moreover, it is of the first importance to present this food to the stomach in 
an easily digested form. As already pointed out, soups and broths are rarely 
tolerated in such conditions, mainly because they dilute the digestive fluids too 
much. Nevertheless there is one fluid form of food which can usually be 



IND 359 IND 

taken, that is milk, and if it cannot be taken fluid it may be coagulated by- 
rennet. When arising from exhaustion, this form of dyspepsia necessitates 
small meals, but these may be frequently repeated, and stimulants may be 
combined with them. No salt or preserved meat should be used, and it should 
be fairly well but not over cooked. Hence recooked meat is forbidden. Mut- 
ton and beef must form the staple diet ; game and fowls may be allowed as a 
change. Pork and veal are entirely excluded, as are ducks and geese. Fish 
is also permitted within certain limits ; herrings and salmon are beyond these, 
and so not allowed ; eels and trout are on the border land. The best for or- 
dinary use are plain boiled turbot, sole, whiting, or haddock. Shell-fish, ex- 
cept oysters, are entirely forbidden. Still more care is necessary with regard 
to starchy food. All vegetable food should be cooked, none raw, and it should 
be young, tender, quite fresh, and well boiled. It is better, on the whole, to 
try stale bread, macaroni, and rice, with some green vegetables, than to use 
potatoes. Such at least is our experience. Light puddings are permissible, 
not heavy doughy preparations, and all pastry is to be forbidden. Butter may 
be used with bread, but in no other way, and it should be quite fresh. Fat 
or oil in any other shape is inadmissible. Fruits must be carefully selected ; 
but most may be eaten, or rather sucked, provided everything solid — husks, 
seeds, and woody matter — be not swallowed. Nuts of all kinds must be re- 
jected. 

Three meals a day is perhaps the best rule : breakfast, say, at nine, some- 
thing about one, and dinner at six. Too long intervals are almost as bad as too 
short, especially should the sufferer aim at cheerfulness during its digestion and 
absorption. To aid this there is nothing better than a moderate quantity of 
good wine. Port rarely suits and should be avoided ; dry sherry usually does 
well ; a sweet sherry is most hurtful. Good sound vin ordinaire suits most, if 
diluted with at least its bulk of water ; whilst some do best on weak brandy 
and water. Tea after dinner almost invariably does harm ; not so black cof- 
fee, moderately strong, with a teaspoonful of brandy in it. As a rule it suits, 
but it must not be swallowed hotter than the temperature of the body, or a 
little over, so as to feel pleasantly warm. 

All the other matters tending to a restoration of health must be observed. 
Change of air and change of scene, a sea voyage, etc., will often do much 
good ; but as the invalid is greatly dependent on food for his cure, he should 
seek to recruit himself where good plain cooking and sound food is to be had. 
A good steady walk of twenty miles a day, through fine scenery, with an old- 
fashioned inn to rest at in the evening, will often do marvels in the way of 
cure. A cold bath in the morning should be the rule to all who can stand it ; 
if not, one as cold as possible, but not warmer than tepid, should be used. If 
a settled residence is desired, one of the bracing localities alluded to already 
should be selected. (See Climate and Health Resorts.) 

An alkali and a bitter, as calumba, are frequently the best drugs to begin 
with, after which iron in one or other of its forms will be found useful. 
Liquor potassae and gentian, too, are useful, but this is mainly when there is 
no inflammation superadded to the atonic condition. 

In simple atonic dyspepsia we can as a rule give iron from the beginning, 
but rarely such preparations as the sulphate or chloride. Usually we must 
begin with reduced iron, the carbonate or ammonio-citrate, and these may be 
given along with meals ; though they are best, perhaps, before them. If not 
well borne they may be given effervescing, but even then they may cause irri- 
tation ; if this is the case, a phosphate may be given. Usually we may combine 



IND 360 IND 

with the iron mix vomica in some shape or other, though, perhaps, it is some- 
times best given by itself. There are certain cases where the tincture of the 
bark of nux vomica does better than the alkaloid strychnia, though the latter 
with a mineral acid is a most efficient tonic. Quinine itself does not seem to 
do particularly well, but some preparations of bark, especially the liquid ex- 
tract and compound tincture, answer well where there is no irritability. Of 
the other bitters commonly used, besides calumba and gentian, cascarilla and 
chiretta seem of undoubted value. The hop, too, in the form of good bitter 
beer, is not to be despised. Ipecacuanha, where there is considerable irrita- 
bility of stomach, is valuable ; but its use, and that of certain other remedies, 
belongs to another form of dyspepsia altogether. In this form of indigestion, 
aids to digestion are of prime importance. Chief among these are the min- 
eral acids and pepsine. The normal acid of the gastric juice is hydrochloric, 
and perhaps on that account we should be led more naturally to prescribe it 
than any other to aid digestion. Nevertheless, it has seemed to us that a 
mixture of nitric and hydrochloric acid, which acts much in the same way as 
does hydrochloric acid, is a better preparation. It should be given in doses of 
ten or fifteen minims in some bitter preparation, as tincture of orange-peel or 
infusion of calumba, just before, during, or after food ; that is, if the meal con- 
tains meat or allied substances, not otherwise. 

Pepsine is even a more valuable remedy, though it has been much decried, 
probably on account of the very inferior preparations abroad. For an adult 
five or six grains will suffice, and it may well be given with hydrochloric acid, 
as above stated. 

The next group, which we shall call nervous dyspepsia, — dyspepsia or in- 
digestion that is due to interference with the functions of the nerves, — is in 
many respects allied to atonic indigestion, but there are certain special causes 
worthy of note. They are much more frequent among women than among 
men ; but exhaustion or general weakness may reduce a man to a somewhat 
similar condition. The whole group of symptoms, of which the indigestion is 
one, are commonly grouped under the heading hysteria. The condition in the 
male called hypochondria is still more closely associated with indigestion; 
and the depressing effects of chronic alcoholism,- though these give rise to 
morbid changes of a specific kind, are in part due to nervous influence. The 
reflex forms of dyspepsia mentioned are, as far as the stomach is concerned, of 
a nervous origin, especially certain connected with imperfectly known con- 
ditions of the ovaries and womb. The pain, which is one of the most promi- 
nent symptoms of this form of indigestion, is usually very severe and inter- 
mittent. The duration of the attack is variable, from a few minutes to hours. 
Frequently it terminates in acid emitations or the ejection of an alkaline 
mucus. Food produces variable effects ; most frequently it gives relief. 
Commonly enough in this class of indigestion, insipid demulcent substances 
frequently give rise to more pain than do matters of a more irritating kind. 
In many cases digestion goes on readily enough in the intervals of the attack. 
The most typical form of nervous indigestion is that to which the term gastric 
neuralgia has been applied. This commonly is accompanied by vomiting. 
Perhaps in this class ought to be included the vomiting of pregnancy, to 
which, however, we shall not here further allude. We have briefly referred to 
some of the main peculiarities of nervous dyspepsias : the pain generally in- 
tense, often most so when the stomach is empty, and relieved by food ; the 
tendency to vomit without much nausea, and from no special change in the 
food ; especially the tendency to nervous pains and disturbances elsewhere in 



IND 361 IND 

the same individual. As to treatment, mix vomica arid iron are the mainstays. 
In most cases iron relieves the neuralgic pain. The carbonate is the best 
preparation, and, if the bowels are confined, a little aloes and rhubarb may be 
given at the same time. Next after these comes opium, but that must be used 
with care. In some of these cases, where there is also constipation, it would 
almost seem as if opium opened the bowels. Aromatic spirit of ammonia will 
also be found of great value in many cases. Hydrocyanic acid is given with 
benefit, though not, I think, with greatest benefit, in this form of dyspepsia. 
Of course it should never be given without a physician's prescription and in- 
structions. Where there is much vomiting ice must be employed. See Hys- 
teria, Neuralgia, and Pregnancy. 

The acute form of inflammation, such as is seen in other organs, is rare in 
the stomach ; but it is very subject to such forms of inflammation as occur in 
mucous membranes, and go by the name of catarrh. This acute inflammation 
of the substance of the stomach apparently occurs almost only in poisoning by 
irritant substances. 

Gastric catarrh may be either acute or chronic. The acute form is most 
common, perhaps, in young children, as in them few articles of food prove 
suitable ; and unsuitable food generally brings about an acute attack of indiges- 
tion due to this malady. In those, too, whose stomachs have been weakened 
from any cause, a slight addition to the inconvenience of digestion may bring 
about an acute attack of catarrh. Thus atonic dyspepsia, or whatever causes 
it, — starvation, drinking cold water when the system is greatly heated, — all 
may directly or indirectly bring about this condition. 

Acute indigestion may assume any degree of severity. Usually it com- 
mences with a feeling of fatigue and heaviness, very likely with pains in the 
back, soon followed by uneasiness in the stomach itself, — this sometimes 
amounting to severe pain. There is also a sense of faintness, with weak, flut- 
tering pulse and cold perspiration ; headache affecting the forehead, some- 
times with intolerance of light and sound. Nausea and increased flow of 
saliva follow till the offending substance is rejected, very likely with a quan- 
tity of thin acid fluid. Then, after a period of rest, relief follows. Instead of 
being thus rejected the offending substance may pass on into the bowels, when 
follow colicky pains and gripes ; probably diarrhoea comes on, and so the sub- 
stance is got rid of, though sometimes a purgative is necessary. There is 
usually, in this' state, a loathing of food and persistent nausea. The tongue is 
loaded and the breath offensive. There is also much thirst, though few liquids 
are well borne by the stomach. There is dizziness, and often palpitation. 

Besides the symptoms already enumerated, there may be disordered vision, 
noises in the ears, and throbbing in the temples and eyeballs. There is great 
depression, sighing, yawning, and shivering. The attack may last a variable 
period, generally under forty-eight hours, and then passes away in sleep. 
After waking the pain is gone, but the patient is weak and nervous and the 
stomach irritable. Great care must be taken of digestion for a day or two. 

If the irritating matters are not got rid of, the condition may last much 
longer, and prove much more troublesome. There are, however, still more 
severe forms of the disorder, which may simulate the early stage of typhoid 
fever. Usually, however, there is a good deal of pain in the stomach, a sen- 
sation of burning, and obstinate vomiting, brought on by the smallest quantity 
of liquid. Mucus mainly is so ejected, sometimes streaked with blood, more 
frequently mixed with bile, and even after the stomach is emptied the retching 
goes on. The tongue, in these cases, is loaded at first, but afterwards becomes 



IND 362 IND 

raw, and sometimes both it and the lips become cracked. There is thirst, not 
easily appeased, as nothing will rest on the stomach, and the appetite is gone. 
Shivering is common from time to time, and a feeling of cold, though the skin 
is too hot. The pains in the back and limbs continue, and during sleep there 
is often delirium. The urine is scanty and high-colored. This form of disease 
rarely lasts long if left to itself or treated properly ; if treated badly it is very 
likely to give rise to prolonged suffering. 

The acute gastric catarrh which follows the abuse of alcoholic drinks is of 
the kind first described. That from the continued abuse of the same is of the 
nature of chronic gastric catarrh, hereafter to be described. In infants such 
attacks are indicated by vomiting and diarrhoea. There is little heat of 
surface, but the bowels often give rise to pain before they are moved. The 
motions are liquid and offensive, and often greenish, and give rise to much 
straining, and the child is greatly prostrated. The vomited matters are in- 
tensely acid, and the coagulated milk is usually accompanied by much fluid. 
There is great thirst, but fluids are retained with difficulty. The disease, if not 
speedily relieved, tends to a fatal issue. Gouty inflammation of the stomach 
may be either accompanied or relieved by attacks of gout elsewhere, or only 
appear when these affections disappear. Flatulence and spasm are the ruling 
characteristics of this form of disease. 

The foundation of the treatment in all these cases is rest. First of all, if 
there is any substance, as there usually is, to give rise to this troublesome con- 
dition, it must be got rid of by emetics. If the substances have passed into 
the bowels, a purgative must be given. The best is castor oil, if it can be re- 
tained ; if not, a few grains of calomel, followed by a seidlitz powder. 

In children, a dose of gray powder (hydrarg : c. creta), with some rhubarb, 
or calomel and magnesia, is perhaps the best thing to give ; but such must be 
given with caution, for they are easily weakened, and if weakened are easily 
carried off by the malady. A small dose of castor oil will generally suffice to 
carry off the irritant matters, and careful dietary must do the rest. 

In the adult, where there is purging, opening medicine should be used with 
caution. A very small dose of castor oil, or, perhaps better, of tincture of 
rhubarb, with a little magnesia, may be given, but nothing more. After that 
it may be even necessary to use astringents, of which compound chalk powder 
is perhaps the best. The patient must be kept absolutely in bed, and it is 
better, if the individual is a fairly strong one, to let twelve hours or so pass 
without any solid nutriment. A teaspoonful of solid beef-tea, frozen if neces- 
sary, may be given, but nothing more. In a considerable number of instances 
this will be all that is required; no other medicine will be needed except 
attention to diet for a short time. But in more severe cases, where food by 
the stomach cannot be borne, and food is necessary, nutrient enemata may be 
given. The first food should be milk and lime-water, or milk with a little 
bicarbonate of soda in it, and soda-water (ordinary soda-water contains no 
soda), or the beef-tea, or essence of beef, which is better, or, better still, new 
pulped meat. An exceedingly small quantity of this last will suffice to keep 
life going for some time. It may be given to infants, too, but sparingly. In 
them milk is the ordinary diet to be given, but largely diluted witli lime-water. 
We disallow farinaceous food altogether, but some permit and even recommend 
it. As for spirits, they are to be avoided as far as possible, and all wines but 
champagne of the driest brand are forbidden. If stimulants are required ab- 
solutely, the best is either a little soda-water and pale brandy, or the dry cham- 
pagne alluded to. A mustard poultice, or even a hot simple fomentation over 



IND 363 IND 

the pit of the stomach, often tends to stop the vomiting ; but a cold compress, 
consisting of a towel wrung out of cold water and applied to the stomach, and 
covered over with flannel, often does better. 

With regard to internal remedies, the first is morphia, and it may be given 
in small doses either as a pill or subcutaneously. In pill not more than a 
quarter of a grain should be given, and under the skin not more than one-sixth 
or one-fii'th. Jf, however, it be necessary to use emetics or purgatives, it 
should not be administered until the action has ceased. It is therefore of 
most value in the severer forms of the disorder. Hydrocyanic acid is rarely 
of much good in such attacks ; its use is in the chronic irritability, still to be 
spoken of. Sometimes it does well given in an effervescing draught. Bis- 
muth, too, is perhaps of greater value in the chronic form of the malady ; but 
even in this it is of great use, provided it be given in full dose. 

Chronic inflammatory indigestion, or chronic gastric catarrh, may either 
originate in some severe irritation insufficient to excite an acute attack, but 
lasting long enough to excite and keep up a subacute form, or it may follow 
on an acute case, when that has been improperly dealt with. Or yet again, 
attack after attack, each following on the other at frequent intervals, may 
finally leave the stomach in that irritable state we call chronic gastric catarrh. 
Such are very common after cholera. 

Diseases which tend to interfere with the venous circulation are very favor- 
able to chronic catarrh. Phthisis is very frequently complicated by it. So, 
too, contracted liver (cirrhosis) and contracted kidneys are both very frequently 
accompanied by catarrh of the stomach. Habitual excess in eating and drink- 
ing, too, very commonly ends by producing a chronic inflammatory state ; habit- 
ual obstruction to the passage of food from the stomach is a regular cause of 
chronic catarrh, whether the obstruction is clue to cancer or to simple stricture. 
The symptoms of the condition are those of aggravated indigestion. There is 
at all times a sense of weight and oppression across the chest, a general uneasi- 
ness after meals, and a tendency to flatulence, which may be considerable. 
Food may not cause pain, but it increases the uneasiness. The pain com- 
plained of is usually under the left breast, and extends through to the corre- 
sponding blade-bone. There is rarely tenderness on pressure. Heart-burn 
and acidity are generally very annoying, the appetite is very variable, and 
eating soon brings satiety — even the presence of a meal is often enough to 
turn the patient against it. Thirst is usually well marked some time after a 
meal, the tongue is usually furred, and there is a bad taste in the mouth in the 
morning ; the tongue in most cases is flabby, and the papillae on its surface 
raised and reddened. In other cases the tongue is raw, red, and inclined to 
crack, whilst in yet others it is covered with a thick yellow fur. The bowels, 
as a rule, are obstinately confined, and there is very often uneasiness of the 
lower bowel, which is increased by the distension necessary for the passage of 
the hardened motions. Frequently the hardened masses are covered with a 
glassy mucus. These motions are pale from deficient bile, and for the same 
reason the smell is unusually unpleasant. Sometimes the stools are frothy and 
loose, and this condition may alternate with the former. As might be expected 
from the habitual constipation, piles are frequent. The skin is dry and harsh, 
frequently sallow, and often with a tendency to scaly eruptions. The hair is 
dry, and tends to split and fall off ; the nails are furrowed, brittle, and marked 
with white lines ; and the teeth frequently decay. There is usually marked 
loss of flesh and strength, and the circulation, as indicated by cold hands and feet, 
is imperfect. 



IND 864 INF 

Headache is frequent. Irritability, timidity, and despondency are generally 
present. The sleep is disturbed, or there is sleeplessness, and the heart's 
action is irregular. The treatment of chronic catarrh of the stomach requires 
modification to the various customs. To use a rule, the best treatment is the 
avoidance of the condition ; but if there is an acute attack, tending to become 
chronic, we must do our best to stop it. Bismuth and magnesia, with or with- 
out alkalies, are the appropriate remedies. It is in this condition that nitrate 
of silver has obtained a great reputation. It does good, but must be used with 
care. It is best given in pill, half a grain for a dose, along with opium or 
belladonna. Oxide of zinc is of value in those cases where the nervous symp- 
toms predominate. In some cases, especially where food has been the cause of 
the irritability of the stomach, blue pill or calomel generally does good; but 
in children this, or the gray powder more frequently employed, must be used 
with caution. When due to obstruction in the portal system, mineral waters 
are frequently the best things to prescribe, especially if they can be taken on 
the spot. If not, such water as Piillna, Carlsbad, and Friedrichshall are the 
best. 

For habitual use as purgatives, too, aloes are of great service, as they act 
specially on the lower bowel, and so tend to relieve the constipation and piles. 
Small doses of the aqueous extract, or of the compound decoction are best 
given. Castor oil is also an excellent remedy for relieving oppression and 
heaviness about the stomach, frequently restoring a healthy appetite. Strong 
purgatives are, however, to be strenuously avoided ; and in many cases a small 
dose of aloes, iron, mix vomica, and belladonna before dinner will do more to 
keep the bowels open than anything. If the condition is due to alcoholic ex- 
cess, the liver must be seen to, and so mild mercurials and salines had best be 
given with opium if the irritability of the stomach is great. Even astringents 
may be given to check the copious mucous secretion from the stomach. The 
dyspepsia of consumption is most difficult to manage. Prussic acid often does 
good ; calumba and liquor potasses are better. In this malady purgatives must 
be avoided, for unfortunately in its course there is only too much risk from 
the purgation which arises from the disease. 

Pepsine and acids are both of great value when the irritability has been re- 
moved. The rules for food are much the same as for acute catarrh and atonic 
dyspepsia. 

Indigo is prepared from various species of plants belonging to the legumi- 
nous order of plants. The original substance is white; but from it may be pre- 
pared an indigo red and an indigo blue. It is this last substance which is com- 
monly employed. Dissolved in the strongest sulphuric acid, it forms a peculiar 
compound sometimes called sulphindigotic acid ; this is decolorized by chloride, 
and is used as a test of the presence of that substance. Indigo has been used 
in epilepsy, but its value is not understood. It appears in the urine as a bluish- 
green compound; sometimes it is found in abnormal urine. 

Induration is a term applied to the hardening of tissues around the seat of 
previous mischief; this induration may occur on the site of an old scar or 
wound, or an old abscess, or in the glands under the chin, etc. 

Infanticide. This term is used to signify the voluntary murder of an 
infant, either during the process of its birth or as soon as it begins to live an 
independent existence from its mother. The law on this matter is very pecul- 
iar, and before convicting any woman of the murder of her infant, it requires 
proof that she has been pregnant, that she has been lately delivered of a child, 
and that she had no assistance during the labor. The methods by which the 



INF 365 INF 

life of a newly-born .child may be sacrificed are, in medical jurisprudence, 
divided into those which consist in omitting the necessary services required by 
an infant, and by inflicting violence. It should not be forgotten that an infant 
may die during or immediately after birth, without any criminality on the part 
of the mother, and in cases of great exhaustion, where disgrace and shame 
would attend the exposure consequent on calling for help. According to the 
law of Scotland, the earliest period at which the crime of infanticide can be 
sustained is from the time of quickening. In England the period assigned by 
law dates from the seventh month, when the child is supposed to be capable 
of living. Experienced surgeons are able by many signs to judge from the 
dead body of a child whether it has ever lived or been horn dead ; the most 
certain proof is, however, by post-mortem examination. The state of the lungs 
indicates whether they have ever been inflated with air, and if so it is certain 
the child has lived ; the next question, therefore, to decide would be, whether 
its death resulted from natural or from violent causes, and on this decision rests 
the nature of the verdict in such a case. The objection of a jury to return a 
verdict of willful murder in the case of newly-born infants evidently killed is 
singular and not uncommon. In the central district of Middlesex (London) 
verdicts of willful murder on the bodies of newly-born children were returned 
in fifty-seven instances for the year 1872. This is a terrible revelation as to the 
loss of life in England, and the immorality which produces it, and is also sug- 
gestive as to the possibility of its prevention or diminution by legislative or 
humane institutions for the reception of mothers who by shame and misery are 
tempted to commit this crime. 

Infantile Convulsions are exceedingly common in children from the time 
of birth up to their seventh or eighth year, particularly about the period of their 
first teething. They are produced in a variety of ways, and often go off, leav- 
ing no evil effects behind them. The earliest convulsive phenomena of the 
kind are ordinarily what are called inward jits ; these commonly occur a few 
days after birth. The baby seems asleep, but its eyes roll so that the whites 
alone are seen, it breathes with some difficulty, and the face twitches or is 
drawn first to one side then to the other; this is commonly produced by indi- 
gestion ; the mother's milk may not agree, or improper food may have been 
given. A little dill water, or a drop of one of the volatile oils, or a little spirit 
of ammonia will relieve for the time, but this should be promptly followed by 
a teaspoonful of castor oil. Almost any irritation affecting the nervous sys- 
tem, local or remote, will in certain children produce fits. The symptoms of 
such fits vary. Most frequently the child is suddenly taken, loses conscious- 
ness and stops breathing ; sometimes the body is stiffened ; sometimes, and 
this is rather the rule, it is agitated by smart contractions and relaxations of 
the muscles. Usually the hands are clenched with the thumb in the palm, 
whilst the face becomes first red, then livid. The contents of the bladder and 
rectum are voided, and the eyes squint. Presently the limbs begin to relax 
and the child gradually recovers, presently falling into a sound sleep. More 
rarely it passes into a comatose state, and so perishes. Most frequently there 
is more than one attack, and sometimes they leave permanent damage of the 
nervous system behind them. As regards treatment there is not much to be 
done during the fit; everything should be loose about the child, and some water 
may be sprinkled on the head and face. Should the fit threaten to recur it is 
best to plunge the child in a warm bath up to the neck and shower cold water 
on the head. The bowels should be seen to, and a dose of calomel or castor 
oil given if necessary. Sometimes an emetic does good, and any source of 



INF 366 INF 

irritation, be it where it may. or what it may, should be sought for and 
removed. 

Infantile Mortality. See Mortality. 

Infection is a term used to denote that the disease may be carried from 
one person to another without either coming in contact. See Fevers. 

Infirmaries are institutions founded by benevolent persons for the treat- 
ment of the sick poor. They generally contain from sixteen to thirty beds. 
The staff consists of honorary physicians and surgeons, who visit the place in 
turns, of a resident medical officer, of a matron, and of sundry minor officials. 
They have also an out-patient department, where on certain days poor people 
attend and receive gratuitous advice and medicine, and in some places the 
poor in the immediate neighborhood are also visited at their own homes. 
These institutions are governed by a committee of influential people in the 
town, and, if of old standing, are possessed of considerable wealth from lega- 
cies and bequests left at different times. Medical and surgical cases are ad- 
mitted, but no midwifery cases, as a rule, unless there are special arrange- 
ments for the purpose. 

Inflammation. Inflammation may be roughly defined as an unnatural 
process, which manifests itself in increased vascularity and sensibility of the 
part attacked, and which is associated with more or less of constitutional dis- 
turbance. This process varies much as to form and degree of intensity, the 
symptoms being sometimes slight and harmless, as with the transient and 
superficial redness of a small portion of the skin caused by the bite of an in- 
sect, and in other instances most severe and dangerous, as in acute inflamma- 
tion of the lungs (pneumonia), or of the thin serous membrane of the abdo- 
men (peritonitis). Very few diseased processes occur in the organism which 
are not at some part of their course associated with inflammation, and the 
great majority of diseases are really due to this process. In ordinary cold in 
the head there is inflammation of the mucous membrane of the nose and the 
adjacent cavities ; in bronchitis there is inflammation of the mucous membrane 
lining the air-passages ; and in sore throat there is inflammation of the mucous 
membrane of the tonsils and fauces. Inflammation follows all severe injuries, 
and serves to repair wounds and to unite together portions of fractured bone. 
When the process runs its course quickly, and is high and severe, we have 
acute inflammation ; when the process is slow and lasts for a long time the in- 
flammation is called chronic. Sthenic inflammation is an acute form of rapid 
progress, which is met with in strong and vigorous persons. Asthenic inflamma- 
tion is a low and lingering form, the subjects of which are generally debilitated 
and unhealthy residents in towns. There are many forms of inflammation in 
which the symptoms of the process are modified by some constitutional dis- 
ease, as scrofula, gout, syphilis, or by blood poisoning, as in cases of erysipelas, 
carbuncle, and the eruptive fevers. In cases of this kind the process is called 
specific. The inflammatory process may terminate in complete restoration of 
the affected parts, or in effusion of serous fluid, or solid fibrinous material, or 
of pus. In these latter the inflammation, according to the character of the 
material effused, is called (edematous, adhesive, or suppurative. 

The chief manifestations of inflammation are the four classical symptoms of 
redness, swelling, heat, and pain, which were taught by Celsus eighteen cent- 
uries ago. Redness of an inflamed part is a necessary consequence of in- 
creased vascularity. The small vessels are dilated and distended with blood, 
and in some cases new vessels are formed. This symptom is very manifest in 
catarrhal inflammation of the conjunctiva (ordinary ophthalmia). Another 



INF 367 INF 

cause of the redness is rupture of some of the over-distended vessels, and effu- 
sion of blood into the inflamed tissues. The redness of inflammation varies 
much in tint and in intensity. In acute inflammation of the surface of the 
body there is a scarlet blush, which differs from the dusky redness of erysipelas 
and the coppery tint of syphilitic eruptions on the skin. In inflammation of 
tissues which possess no proper blood-vessels, the redness does not extend be- 
yond the adjacent structures : thus, when the cornea is inflamed, it does not it- 
self become red, but is surrounded by a zone of enlarged conjunctival vessels. 
Swelling is due in the early stages of inflammation to the increased quantity 
of blood contained in the vessels of the affected tissues, and afterwards to the 
effusion of fluid. The fluid effusion of inflammation varies in character ac- 
cording to the intensity of the inflammatory process and the health of the 
patient. In debilitated patients the exudation resembles unhealthy pus, and 
in chronic inflammation the effusion is fibrinous, and forms a hard and tense 
swelling. In croup and diphtheria the effusion contains much fibrine or coagu- 
lated material, and forms white membranous deposits on the surface of the in- 
flamed mucous membrane. Pain varies in intensity, and is influenced more 
by the structure and relations of the part inflamed than by the severity of the 
inflammation. It is most acute in inflammation of the structures which do not 
readily yield to the increased flow of blood and the effusion of serous fluid, as, 
for instance, bone and cartilage ; it is also very violent when the inflamed 
structures are bound by thick fascia. In acute inflammation it is not restricted 
to the affected parts, but radiates for some distance along the nerve supplying 
those parts. Pain in inflammation is due to stretching and compression of the 
nerve fibres of the inflamed tissues. The temperature of an inflamed part is in- 
creased in consequence of the increased flow of blood, and of the active changes 
of tissue which take place in connection with the inflammatory process. 

No one of the above symptoms is peculiar to inflammation. Redness may 
be due to venous obstruction, and to that process of local determination of 
blood to a part called hypergemia. The severe pain of tic-douloureux, and other 
varieties of neuralgia, is not due to any inflammatory process. Increased heat 
of the skin of the face and head follows division, in an animal, of the sympa- 
thetic nerve of the neck. Acute inflammation is invariably associated with a 
train of constitutional symptoms indicating the condition known as feverish- 
ness. This condition in cases of idiopathic inflammation, as pneumonia or 
facial erysipelas, is termed pyrexia, or symptomatic fever, and in cases of in- 
jury, as compound fracture, surgical or traumatic fever. In a typical case, 
such as one of pneumonia or of compound fracture, the patient first complains 
of chilliness, or has an attack of shivering. Vomiting sometimes occurs at 
this stage. The surface of the body then feels very hot, and the mouth and 
tongue become dry ; the urine is scanty and dark-colored ; the respirations are 
increased in frequency, and the pulse is raised to 120° or 130°. There is in- 
tense thirst, and the patient suffers from headache, has no appetite, and feels 
very uncomfortable. At times, especially at night, he is "light-headed," and 
if he has been a drinker becomes violently delirious. These symptoms vary 
in intensity in different patients. In cases of inflammation, the invariable co- 
existence of feverish n ess is shown by these two symptoms, high pulse and high 
temperature. To this latter symptom considerable attention has been paid by 
the medical profession for some few years, and the clinical thermometer has 
now become a valuable means in the diagnosis and prognosis of disease. When 
kept for about ten minutes in the arm-pit or mouth of a patient suffering from 
inflammation, this instrument will indicate an elevation of temperature by four 



INF 368 INF 

or five degrees. Instead of 98.4° Fahr., the normal point, the temperature of 
the patient will he 101°, 102°, or 103°, or even higher. As a rule it does not 
rise very far above 102 Q . This increased production of heat also occurs in the 
fevers, commonly so-called, as typhus and typhoid, and in the eruptive fevers. 
The cause of this increase of bodily temperature in cases of inflammation has 
not yet been satisfactorily determined. According to the views of many in- 
fluential pathologists, the blood as it flows through the inflamed part is warmed, 
the heat thus acquired being accumulated in the general mass of the blood and 
distributed to all parts of the body; the circulating fluid, the temperature of 
which has been thus increased, then undergoes active changes, and also stimu- 
lates every part of the body through which it flows to active textural change. 
This is produced by over-production and increased excretion of nitrogenous 
waste products, processes which are always associated with elevation of tem- 
perature. 

By other pathologists it is supposed that portions of the inflamed tissues are 
disorganized and destroyed, and that the products of this destruction are taken 
up by the blood, and produce active changes in that fluid and in the tissues to 
which it is distributed. 

In acute inflammation the blood, when shed into a vessel, as in the operation 
of bleeding, coagulates slowly, owing to excess of fibrine, and the red corpus- 
cles run together and form masses which fall to the bottom of the vessel before 
the clot is formed. The fibrine thus strained coagulates at the surface of 
the mass of blood, and forms a yellowish-white clot, which contracts and is de- 
pressed at its centre. When these changes have taken place, the blood is said 
to be " buffed " and " cupped." 

The causes of inflammation are of two kinds, exciting and predisposing. Of 
the former the following are the chief : injuries, as wounds, fractures, the in- 
troduction of foreign bodies ; under this head may be included intense heat and 
cold, the effects of which are shown in cases of burns and scalds on the one 
hand, and in cases of frost-bite on the other; catching cold is a frequent cause 
of inflammation; another frequent cause of inflammation is the retention 
within the body of secretions, and of dead and putrefiable material ; a portion 
of dead bone or of a slough formed after the mortification of a portion of an 
organ will generally give rise to prolonged inflammation in the surrounding 
parts ; poverty of the blood, due to chronic disease or to insufficient nourish- 
ment, and a poisoned state of that fluid may give rise to inflammation. In- 
flammation of a part occasionally follows injury or division of the nerve by 
which that is supplied. 

The predisposing causes of inflammation are : advanced age, debility from 
insufficiency of nourishment and in consequence of some exhausting disease, 
abuse of alcohol, residence in damp and badly ventilated rooms, great mental 
and bodily fatigue, chronic diseases of the blood-vessels, certain morbid condi- 
tions of the body, as gout, rheumatism, and scrofula. In favorable cases, where 
the affected tissues return at once to their previous healthy appearance and 
condition on the subsidence of the general symptoms of inflammation, the pro- 
cess is said to terminate in resolution. The serous fluid effused in cases of 
acute inflammation often coagulates and is converted into a fibrous and living 
substance, which in cases of wounds and fractures serves to bind together the 
several parts, termination in adhesion. The process sometimes terminates in 
the formation of pus, which is either discharged from an open raw surface or 
is accumulated in the midst of living tissues and forms an abscess. 

The process of inflammation, as revealed by microscopical observation, has 



INF 369 INF 

of late years been a subject of increased interest, in consequence of the results 
of investigations made by modern German biologists, and of the prevalence of 
new views concerning the nature of certain constituents of the blood. The 
following particulars are gathered from an able and elaborate article on this 
subject by Dr. Burdon-Sanderson contained in the fifth volume of Holmes's 
System of Surgery (second edition). 

First stage in the process of inflammation. From microscopical observations 
of the web of the frog's foot and the mesentery of the frog, it has been found 
that on the local application of an irritant the smallest arteries, and subse- 
quently the capillary vessels, become detached and slightly increased in width, 
so that there is more or less contortion of these vessels ; at the same time there 
is acceleration of the blood-current. This dilatation on the application of 
most irritants, as dilute sulphuric acid, acetic acid, caustic soda, etc.J' com- 
mences immediately, but where liquor amrnonise or carbonate of ammonia is 
used, there is at first contraction of the capillaries, with retarded flow of blood, 
which, after lasting for an hour or two, is followed by dilatation and acceler- 
ated flow of blood. Concerning the cause of this phenomenon, there are and 
have been many views, the most probable, however, being that it depends 
upon irritation of the nerves which proceed from the injured or inflamed part 
to the brain, which irritation or impression is then reflected through the spinal 
and sympathetic nervous system, and finally along the nerves which are distrib- 
uted to the walls of the vessels of this part. 

Second stage. In the second stage of the inflammatory process the current 
of blood becomes slower and slower, then oscillates, and finally ceases alto- 
gether. If the vessels of the inflamed part be examined in this condition, 
which is called stasis, it will be found that the inner surface of each vessel is 
lined by a continuous layer or pavement of white blood-corpuscles, some of 
which pass from the vessel into the surrounding tissue in the following man- 
ner : " Here and there on the outer contour of the vessel minute colorless, 
button-shaped elevations spring, just as if they were produced by budding out 
of the wall of the vessel itself. The buds increase gradually and slowly in 
size, until each assumes the form of an hemispherical projection, of width cor- 
responding to that of a white blood-corpuscle. Eventually the hemisphere is 
converted into a pear-shaped body, the stalk end of which is still attached to 
the surface of the vein, while the round part projects freely. Gradually the 
little mass of protoplasm removes itself further and further away, and as it 
does so begins to shoot out delicate prongs of transparent protoplasm from its 
surface, in no wise differing in their aspect from the slender thread by which it 
is still moored to the vessel. Finally the thread is severed and the process is 
complete. The observer has before him an emigrant white blood-corpuscle." 
These phenomena were first observed and described by Professor Cohnheim, 
of Germany, whose words, as quoted by Dr. Burdon-Sanderson, are here given. 
Those white blood-corpuscles then accumulate in considerable quantities around 
vessels, and, together with the serous fluid of the blood, a liquor sanguinis, 
which is effused at the same time, give rise to the swelling which forms one of 
the cardinal symptoms of the inflammatory process. 

Besides the above changes which have their seat in the blood-vessels, there 
are others which have their seat in the tissues, — textural changes. It has 
been found by microscopical examination, both of the non-vascular tissues, 
such as the cornea, cartilage, and tendon, and also of the vascular tissues, as 
connective tissue and muscle, that in consequence of the stimulating properties 
of the effused liquor sanguinis, with which an inflamed structure is soaked, the 



INF 370 INF 

permanent cells of the affected tissue which have for their function the main- 
tenance of the unchanging life of these tissues, germinate, as it were, and be- 
come metamorphosed into mobile masses of protoplasm, resembling in all re- 
spects the white corpuscles of the blood. These bodies, when collected in 
large quantities, form pus, and the inflammatory process then terminates in 
suppuration. These views, as to the textural origin of these mobile bodies, 
have not been undisputed. By Professor Cohnheim and his followers it is held 
that these and the pus cells formed in masses are not the offspring of the per- 
manent tissue cells, but wandering blood-corpuscles which have a tendency to 
escape from the vessels, as has been stated above, and then to move away 
from the blood-current in a direction at right angles to the axis of the vessels 
from which they have escaped. There seems to he no doubt that pus is 
formed both by wandering cells and by the cells formed by textural changes, 
and in acute and rapid suppurative inflammation it is probable that the pus 
cells are mostly, if not all, wandering blood-corpuscles. 

Influenza is a specific and epidemic fever, which chiefly attacks the lining 
membrane of the nose, larynx, and bronchial tubes, lasting from four to eight 
days, and not preserving the individual from a future attack. This disease has 
occurred in various countries at different times, and has received a vast num- 
ber of names; in the seventeenth century it appeared in Italy and first re- 
ceived the name of influenza, because it was attributed to the influence of the 
stars. The area attacked has also much varied in extent ; sometimes only 
part of a country has been affected, at other times it has spread over a great 
part of the civilized world. One of the earliest recorded epidemics in England 
appears to have taken. place in 1510; since that time America and England 
have been invaded by it quite often. A disease is said to he " endemic " when 
it is confined to a small area, as a village or town ; " epidemic " when it 
spreads over a country ; " pandemic " when it invades a large portion of the 
earth's surface. Influenza occurs in both an epidemic and pandemic form. 
The poison seems to be conveyed by the air, and persons at a distance from 
land may become attacked. Attacking a community, the disorder generally 
remains among them from six to eight weeks, but occasionally it has remaiued 
longer ; the epidemic will completely disappear then for a time, nor is it usual 
to find an occasional case breaking out in the interval of epidemics. It is 
common to hear people complain in the winter of having an influenza cold, 
but this is a misapplication of the word. The onset of the disease is generally 
very rapid, while the decline is more gradual, and may last several weeks. 
Various physical conditions have been supposed to influence the outbreak of 
this disease. Volcanic eruptions were once thought to be a cause, but there 
has been no trustworthy evidence of this ; soil seems to have no effect, for the 
complaint has appeared in every variety of country, in high lands as well as 
in low lands, in hill countries as in marshes and plains. Nor does the 
time of the year seem to have any effect, since it has been prevalent at all sea- 
sons. There is also no connection between temperature and influenza ; it 
occurs in high as in low temperatures ; nor does any sudden variation of cold 
or heat seem to produce any effect. Moisture also has no apparent influence, 
nor is there evidence at present that any atmospheric condition has any effect 
on this disorder. The intercourse of human heings does seem to have an in- 
fluence on the disorder; thus an affected person coming into a village seems 
to be a centre from which the disease spreads ; nevertheless it is very remark- 
able that thousands may be attacked in the same town in the course of a few 
hours, while in other contagious disorders the progress is much slower. In 



INF 371 INF 

this disease, as in other contagious diseases, there seems to be a period of incu- 
bation, when the poison seems for a time to be latent in the system, before 
any of the marked symptoms declare themselves ; and although in most cases 
persons seem to be suddenly struck with influenza, yet there is probably a pe- 
riod of incubation, which may be - very short and may last for some days. 
Most people who have suffered from a contagious disease are not liable to a 
second attack, but iu influenza one attack gives no immunity from another, 
although persons seldom suffer twice in the same epidemic. Various specula- 
tions have been made as to the nature of the exciting causes of this disorder. 
It cannot arise from contamination of water, as it would then be confined to a 
particular locality, nor to any kind of food. The rapid way in which it 
spreads shows that the poison must exist in and be conveyed from place to 
place by the air, for in this way alone can we account for the rapid transmis- 
sion of the disorder. But as to the nature of the poison in the air, nothing 
at all is known ; were it a gas, it would become diluted by mixing with air, 
and lose its virulence, but this is not the case in influenza ; nor does it seem to 
be made of organic matter, or to be suspended mineral matter. One thing 
seems clear, that the poison can multiply in the air and reproduce itself. Nor 
can the poison be accounted for by the presence of fungi in the air, for 
warmth, moisture, and organic effluvia favor the growth of these minute organ- 
isms, but seem to have no effect on influenza. Race and sex seem to be equally 
attacked by the disease ; the young are said to be less liable to it than old 
people. Overcrowded habitations seem in some epidemics to have increased 
the mortality, and places which are low, clamp, and badly ventilated appear 
to predispose to it. 

Symptoms: The symptoms consist chiefly of a general and definite febrile 
disturbance, and of a special affection of the nose and air-passages. The disease 
commences with shivering or a feeling of coldness down the spine, with a hot, 
dry skin, quick pulse, thirst, and severe headache. Sometimes these symptoms 
come on suddenly, sometimes they develop slowly in two or three days. If 
they come on suddenly, intense frontal headache with aching pain over the eyes 
is generally the first symptom. This feverish state usually lasts four or five 
days, and then gradually disappears, and its disappearance may be accompanied 
by profuse perspiration or a troublesome diarrhoea ; in some cases the fever 
may last several days longer, but then some complication has probably arisen and 
given rise to inflammation of the lungs or some other organ. The peculiar 
catarrhal affection usually follows the early symptoms of the fever ; it begins 
with swelling and dryuess of the lining membrane of the nose, and the tissues 
or cavities of the forehead, causing great frontal headache and frequent sneez- 
ing ; the mucous membrane of the eyes, or the conjunctiva, is generally affected 
in a less degree, and a thin acrid discharge takes place ; now and then bleeding, 
occurs from the nose ; this condition then extends all the way down the air- 
passages, even down to the smallest branches of the bronchial tubes. This 
affection may occur in the whole tract of the membrane at once, or, beginning 
in the nose, it may spread downwards into the lungs. The inside of the mouth 
and the tongue and pharynx may also become implicated, but in a less degree. 
The discharge from this inflamed surface is at first thin and acrid, and at times 
bloody ; it then becomes thicker, tenacious, and purulent. The patient sneezes, 
has a troublesome and violent cough, and pains in the side. There is great 
distress in breathing, and the pallor of the face and lividity of the lips show 
how great is the obstruction to the circulation in the lungs, for the blood be- 
comes in such cases imperfectly aerated, and, owing to the accumulation of 



INF 372 INF 

carbonic acid, flows through the vessels with difficulty. In most cases the ca- 
tarrh is at its height by the third or fourth day, and generally declines from 
the fifth to the seventh, but in severe cases it may last longer. Coincident 
with the fever and catarrh, and perhaps in proportion to the severity of the 
former, is a peculiar state of the nervous system. There is great depression 
and loss of spirits, with aching pains in the muscles and neuralgic pains in 
various parts of the body or extremities. The mind is often affected, and the 
patient may become stupid or delirious. The temperature of the body appears 
to be raised in most cases, but no exact observations on this point have yet been 
made. .Sweating of the skin often occurs during the defervescence of the fever, 
or at the time when a descent of the temperature takes place, but rarely in the 
early stages. Crops of minute transparent vesicles, or little blisters containing 
fluid, are often seen on the skin. Meningitis, or inflammation of the mem- 
branes of the brain, and otitis, or inflammation of the ear, may come on now 
and then. Great delirium, as well as intense headache, is a dangerous symptom. 
Neuralgic pains are met with in many parts of the body, and there is also a 
remarkable prostration of the muscular strength. The cough comes on in par- 
oxysms, and may be so severe as to bring on a rupture, or even abortion in 
pregnant women. There is but slight expectoration at first, and then the phlegm 
which is expectorated is stringy and often bloody ; then it becomes more con- 
sistent, opaque, and purulent. Bronchitis, or inflammation of the bronchial 
tubes, pneumonia, or inflammation of the lungs, and pleurisy, or inflammation 
of the serous covering of the lungs, are present in some cases, and add to the 
danger ; however, the frequency of their occurrence varies much in different 
epidemics ; their presence may be detected by a careful physical examination 
of the chest, and by the increase in the distress of breathing. Vomiting and 
nausea often come on at the commencement of an attack ; diarrhoea, as a rule, 
occurs later on in the disease, when the fever begins to abate. In some cases 
the skin assumes a yellow tint, and bilious vomiting comes on. As in most 
febrile affections, the urine is at first high-colored and scanty, and afterwards 
it often deposits a pink or reddish sand, made up of lithates. Occasionally 
there is complete or partial suppression of the urine. Now and then swelling 
of the glands under the chin or in the neck has been observed. Convalescence 
is often retarded by rheumatic-like pains in various parts of the body, and by 
prolonged debility or unusual nervous depression. 

Mortality: The mortality varies much in different epidemics, yet at no time 
is it very high, for in the epidemic of 1837, which was looked upon as severe, 
not more than two per cent. died. Age seems to have an influence on the death- 
rate, and it is more fatal among the old than among the young. It is higher, 
too, in those who have suffered from heart disease, bronchitis, or emphysema, 
.and especially in those who have weak and fatty hearts. 

Treatment: When the disease has declared itself the patient must be kept 
in bed, and the room should be cool and well ventilated, although draughts are 
to be avoided. Solid food for the first three or four days had better be avoided. 
Plenty of cold drinks may be given, and if there is much fever they may be 
iced ; those are the more grateful which are made slightly acid ; barley-water 
and lemon juice, raspberry vinegar, oranges, and cream-of-tartar water may be 
given with benefit. Stimulants, except in case of the old and feeble, need not 
be given ; claret or hock, in combination with seltzer water, may be given if 
necessary. Beef-tea in not of much use, but the patient may take plenty of 
milk. Too much food should not be given, as it will only tend to derange the 
stomach ; too much fluid should not be given at one time, as it may cause painful 



INF 373 INF 

distension of the stomach and flatulence ; nor should any acid drink be taken 
just before or after the administration of milk, as it will only cause clotting of 
the latter and perhaps subsequent vomiting. The patient may be allowed solid 
food as soon as the severity of the fever has passed away ; a portion of a boiled 
or fried sole or some well-boiled mutton may be given at first, or any easily 
digestible food ; in these cases, however, the diet should be similar to that which 
is recommended in the article on Fevers. The air of the room should be kept 
moist by keeping a kettle of boiling water on the fire, or by putting boiling 
water in shallow vessels about the room; in this way the steam passing into 
the air in the room keeps it moist and eases the cough. Drugs are not of very 
much use, and in slight cases nothing is required, but some cooling saline or 
effervescent medicine may be given to check the febrile symptoms and to allay 
thirst. If pleurisy supervene and there be much pain, a few leeches to the 
affected side may alleviate that symptom. In the early stages a purgative is 
often given with benefit, but this must not be carried too far ; a dose of calomel, 
followed by a saline purgative, will generally suffice to open the bowels enough 
and relieve the patient, but the persistent use of purgatives is injurious. In the 
case of children a dose of gray powder may be substituted for the calomel, or 
a little castor oil may be given for the same purpose. In no case should re- 
peated doses of any mercurial preparation be given so as to produce salivation. 
Opium should be administered with the greatest caution ; in all cases where 
there is a tendency to congestion of the lungs this drug seems to intensify the 
condition, so that its use may seriously increase the danger of the patient ; but 
if there be not much congestion and the cough be very violent, then small doses, 
of Dover's powder may be given, or preparations containing belladonna. If 
there is great tightness across the chest, or a severe stitch in the side, hot lin- 
seed-meal poultices will be of great use in alleviating the pain ; flannels wrung 
out of hot water may be applied with the same object, or, if the pain be very 
severe, the application of three or four leeches will be found very useful. 
Later on, when the expectoration is more profuse, ammonia, chloric ether, and 
senega may be ordered with advantage. Quinine seems to be very useful as 
soon as the acute stage is passed. Blisters do no good, and only increase the 
patient's sufferings. Inhalation of steam may be tried, either by using an 
ordinary inhaler, or by breathing in the steam from a jug of boiling water. If 
the diarrhoea be excessive it should be checked. Should suppression of urine 
come on, a hot hip-bath should be used, and flannels wrung out of hot water 
ought to be applied to the loins ; dry cupping is also useful, and the patient 
should drink plenty of linseed tea or barley-water. An ice-bag to the head 
will often relieve the intense frontal headache ; this may be applied by putting 
pounded ice into a bladder or india-rubber bag, and may be kept on for two or 
three hours. Sometimes a single piece of linen dipped in vinegar and water 
may be applied to the forehead with relief. During convalescence iron and 
quinine should be given to promote an appetite and to act as a tonic to the sys- 
tem. A generous and nutritious diet must be given, including milk, meat, and 
some beer or wine. For some time after an attack the patient should avoid ex- 
posure to cold, and wear flannel next the skin. 

Infra-mammary Region. See Chest. 

Infusions are preparations of remedies which yield their properties to hot 
'water. The substance is, as a rule, reduced to coarse powder or roughly com- 
minuted, placed in a pipkin, and covered with a measured quantity of distilled 
water. In most of the preparations boiling water is used, and the time of in- 
fusion varies from ten minutes to four hours, according to the time requisite 



INF 374 IN J 

to separate the active ingredients. In some few cases water at a lower tem- 
perature is used ; with chiretta and cusparia, water at 121° Fahr. is used ; with 
yet others, as columba and quassia, absolutely cold water is used. In any case 
the great point with an infusion is that no heat shall be applied after the first. 

Infusoria are minute microscopic organisms developed in water in which 
animal or vegetable matter has been dissolved by steeping. 

Inhalation is a method of introducing remedies into the system which has 
only recently come into vogue. Some of the substances given in this way are 
nominally in a gaseous state, and only reduced to the fluid condition for the sake 
of convenience in stowage : such is nitrous oxide, the favorite dental anaesthetic. 
Others, again, are substances which very readily pass from the fluid to vapor- 
ous condition : such are chloroform and ether. These substances are used to 
deaden pain or overcome sensibility generally ; but. what are technically termed 
inhalations are substances which, nominally solid or fluid, can be made to 
evaporate, and so act as local medications to the lungs and air tubes. Conium, 
creasote, and hydrocyanic acid are given in this way. To enable the substances 
to be volatilized, and these, too, at a suitable temperature, proper vessels have 
been made called inhalers. The best we have seen is the invention of Dr. 
Morrel Mackenzie. It consists of earthenware : an outer vessel containing 
water, and an inner with a tube containing the volatile material to be inhaled. 
The outer vessel is filled with hot water and suffered to cool to 100° Fahr.; 
the tube of the inhaler is then applied to the lips, and inhalation goes on. 
The heat is kept up by an ordinary Child's light. This apparatus answers 
Well, but it is rather expensive. We generally tell the patient to put some of 
the material to be inhaled in a jug with hot water, to place it close to the 
mouth, and cover head and all with a towel. The plan answers well. The 
smoking of stramonium, fumigation by sulphurous acid, and inhaling the fumes 
of nitrate of potash paper are all modifications of this process. 

Injection, Hypodermic or Subcutaneous, is a method of giving 
some of our more powerful remedies which has recently come into extensive 
use. For practicing this plan of medication a small and carefully graduated 
syringe is required, but arranged so that the piston shall not touch the liquid. 
It need not contain more than six minims, but should be long enough to 
show a very distinct interspace between each minim mark. The jxnnt must 
consist of a fine hollow gold needle, but this may be pointed with steel and so 
have the openings in the substance of the gold half way up its sides. 

The solutions to be used must be highly concentrated, so that a drop will 
suffice for a dose, though some prefer a strength somewhat less. This plan 
has been mainly used for giving morphia, and its advantages are that less is re- 
quired to fulfill any given purpose ; this is introduced irrespective of the stomach, 
which so is not interfered with in the fulfillment of its functions ; moreover, 
it causes less disturbance of the constitution than when given in the old way. 
Acetate of morphia is the salt commonly used, the other, the hydrochlorate, 
being less soluble, and it is usually so prepared that it will easily remain fluid, 
and that one, two, three, or four minims shall contain the ordinary dose, one- 
fifth of a grain. 

The syringe having been filled, the skin of the fore-arm, or whatever portion 
of the body is selected for the purpose, though that is best, is pinched up be- 
tween the forefinger and thumb, the sharp point of the needle is thrust smartly 
through the stretched integument well into the tissues beneath, and the piston 
is pressed until, measured by the marks on the syringe, the proper dose has 
been ejected from it, when the syringe is to be smartly withdrawn, the left 
thumb covering the orifice as it leaves the skin. 



INO 375 INS 

Sometimes troublesome sickness follows the use of morphia in this manner, 
and even fainting of a more serious character. This is avoided by the addi- 
tion of a small quantity of atropine to the solution. 

Atropine itself, or rather its sulphate, is sometimes used in this way, but 
must be employed with caution. 

Chloral hydrate has been used in the same way, and successfully. So, too, 
have a variety of other substances, many of them altogether unsuited for the 
purpose ; for it is requisite that the substances should be unirritating in them- 
selves, and so not likely to set up inflammation in the parts into which they 
are injected. 

Strychnia has been injected under the skin in certain cases of paralysis, ap- 
parently with good effect. But the curious thing with regard to it is that 
doses have been administered in this way which could not have been given by 
the mouth. We should strenuously advise its avoidance. For the public, a 
much more practical and important point is this, — that quinine may be so used 
with advantage in malarial fever ; and as by the subcutaneous method about 
one third of the usual quantity suffices, this constitutes a great saving when 
the drug is scarce. Moreover, quinine not being poisonous, this remedy may 
be so given by any well-instructed individual, and the good so done may be 
immense. The sulphate of quinine should be dissolved by a drop or two of 
dilute sulphuric acid and a little water, no more than will dissolve it at blood 
heat ; or perhaps it is better to dissolve with a sufficiency of acid, to be subse- 
quently neutralized by liquor potassse as nearly as it will bear. The solution 
should be injected at blood heat, or the alkaloid will crystallize out. This ap- 
plication of the hypodermic method is invaluable for those going into malarial 
regions. 

Inoculation really means the introduction of any poisonous matter, particu- 
larly if that be of an animal origin, beneath the skin. It has come, however, to 
mean in great measure the introduction of the small-pox virus into a healthy 
system. The term vaccination is on the other hand limited to the introduc- 
tion of cow-pox into the system in the same way. The plan of inoculating 
with small-pox has been known in the East from a very remote antiquity, and 
was introduced into England from Turkey in 1717 by Lady Mary Wortley 
Montagu. Nowadays, when vaccination has become almost universal in this 
country, the practice of inoculation has fallen into desuetude. Nevertheless, 
occasions may arise when its practice would be sound wisdom. Abroad, for 
instance, where sometimes it is impossible to procure vaccine matter, should 
&n epidemic of sma]l-pox break but, it might be good policy on the part of an 
American to inoculate his family. Should the plan be had recourse to, every 
individual of the family must be inoculated, provided they have not suffered 
from small-pox ; otherwise the disease would spread in the ordinary way, and 
run in the non-inoculated individuals its ordinary course. The method of in- 
oculating is as simple as that of vaccinating ; any instrument sharp enough to 
scratch the skin is to be dipped into the small-pox matter, and the skin of the 
upper arm scratched until the blood begins to appear." This should be done in 
one or two places slightly apart. Very probably no other eruptive spots will 
appear. 

Insanity, being a word of negation, is not easy to define. Doubtless we 
may speak of it correctly enough as any condition which is not that of sound 
mind, but as this soundness of mind cannot be judged absolutely, but only rel- 
atively, in giving such a definition we are simply tossing the ball from one 
hand to the other. 



INS 376 INS 

Each case, in point of fact, must be considered by itseli and as a whole. 
Nay, more ; the law winch defines insanity lays down different tests to be ap- 
plied in different classes of cases. Broadly, it may be said that the tests of 
lunacy, which term is commonly used in exactly the same sense as insanity, 
are in each case incapacity to manage property or danger to the public ; in 
criminal law, however, it is broadly laid down that the test of sanity is the 
knowledge of right from wrong, — a test, as has been well said, which, applied 
to our lunatic asylums, would set at liberty three-fourths of their inmates. It 
would be useless here to enter into metaphysical speculations as to the con- 
nection between mind and brain, or the alterations in brain substance which 
are most commonly associated with the insane condition ; suffice it to say that 
the current belief is that in the great majority of cases of insanity there is a 
change in the brain substance, just as there are changes in the lung in diseases 
of that organ, or of the heart when that part of the body is affected. For just 
as the function of the lung is respiration, and that of the heart circulation, so 
is the function of the brain the manifestation of mind. As we find in other 
parts of the body, however, when the self-balancing power is lost or in abey- 
ance, there may be disorder of its functions without any marked, or at all 
events protracted, signs of local change, so we may have, in the case of the 
brain, temporary insanity without any permanent disease of its structure such 
as gives rise to the more permanent form of the malady. The causes of insan- 
ity are generally assumed to be of two kinds, as is usual in medicine, pre- 
disposing and exciting ; but the so-called predisposing causes mean merely a 
state in which the individual is more likely to become insane than if the same 
set of circumstances were operating on him in any other state. Accordingly, 
the term predisposing cause may be looked on as synonymous with tendency, 
and the origin of these tendencies has here to be discussed. 

By far the most potent of these tendencies is derived from hereditary trans- 
mission, or, as would sometimes seem, transmission from collateral branches 
of the family. It is of the greatest possible importance fully to understand 
and to face the tendency of insanity to become hereditary, for an individual 
with such an inheritance, if duly guarded, may pass through life fairly able 
to fulfill its duties, whereas if the fact of this inheritance be ignored, and the 
individual left to face the world like men of stronger mental equilibrium, it 
is more than likely that at some crisis the equilibrium will be upset more or 
less permanently. The most difficult question arises, however, when marriage 
comes into play. Too often these things are kept profoundly secret, or even 
intentionally hidden away, especially where property is concerned ; the result 
in many cases is unfortunate, the more so that the consequences of the decep- 
tion frequently fall on the guiltless. We may, however, lay it down as a rule 
that if one has once been insane — be the individual male or female, though 
the rule is more binding on the latter than the former — marriage should 
determinedly be put out of the question. Much more difficult is it to decide 
in the case of those who belong to an insane family, but who have not them- 
selves shown any signs whatever of the malady. There is always a certain 
risk, and this must be fairly faced, but the risk is less the further removed the 
insanity is from the individual concerned. Thus, an insane uncle or aunt 
would be a matter of much less moment than an insane father or mother, and 
an insane father and mother portends less risk than does an insane brother or 
sister. This heredity, however, tends to obliterate itself in course of time in 
two ways. Intermarriage with a healthy stock gradually diminishes the tend- 
ency to insanity in the survivors, and there is besides not only a natural but 



INS 377 INS 

an artificial tendency to put an end to the heredity from the increasing num- 
bers thereof. Thus, a certain number of those tainted will probably be inca- 
pable of propagating the race, and a certain number more being locked up will 
have no opportunity ; and so, between the two, the insane members of the 
family tend to die out, whilst the stronger, having intermarried with a more 
healthy stock, in course of time become like other people. Age has something 
to do with the liability to insanity. It is greatest between 25 and 40, least in 
the first ten years of life. Then, too, the nature of the insanity varies with 
the age at which the individual is attacked. In the earlier years of life there 
is much more violence connected with insanity than there is with the later; 
if this rule is reversed, the likelihood of recovery is very greatly lessened. 
Sex, as already hinted, has a good deal to do with the liability to insanity, 
though not in the way one might have conceived. When men have grown up 
they are exposed much more to conditions likely to disturb the mental equilib- 
rium than are females ; but, on the other hand, if there is a tendency to insan- 
ity in married females, it is, especially in the time of child-bearing, etc., likely 
to have full effect. Next come the causes called exciting, which are special 
to the individual, and not to any class or group, though practically it is found 
that the same causes do operate in a very considerable number of instances. 
Chief among these are the moral causes of insanity, which may operate sud- 
denly in the way of mental shock, or they may act over a number of years. 
Doubtless the former are the more potent in destroying mental equilibrium, 
especially in a mind which is badly balanced by heredity, or by means of the 
individual's own habits and training. These last, however, belong rather to 
the group of physical exciting causes. The most important, according to all 
accounts, is the inordinate use of alcohol. This is especially to be avoided in 
those of originally weak mind. 

The symptoms of insanity differ greatly from the signs of any other disease. 
They consist in great measure of the sayings and doings of the insane individ- 
ual, either acquired by the observer from direct inspectiou or by hearsay. 
There are certain words used in connection with the mistaken beliefs of the 
insane, which, though in ordinary parlance used synonymously, yet, strictly 
speaking, have got totally different significations. These are delusion, illusion, 
and hallucination. 

A delusion is a false belief relating to something which has a real existence, 
but to which the insane individual supplies attributes totally false. Thus he 
entertains a belief that some one — probably the person least likely to do so — 
desires to swindle him ; that he himself is a prince possessed of boundless 
wealth, etc. 

An illusion is a false interpretation of the senses. There is something to 
be and something to have, but the patient gives them a totally false signifi- 
cance. A few rag's are gorgeous robes; pebbles, pearls of great price; a few 
words spoken in an ordinary tone a command to an army, etc. 

An hallucination is, on the other hand, a mistake on the part of the senses. 
The eye or the ear itself seems to be at fault ; the patient hears and sees things 
where there is nothing to see or hear. The word delusion is that commonly 
used so as to cover both the other terms, but should be limited to the mistaken 
imaginings of one whose brain is disordered. These delusions are sometimes 
of a gloomy description. The patient is depressed or nervous, and proceeds to 
account for this feeling in the way most congenial to his fancies. A rich man 
may imagine himself a beggar ; a good and worthy man damned to all eternity. 
Moreover, everybody knows it and treats him accordingly, or he has some 



INS 378 INS 

special tormentor who will never leave him alone. Some patients entertain 
delusions of a totally different character; they are not depressed, but exalted. 
They fancy themselves rich and powerful, and they are happy ; and yet the 
bodily condition of some of these poor patients is most miserable. They very 
frequently indicate a form of brain disease which advances through what to the 
bystander are exceedingly painful stages to certain death. Such delusions are 
most frequent in the condition known as general paralysis of the insane. Again, 
there are patients whose delusions take a different turn : they live in fear and 
dread, but they are not thereby rendered passive; they are prepared to fight, 
do anything for their life and liberty. Such are amongst the most dangerous 
class of lunatics. But it is not only by means of ideas, it is also by means of 
acts, founded or not on these, that we judge of a man's sanity. 

Amongst the most notable acts of the insane are indecent exposure, which 
very often occurs in the early stage of general paralysis, and stripping off of 
clothes, which has a most variable signification. Very frequently the removal 
of clothes is had recourse to out of revenge for not being allowed to do as the 
patient pleases. In other cases he cannot bear the feeling of clothes on the 
surface, and so tears them off him to get rid of them forever. In either case 
it is a troublesome and an expensive symptom. In many cases it is hopeless 
to cope with it. Give the patient the strongest materials, fastened on ever so 
carefully, by and by they will be torn off and torn to pieces ; blankets are 
torn in the same way. For the former class, that is to say those who destroy 
clothing not knowing what they do, nothing can be done; but for the others 
some sort of punishment has to be devised, — for they know perfectly well 
what they are about, — and if this fails, constant watching will generally put 
a stop to the nuisance. 

Suicidal acts, or acts of self-mutilation, are frequently committed by the in- 
sane. In the form of insanity called suicidal melancholia, where from the 
depression of mind life has become unbearable, it is frequently hardly possible 
to prevent the patient from destroying his life. He will watch his opportunity 
for years, and the first opportunity is sure to be taken advantage of. Very 
frequently in these patients the homicidal is closely associated witli the suicidal 
impulse. The subject of homicide, however, brings us to the consideration of 
those acts which are directed towards others rather than to the patient himself. 
Not unfrequently homicide or suicide is the result of an overpowering terror. 
This perhaps is the most frequent form assumed in the insanity of drunkards. 
The patients in dread of their lives attempt to escape, and are killed in the 
attempt, or in their desperation and dread of attack turn upon the attendants 
and kill them. A goodly number of the murders committed by the insane are 
from delusions. A man thinks his wife and children are going to starve, and 
so thinks it better to kill them at once; or he fancies he has got a command 
from on high to sacrifice them, and does so. Yet again it may be done from 
sheer wantonness, as by an imbecile. In all of these cases there is, as a rule, 
no difficulty in making out the insanity ; it is not concealed, and may other- 
wise be only too apparent; but there is yet another group of cases, which are 
of a much more doubtful category. It is well known that the great majority 
of confirmed epileptics sooner or later become totally insane. These consti- 
tute the very worst class of insane patients. Utterly untruthful, not a word 
can be depended on. Nor is an attendant's life safe with them. Before the 
onset of the epileptic fits, if they have them at intervals, they generally go 
through a stage of excitement, In which they are exceedingly dangerous. Now 
the stage is sufficiently well marked long before the minds of the patients are 



INS 379 INS 

so far gone as to require them to be sent to an asylum, and during or just 
after these periods they are at any time liable to commit murder. 

On the subject of paroxysmal insanity there has been a great diversity be- 
tween the opinions of alienists and the public at large. To the latter the idea 
is not pleasant that a man may go on all his life quietly and decently, then 
suddenly yield to an uncontrollable impulse to murder some individual, and 
afterwards return to his normal state. Yet many physicians who have studied 
the subject have been disposed to favor this view, and judicial opinions have 
been laid down which were apparently based upon it. 

A great deal of light has been thrown upon the subject of insanity as a de- 
fense for crime in the able charge of Judge Cox to the jury in the trial of 
Guiteau for the murder of President Garfield. The defense being that the 
prisoner was not responsible by reason of insanity, the judge ruled as follows : 

" In order to constitute the crime of murder the assassin must have a rea- 
sonable mind ; in technical terms he must be ' of sound mind, memory, and 
discretion.' An irresponsibly insane man cannot commit murder. If he is 
laboring under a disease of the mental faculties to such an extent that he does 
not know which he is doing, or does not know it is wrong, then he is wanting 
in that sound mind, memory, and discretion that is a part of the definition of 
murder. ... A man does not become irresponsible by the mere fact of his 
being partially insane. Such a man does' not take leave of his passions by 
becoming insane. He may retain as much control over them as in health. He 
may commit offenses too with which his infirmity has nothing to do. He may 
be sane as to the crime he commits ; may understand its nature, and may be 
governed by the same motives in relation to it as other people, while on other 
subjects, having no relation to the crime, he may be the victim of delusion. 
Whenever this partial insanity is relied on as defense, it must appear that the 
crime charged was a product of the delusion or other morbid condition, and 
connected with it as effect with cause. . . . The true test of criminal responsi- 
bility where the defense of insanity is interposed, is whether the accused had 
sufficient use of his reason to understand the nature of the act with which he 
is charged, and to understand that it was wrong for him to commit it. If those 
were the facts, he was criminally responsible for the act, whatever peculiarities 
might be shown of him in other respects. On the other hand, if his reason 
were so defective, in consequence of brain disease, that he could not under- 
stand what he was doing, or could not understand that what he was doing was 
wrong, he ought to be treated as an irresponsible lunatic." 

Homicidal mania, on account of its great importance, is not unfrequently 
elevated into a special form of insanity. So too are certain other manias, which, 
however, we hear of only when affecting some of the higher classes of society. 
These are kleptomania, an uncontrollable impulse to steal, when there is no 
object to be gained by it ; dipsomania, an uncontrollable propensity to drink 
intoxicating liquors ; and pyromania, a tendency to set things on fire. 

lioughly, we may divide most cases of insanity into two divisions, those in 
which there is apparent exaltation, and those in which there is depression, and 
these two we shall describe as mania and melancholia ; but both of these tend 
in the long run to end in a condition characterized by absolutely no mind, — 
what we term dementia, though there is a condition not inappropriately termed 
acute dementia. 

Most forms of insanity are preceded by a period during which the patient is 
not quite himself : he is odd in his ways ; there is confusion of intellect, bad 
sleep at night, and he is easily excited. The advance of the malady depends 



INS 380 INS 

a good deal on the amount of sleep taken. His delusions, at first mere mo- 
mentary fancies, become fixed and insuperable, and drive him to acts of in- 
sanity. Then most likely the medical practitioner is called in, and the patient 
is probably removed to some asylum for treatment. At this time the pa- 
tient will probably complain of headache, very likely with slow pulse and con- 
fined bowels ; if a woman, the menstrual function is generally impaired, or 
there may be pregnancy, recent parturition, or suckling. All these may be 
removed, and yet the patient does not get well ; we cannot restore the mental 
balance. As a rule, the first thing is to remove the patient from home, and 
surround him with new attendants, who will take him duly in charge in every 
way, so that lie will be cut off from the causes of aggravation, be they what 
they may. With this change of scene and pursuit there should be a change of 
diet to a nutritive one, if it has not been so before, and then everything must 
be done to secure good digestion and a due nutrition. The bowels must be 
properly looked after, and sleep must be had. Opium is not good ; in such 
patients it often excites rather than soothes, and increases the headache. 
Chloral is better, and had better be given in good full doses, thirty grains or 
so. It does not confine the bowels. If there is a tendency to epileptic fits, 
bromide of potassium had better be given them too, in full doses of twenty or 
thirty grains, three times a day. Tonics, especially strychnine, in careful 
doses, given so that the patient can never command enough to do himself harm, 
should be administered. 

All these things require very careful superintendence, and as it is quite pos- 
sible that the patient may get worse instead of better, when constant action 
may require to be taken, it is always better to select a place for change of air 
and scene where there is a good practitioner on whom you can rely, not only 
for medicine, but also for what in such cases is more valuable, namely, advice 
how to act. Most probably, if the case assumes a confused character, it will 
also assume the phase either of melancholia or of mania. If melancholia, then 
the utmost depression overpowers the unfortunate individual. Everything that 
happens round him seems to be connected with his evil fortune. Very likely 
he thinks he has committed sins too black for him to hope for forgiveness. No 
argument will get him out of these notions, and it is useless at this stage to 
attempt it. The appearance of such a patient is very striking. Woe-begone 
in the extreme, he may stand for hours in one spot, never moving, or he 
may be restless and trying to wander away, so to speak, from his evil fate. 
Usually such patients suffer a good deal in health ; they become thinner from 
want of food and sleep. The pulse is slow and weak, and the general con- 
dition of the patient indicates imperfect nourishment and bodily change. Sui- 
cide is greatly to be apprehended in a good many cases, perhaps the majority ; 
and this tendency may be so suddenly developed as to defy anything save the 
greatest caution from the commencement. For this reason, skilled attendance 
is of the first necessity, but it does not greatly matter whether that be carried 
out at home or in an asylum. Food and sleep are the two great remedies for 
this state, with absolute mental quiet. For sleep, chloral is best ; but if this 
does not suit, morphia may be given under the skin. The diet should be care- 
fully selected, so that nourishment in abundance may be given. Sometimes 
these patients refuse their food, and when that is so, they must be made to 
take it, either by the stomach pump or through the nose. The bowels must 
be moved and kept open. First had better be administered a turpentine 
enema, after which a dose from time to time of castor oil, or a small quantity 
of aqueous extract of aloes, daily, at dinner time, will suffice to keep them open. 



INS 381 INS 

The moral treatment of such patients needs to be begun as early as possible. 
The great thing is to draw their attention from themselves, and that must be 
done carefully and judiciously. Once they are brought to take an interest in 
anything outside themselves, they will generally do well ; this is the first step 
towards recovery. At this stage, any sudden event which necessitates, or 
ought to necessitate, exertion will frequently suffice to complete a cure ; but if 
there has been no improvement, it may do harm. Certain of the peculiarities 
above alluded to as characteristic of melancholia are much better marked in 
the form of the malady known as acute melancholia. The patient becomes 
actually frenzied from fright. Such patients have very high suicidal tenden- 
cies, and require the most careful watching. These, too, are the patients who 
must commonly refuse food, and who require to be fed forcibly. They also 
refuse to lie in bed at night, and especially to be covered by bed-clothes. This 
too must be forcibly combated. Patients, the subjects of this form of disease, 
generally end badly. They are sure to be badly nourished and a very little 
super-addition to their troubles in the way of acute disease finishes them. 
The lungs are especially liable to be fatally affected by low forms of inflam- 
mation. 

Mania, accompanied by delirium, is perhaps that form of the malady which 
is taken as the type of madness by uneducated people. The patient may be 
suddenly seized with this form of the malady, and may as suddenly become 
free from it. It is most frequently caused by violent passions, disappointed 
love, violent grief, and the like, especially if the patient be weak-minded or 
hysterical. The importance of such an attack must depend very greatly on 
the idiosyncrasy of the indivdual ; if there be much of a hereditary taint, 
the attack may be a final and complete one, whereas under more favorable 
circumstances it may speedily pass away. As a rule, the more marked the 
sj'mptoms of onset, and the longer they have shown themselves before the 
actual malady bursts forth, the more severe is it likely to be. It is not always 
desirable to hurry these patients to an asylum, for, as said, they may recover 
perfectly in a day or two ; but frequently it becomes absolutely necessary to 
do so. 

Acutely delirious patients generally behave much in the same way. They 
sing and shout, and will not rest a minute. Commonly they are utterly inco- 
herent, jumbling their words together, or they repeat one word or phrase like 
a parrot ad infinitum. They show less delusions than do many other insane 
patients ; their condition is indicated more by gesture and behavior than 
word. Sometimes they are full of glee, laughing and shouting ; at other 
times they are angry and outrageous, but not nearly so dangerous as some who 
are quieter in their demeanor. As in most similar conditions, the great object 
here is to get sleep and rest, for which chloral is the best medicament. Opium 
generally does harm. Some prefer digitalis to all other remedies, or give its 
active principle, digitalin, under the skin. The wet pack is a means of treat- 
ment greatly commended by some. (See Packing.) It is chiefly with re- 
gard to these cases, or to the occasional outbursts of chronic lunatics, that the 
question of restraint or non-restraint arises. To some it may seem superfluous 
to speak of there being nowadays a question between the two. Nevertheless, 
no asylum can be carried on without some system of restraint. It is itself a 
system of restraint, and the only question is how best to restrain the patient ; 
if that can best be done by living force, let it be applied in the form of the 
male or female attendant's hand. If such is likely to do more harm than good, 
or even if it cannot be used with such advantage as can some other form of re- 



INS 382 INS 

b train t, let the other, even if it be the strait-waistc ).-it, be applied. During 
tbe very acute attack there will be sometimes an entire absence of sleep for 
days and nights. Women can stand this much better than men : but both 
men and women require to be well sustained by food during the sleepless 
period. Rest, food, and sleep are the great remedies, and the means of pro- 
curing the last have once more to be examined. Once more chloral stands at 
the head of the list ; once more opium has otdy to be mentioned to be forbid- 
den. Indeed, before chloral came in, treatment by baths was relied upon, so 
general was the distrust against opium. No doubt the baths did good by 
soothing, but they also weakened the patient. The bath, to do any good, 
must be hot, and a stream of cold water or an ice bag should at the same time 
be applied to the head. The best temperature for the bath is about 92° or 93° 
Fahr., and the patient must be kept in it for a considerable time — half an 
hour or so. Shower baths are not to be given. If the bowels be confined, a 
good dose of calomel may be given ; but this had better not be repeated. 

There is still another form of mania, which may be acute, and yet there is 
no delirium. This insanity may consist of delusions, but more frequently 
manifests itself in actions, usually of a violent and dirty description. Fre- 
quently the patients have their wits about them in an almost surprising fash- 
ion, quite baffling the medical man who endeavors to examine them, so as to 
sign a certificate for their admission to an asylum. Yet, as soon as the prac- 
titioner is gone, they are dirty and abusive as ever, shameless in their conduct, 
tear up clothes and sheets, break windows, ohairs, and the like — in short, act 
like the veriest demons. Their incoherence might sometimes be mistaken 
for delirium ; but it is totally different. The health of these patients is fairly 
good ; they eat well and sleep well .apparently when they like. At all events, 
they will have good rest one night, and the next they will disturb the whole 
ward throughout the whole night. Sometimes they may go on like this for 
long periods together, and. as they are exceedingly troublesome, care must be 
taken to get them quieted. This was the class, and they constitute a goodly 
proportion of our asylum folks, who used to be dealt with by bodily punish- 
ments. The plan did not succeed. The plan now adopted, which as a rule, 
but not invariably, answers, is to give to those who are quiet and well behaved, 
and who do any work, some trifling reward — the privilege of excursions and 
the like. Work in the field or garden is the best means of keeping such 
maniacs out of mischief. Very often these patients are allowed to run on 
without care or attention until too late, provided they are not especially trou- 
blesome, for the malady tends to a chronic course if not speedily cured, and the 
only hope of cure rests in seclusion. 

There is a variety of insanity to which the name monomania lias been given, 
and kleptomania, dipsomania, and pyromania are commonly adduced as ex- 
amples. But it is rare, if indeed such a thing ever happens, to find a man mad 
on one point, and not on others also. At all events this almost invariably 
happens ; one permanent feature of their madness may for a time be most 
marked, but by and by, as time passes, the madness is seen in other features 
of the patient's character, and he probably ends by becoming a chronic maniac 
of. the class just described, or a melancholic, but without the characters of 
either division being very strongly marked. 

Such are the main divisions of insanity ; but there is one other so peculiar 
that we are fain to give a brief sketch of its history. The malady is com- 
monly called general paralysis of the insane. It is commonly described as 
constituting three stages, of which the first is such as may give rise to little 



INS 383 INS 

anxiety on the score of insanity, though the individual is often greatly altered 
from his former self. The second period is one of acute mania, with exalted 
delusions, and the third one of complete dementia, with complete prostration of 
mind and body. In the first stage, a general paralytic is usually a prey to ex- 
alted notions of his own importance and power. If he has money he scatters 
it broadcast, fancying his supply of it is unlimited. He asserts himself to 
be some great dignitary, not unfrequently God himself; but if this position 
is denied, he will not take the trouble to argue the question, — he will let the 
objector go in what seems to him his besotted ignorance. As a rule, too, sex- 
ual ideas take hold of him ; he exposes himself in any situation, or assaults 
women in the most unlikely neighborhoods. He is restless, and, above all, for- 
getful. He takes an interest in nothing, or if he do it is laid aside in a mo- 
ment, all about it being forgotten. At this period, too, in some cases, though 
not in others, there may be observed a tremulousness about the upper lip and 
a slowness of speech, which are very characteristic. Both these signs are, 
however, much more marked in the second stage, when the patient becomes 
fairly the subject of delusions. These delusions, as already pointed out, are all 
of an exalted character. He can do wonders in every way. All his .sur- 
roundings, though of the most trumpery kind, are interpreted as being of the 
grandest character ; his power is immense, and his bodily strength, though 
like that of a child, he thinks incomparable. As to physical signs, as already 
pointed out, they commonly begin with slowness of speech, or rather a kind of 
interval between each syllable, with a kind of stutter or drawl, something like 
the utterance of an intoxicated man. There is, too, that tremulous motion of 
the upper lip which is so peculiar ; but in some there is a kind of stiffness and 
swelling instead of the tremulous condition. The tongue, too, trembles when 
thrust out, and it is thrust out with a jerk, as if the patient had not full com- 
mand of it. 

As the malady advances the delusions of these unfortunately get worse. At 
the same time they are liable to break out in fits of violence of a most dan- 
gerous character. They are altogether unreasoning, and as they are generally 
men in the prime of life they are not easy to manage when they break out in 
fits of violence. . By and by they become subject to fits of a peculiar kind, not 
seldom resembling the slighter attacks of epilepsy called petit mat. The walk 
alters; it becomes vacillating about the hips, and the legs are not moved as 
usual, but are rather thrown forward with a kind of jerk. The handwriting, 
too, becomes imperfect both as to mechanism and material. Words or let- 
ters are omitted or inserted wrongly, the same word is repeated over and over 
again ; the whole is nonsense. The food is eaten voraciously, sometimes 
bolted, but in other cases, especially as the malady advances, there is difficulty 
in swallowing from paralysis of the fauces. Such patients are very destruc- 
tive and very dirty, but they tear up their bedding without knowing what they 
are doing, and they dirty themselves very frequently for ornament. 

By and by the patient gets worse ; he can hardly walk or shuffle round the 
room ; he loses power over the bladder and rectum if not constantly attended 
to. His face has lost all expression, and yet it seems fat and puffy. He can 
hardly hold anything in his hand, and if he is confined to his bed sores form 
which are hard to heal. Grinding of the teeth is very often a marked symp- 
tom. His appetite is still good, but he has lost the power of swallowing con- 
iortably, so he crams his mouth and throat, so that there is risk of suffocation 
if this is not seen to. At this time all such patients require to be fed. In 
point of fact everything must be done for them. But even in this state they 



INS 384 INS 

may survive a good long time if care be taken of them, and if they are pro- 
tected from cold, to which they are very sensitive. The average duration of 
the disease, from the onset to the end, does not exceed, as a rule, two years, 
whilst it may be much less. 

The causes of the malady are hard to determine. It generally occurs in the 
prime of lij,'e. and most frequently in males. In a certain number of cases it 
can be traced to overwork of the brain, but as the malady is more common 
among the laborers than the rich, this will not account for nearly all. An- 
other cause assignerl is sexual excess. This, of course, is not easy to make 
out, but irregular lives have been noted in a considerable number. As to 
treatment, that is useless ; we must just do our best to keep the patient quiet, 
clean, and orderly. We must try to feed him well, and as soon as any difficulty 
in swallowing appears, no food must be given in the solid state ; the pulpy 
condition is best. If the patient is confined to bed for a day or two his back 
must be carefully watched, and, if necessary, washed with some weak spirit 
with a little corrosive sublimate in it. Stimulants are usually necessary, es- 
pecially in the latter stages ; in the maniacal stage, they must be given with 
caution. In these cases during a maniacal paroxysm digitalis or digitalin often 
does good, but only for subduing the paroxysm ; nothing does good perma- 
nently. Meanwhile, as far as we know, the malady invariably ends in death. 

Feigned insanity has already been alluded to, but briefly. Often as insanity 
is assumed, the fiction rarely succeeds. The would-be lunatic, as a rule, over- 
does his part ; most likely he has never seen a lunatic, and his only conception 
of one is a raving maniac. The means of detecting feigned insanity are not 
too numerous; each case must be dealt with on its own merits; and there are 
some men known to be sane who have for years succeeded in keeping up an 
ostensible insanity. 

Insects, Poisonous. (1.) Of the Tnvei-tebrata, the scorpion is perhaps 
the most formidable. Its sting is the claw with which it is armed at the end 
of its caudiform abdomen ; this claw is perforated and connected at the base 
with poison-glands. The symptoms produced by its attack very much resemble 
aggravated forms of wasp-stings. It is found in the hotter regions of the 
globe, and a small species in Southern Europe. The best remedy is the exter- 
nal application of ammonia, as well as its administration internally. 

(2.) Centipedes (Scolopertdridce). The poison of these creatures is con- 
veyed by some curved fangs connected with the mandibles, which are per- 
forated, and probably communicate with poison-glands. 

(3.) Spiders (Arachneida). Of these there are a few species deserving of 
special notice. The tarantula (Southern Italy) has long enjoyed a reputation 
for the extraordinary effects said to be produced by its bite. Direct experi- 
ment, however, has shown that nothing beyond slight local irritation is pro- 
duced ; in fact, most of the tales connected with spiders' bites are fabrications. 
The bites of insects are comparatively innocuous ; but it is otherwise with 
their stings. Stinging insects belong chiefly, if not exclusively, to the order 
Hymenoptera, in which the sting, in the sterile females, represents the modified 
ovipositor. The instrument consists essentially of two exceedingly fine, sharp 
darts, inclosed in a tubular sheath, at the base of which is placed a special 
venom gland or sac, whose contents are injected into the wound made by the 
serrated or barbed darts. (Busk.) 

Treatment: Ammonia in the form of sal volatile is the best application for 
allaying the smarting and inflammation produced by the stings. If a person 
has been stung sufficiently to cause faintness, cordials and opiates must be ad- 



INS 385 INT 

ministered without dels}'. The point of injury should be examined minutely, 
and the sting, which is frequently left in the wound, removed with a fine 
forceps. It sometimes happens that a wasp or bee may be swallowed in fruit 
or drink : the danger then is very urgent, from the rapidity with which the 
fauces swell up the moment the sting enters ; leeches should be applied exter- 
nally, and hot salt-and- water gargle used frequently. The operation of laryn- 
gotomy, however, is usually the only available remedy. 

Insolation, Coup de Soleil, and Sun-stroke are three terms applied to 
the same condition ; this is closely allied to the condition already described as 
heat-stroke, but differs somewhat. Thus, heat-stroke is dependent rather upon 
actual heat of the atmosphere than exposure to the direct rays of the sun. 
Sun-stroke, again, may take place instantaneously; the individual is struck 
down as by a blow, whence the term. Most frequently the two go together, 
and the treatment for the one is much the same as for the other. Keep the 
patient quiet, and keep down the temperature. See Heat-strokk. 

Intermittent Fever, or Ague, is a specific fever, occurring in paroxysms, 
and characterized by a cold, a hot, and a sweating stage, followed by a period 
of complete absence from fever, or apyrexia. The exciting cause of this 
malady seems to consist in certain invisible effluvia, or emanations from the 
soil of marshy districts, to which the term malaria has been applied. Of the 
nature of the poison we know nothing; whether gaseous or aeriform, it un- 
doubtedly exists in the atmosphere of particular districts, but nothing as yet 
has been made out of its physical or chemical qualities. Climate seems to 
exert a marked effect upon this malady : in the Arctic circle it is not known 
to exist, nor is it found in the colder seasons of more temperate climes. 
Seldom met with above the 56th degree of latitude, it occurs in its most per- 
nicious and injurious forms as the torrid regions are approached. In England 
it generally assumes the tertian form, and is intermittent ; in Spain and along 
the shoi'es of the Mediterranean the same influences will set up a remittent 
variety, and such patients often pass into the intermittent form when they 
have removed to a colder climate. In tropical countries malaria may set up 
fevers which are continued in their course. Moisture seems to be essential 
for the development of the poisonous germs ; in England this fever is almost, 
if not quite, confined to the eastern coast, and in parts which are humid and 
swampy. In Kent, Essex, Cambridgeshire, Lincolnshire, Norfolk, and the 
East of Yorkshire are large tracts of low-lying country, and the marshes and 
fens are at certain seasons of the year overflowed with water. Since the com- 
mencement of this century much of this land has been well drained and cul- 
tivated, and in this way ague is much less prevalent than it was fifty years 
ago. Nor is the disease confined to the poor, for James I. and Oliver Crom- 
well both died of ague contracted in London. One remarkable benefit which 
has resulted from improved drainage and sewage is the comparative freedom 
from malaria which is now enjoyed in London. The low and level coast 
of Holland is a fertile source of intermittent fever. In Italy the Pontine 
marshes, near Rome, have long been famous for their noxious influence ; 
there, also, the Maremma, a district stretching for miles along the Mediter- 
ranean shore, is rendered unfit for human habitation from the dangerous ema- 
nations from the soil. Nor is the New World exempt, for here in America 
large areas of low and swampy lands set up the disease. In India the ague is 
very rife, and many in Bengal and the Upper Provinces suffer from it. Alike 
harmful to man and beast, from the beginning of April to October, every one 
migrates to the higher countries. It is in the great heat and after the rains 



INT 386 INT 

have ceased in May, August, and September, that the disease is most preva- 
lent, while from the middle of November up to March men and animals may 
dwell in comparative safety. Those who are in perfect health and become 
exposed to the malaria may be suddenly overcome by it. At the commence- 
ment of this century the prevalence of this disorder led to the disasters of the 
unfortunate expedition to Walcheren. The experience of men in India has 
led them to observe that those who suffer from mild intermittents in the cooler 
and more elevated regions, yet have severe remittent fever when they descend 
to the plains. Intermittent fever, prevalent though it is in some countries, is 
not a very fatal disease, at least directly ; it does harm by inducing other com- 
plaints and laving the foundation of other evils wdiich crop up in later life; 
thus it is that so many British soldiers become invalided in India, while the 
mortality from this disease is not very high. "Even in Bengal, out of a 
strength of 341,152 men, with 111,687 admissions into hospitals, the percentage 
of deaths to the number of men is 0.21, and the percentage of deaths to admis- 
sions is 0.76." Observers are not yet agreed as to the exact nature of the soil 
which breeds the mischief ; some have thought that decaying vegetable matter 
was a cause, but in vegetable markets, where rotting leaves are abundant, ague 
is not found ; and again others have shown that this fever is produced where 
there is no vegetable matter to decay. Heat and moisture together are not 
sufficient, for the disorder does not prevail among sailors at sea, in whatever 
climate they may be ; the air and water of affected districts have been exam- 
ined, but at present with no result. Many interesting facts have been recorded 
in which troops have from time to time suffered from this malady. During 
the Peninsular war many such instances occurred. In the year 1809 several 
regiments of the British army in Spain encamped in a hilly ravine which had 
once been a water-course. On the stony bed of the half dried ravine no vege- 
tation existed or could exist, while pools of water lay amongst the rocks, so 
pure that the soldiers wished to bivouac there for the sake of the water ; yet 
here, according to Dr. Ferguson, " it proved as pestiferous as the bed of a 
fen." After the battle of Talavera, a retreat of the army took place into the 
plains of Estremadura along the banks of the Guadiana River. The want 
of rain had made the country so arid and dry that the river itself and the 
smaller tributaries had, in fact, ceased to be streams, so that detached pools of 
water lay in the former water-courses; here, also, the troops " suffered from 
intermittent fevers of such malignity that the enemy, and all Europe, believed 
that the British host was extirpated." Dr. Ferguson has shown that water 
may be putrid and bad and yet will not set up ague, as in the following case. 
AtLisbon, the river Tagus is about two miles broad; on the one side, which 
is healthy, the soil is bare and hilly ; rock forms the foundation of the soil and 
the bed of the stream, while open water-courses lie among the hills. But, on 
the other side, the Alentejo land, which is flat and sandy, although equally dry 
on the surface, is very pernicious. In and near Lisbon there are numerous 
gardens where water is kept in stone reservoirs during the drought of the sum- 
mer months. The water in these reservoirs becomes foul and putrid, and, 
being placed close to the houses and sleeping-rooms, the people actually live 
and breathe in the impure atmosphere. " Yet no one," says Dr. Ferguson, 
" ever heard or dreamt of fever being generated amongst them from such a 
source ; though the most ignorant native is well aware that were he oidy to cross 
the river, and sleep on the sandy shores of Alentejo, where a particle of water 
at that season had not been seen for months, and where water, being absorbed 
iuto the sand as soon as it fell, was never known to be putrid, he would run 



INT 387 INT 

the greatest risk of being seized witli remittent fever." It would seem, then, 
that those parts are the most dangerous which have been flooded and then be- 
come dry ; so the edges of swamps or the banks of drying or half-dried rivers 
become dangerous, according to the season and the amount of water in them. 
It has often happened that those living in the lower part of a district are very 
liable to the fever, while those in the same locality, but perched upon a hill, 
escape it. This is the case at Plumstead, England, where those who live close 
to the banks of the Thames often suffer from ague, while the residents in Wool- 
wich Hill, close adjacent, do not have the complaint. So also in the neighbor- 
hood of the Pontine marshes the Italians live in villages high up on the inter- 
vening hills, so as to avoid the dangerous miasmata. Ague and aguish fevers 
are, therefore, in temperate climates, more common in the autumn than at any 
other period of the year, and follow after the heat of summer. Persons who 
live in marshy districts become acclimatized to it, while strangers are readily 
affected. Troops in time will become used to an unhealthy spot, although at 
first many will suffer. Although the natives in such places are not so liable 
as new-comers to catch ague, yet they seem to be chronically affected by the 
unhealthy atmosphere ; they are a weak race, short in stature, of a sallow 
complexion, a melancholy and short-lived people. It is a very remarkable 
fact that the negro seems to enjoy a marshy swamp; places which to the white 
man are most pernicious seem to have no effect on his darker brother, while 
conversely the black can find no enjoyment on the hilly lands where the white 
man flees for health and safety. Persons are much more liable to catch the 
disease at night than during the day, so much so that many places which are 
safe during the day are pernicious at night-time. Even now travelers at 
Rome are warned against crossing the Pontine marshes after dark. Again, 
the malarious poison, whatever it may be, likes to keep near the ground, so 
that those who sleep in the upper rooms of a house are safer than those who 
sleep on the ground-floor, and this may be the reason why lying down in the 
open air in such places is so dangerous. The malaria is movable by the wind ; 
sometimes it hangs over a district like a thick fog or milky vapor near the 
surface of the ground. The malaria seems to lose its effect by passing over a 
sheet of water, so that while troops on shore are having ague, those in the 
ships a few hundred yards off may be perfectly free. The marsh poison seems 
to cling to the foliage of thick and lofty trees in those districts, so that it is 
very dangerous to go under them, and still more to sleep there ; and this fact has 
been made use of, for, in Guiana, where large trees abound, the settlers live 
fearlessly and unhurt close to the most pestiferous marshes, and to leeward of 
them, provided that a screen or belt of trees be interposed. Some curious 
notions were entertained in earlier times about the salutary effect of an ague. 
Dr. James Sims, a London physician, when suffering from .an illness, which 
afterwards proved fatal, felt convinced that he should recover if he could 
catch an ague; for this purpose he went down into a marshy district, but came 
back complaining that there was no ague to catch, and that the country had 
been spoiled by draining. 

Symptoms : The person who has been exposed to malaria will generally 
suffer for a few days from premonitory symptoms. There is nausea and loss 
of appetite, with a* slight feeling of chilliness ; often, too, there are muscular 
pains' in the back and lower extremities ; these symptoms may last only for a 
few hours or may be prolonged for several days. Then comes on the regular 
attack, beginning with a cold stage, in which the patient lies shivering in the 
bed, with chattering teeth, gathering the clothes round about him to keep him- 



INT 388 INT 

self warm ; yet there is only a feeling of cold, for in reality the patient is hot- 
ter than usual, and the temperature in this stage will rise from 98.5° to 101° 
or 102° Fahr. This is followed by a hot stage, in which all shivering has 
ceased, while the temperature goes on rising, so that in three or four hours 
from the commencement of the tit it may have risen to 105° or 106° Fahr. ; 
thus in that short time the whole mass of the human body has been heated 
up seven or eight degrees in many cases. "When this hot stage is present, 
there are flushes of heat about the face and neck ; the coldness ceases ; the skin, 
which before was shriveled and pale or even livid, now returns to its natural 
color, and the face assumes an ordinary appearance ; then a reaction takes 
place and the face becomes red, the skin hot and dry ; there is a violent head- 
ache and throbbing of the temples ; the pulse is full and quick and strong, 
while the breathing is oppressed ; the patient feels very miserable and restless. 
But presently the skin becomes softer and breaks out into a gentle perspira- 
tion on the head and face ; this quickly increases, so that soon the whole body 
is bathed in sweat, and great relief is experienced ; the thirst ceases, the tongue 
is clean again, the pains go away, and the heat and discomfort pass off, so 
that in a few hours he will feel again as well as ever until the next recurring 
fit. During the sweating stage the temperature is falling, and at last reaches 
the normal line of 98.4° Fahr. But the cold stage may occur and never be 
followed by the hot, and again there may be a hot stage not preceded by a 
cold one; those who suffer in this way often speak of it as dumb ague, and 
they generally have suffered from the ordinary ague previously. This set of 
symptoms is exceedingly well marked, and no one can mistake the disease : 
yet there is great misery endured by the patient during an attack, although it 
is only temporary, and in this country very curable. A most characteristic 
feature of ague is its recurrence, and hence it is called an intermittent fever; 
the intervals between the attacks are marked by a total absence from fever; 
when these intervals are imperfect and the patient remains ill between the 
paroxysms, the disease is called remittent ; this form is met with, as has been 
said, in tropical climes, while the former is most common here. There are 
three principal types of ague. When the paroxysm comes on every day, it is 
called quotidian ; when it comes on at the same time every other day appearing 
and remaining absent day by day alternately, it is called tertian ; and when 
two whole days intervene between the paroxysms it is called quartan ; the two 
latter terms ought to be " k secundan " and " tertian " respectively, but old 
observers gave the names, and they have been kept in the language. These 
types differ from each other somewhat, not only 'n their respective intervals, 
but in the duration of the paroxysm and in the period of the day at which the 
paroxysms commence. In the quotidian form the fit lasts ten or twelve hours, 
while in the tertian its duration is from six to eight hours usually, and in the 
quartan it may be only four or six hours. Of these various forms the tertian 
is the most common in this country, although the others are far from infre- 
quent. Besides these forms there seem to be others in which two types are 
mingled: thus a double tertian or a double quartan may be met with, and a 
patient may have two attacks in the same day. It is a vulgar but common error 
that if the patient vomit during a fit he may rid himself of the ague. In a 
temperate climate, ague is hardly ever fatal unless the patient be very old or 
infirm, or suffer from some other serious disease ; in hot countries an attack is 
attended with danger. 

Treatment : Ague is a very curable disease, aud in this country, at least, 
very simple measures may be taken. During the cold stage the patient will 



INT 389 INT 

naturally prefer to go to bed and wrap himself up as warm as possible, and 
he may be allowed to drink any simple fluid that he likes, such as tea, barley- 
water, weak wine and water, etc., and no more need be done. Iu Italy, how- 
ever, at the present day they bleed for ague, as indeed they do for almost every 
complaint, but this is a practice very strongly to be condemned. There is no 
occasion to be over-fussy during a paroxysm, as the patient will come out of it 
all right. Of all the remedies in the Pharmacopoeia, none are more valuable 
than quinine and arsenic in the treatment of ague. Quinine is an alkaloid 
obtained from various species' of bark growing in Peru and on the slopes of the 
Andes ; other alkaloids, as cinchonine, cinchonidine, and quinidine are also 
present in the bark, and exercise a beneficial effect. Expensive as quinine is, 
it is yet preferable to. arsenic, because not only is it more efficacious, but it is 
not poisonous, and can be left about with safety. Given in large doses it is apt 
to produce giddiness, singing in the ears, and deafness, but these effects will 
pass away of themselves. Four or five grains of the sulphate of quinine taken 
every four or six hours during the interval of an ague fit will generally cure 
the patient. Very often the cure is immediate and the patient has no more 
attacks ; more often he has one or two very slight ones, and then becomes con- 
valescent. In hot countries larger doses may be required ; and for travelers in 
aguish districts nothing is more invaluable than a plentiful stock of quinine. 
If a relapse takes place, quinine or cinchonine must again be taken. Sometimes 
quinine is disliked, and then arsenic may be tried, but it is very poisonous, and 
must be given only under medical advice ; the injurious effects that should be 
looked for are a soreness of the throat, vomiting, diarrhoea, pain in the abdomen, 
smarting and redness of the eyes and nose. Numbers of other remedies have 
been tried, but no remedy is so powerful, effectual, and simple, as quinine or 
cinchonine. A century ago the web of the black spider was believed to cure ague, 
and in some cases it seemed to answer ; and even at the present day there 
are those who believe that swallowing a spider will cure them. Pepper is also 
a popular remedy, and many take a teaspoonf ul of pepper in a glass of gin for 
the purpose. Several remarkable cures have been recorded in which emotional 
influences have cured an ague, such as great joy or great terror ; it is very pos- 
sible that in this way many old-fashioned remedies did good by acting strongly 
on the imagination and causing an intense emotional disturbance. The diet 
should be liberal and nourishing; the patients, being much weakened by the 
attacks, will not bear any depressing influences ; strong beef tea, milk, and 
some wine may be given daily, and meat or fish, etc., if the patient care for it. 
After an attack, a nutritious diet, abundance of exercise, pure air, and pure 
water are very important ; the individual, if possible, should leave the neigh- 
borhood or live at a higher elevation. After repeated attacks, the liver and 
spleen are liable to become enlarged, and the latter condition is known as ague- 
cake. An ointment of the red iodide of mercury has been strongly recom- 
mended for this affection ; a portion, the size of a hazel-nut, may be rubbed into 
the left side and exposed to the heat of the fire ; its application should not be 
too often repeated, as it is apt to make the skin sore. 

Brow-ague is another disease allied to an intermittent fever, and produced by 
malarious influences also ; it consists chiefly in an intense pain confined to one 
side of the head, lasting for several hours and gradually passing off ; it comes 
on in paroxysms with varying intervals, and is chiefly met with in sensitive 
and nervous people, and more especially if they have experienced any mental 
trouble previously. From affecting half the head only, brow-ague has been 
technically called Hemicrania ; Migraine is also another term for the same 



INT 390 INT 

affection. It generally occurs in the adult, and is more common in women than 
in men. This form of headache is very different from that which comes on 
after a debauch or from over-eating, and which is generally accompanied by dis- 
turbance of the functions of the stomach or liver. True sick headache is a purely 
nervous affection, and is quite independent of excessive eating or drinking; it 
occurs in very temperate people, and is often hereditary in families. Expos- 
ure to heat and fatigue, breathing the hot and impure air of a theatre or concert 
room, working late at night by gas-light, working with a microscope, and any 
special mental worry or excitement will cause this painful affection. Those 
who suffer in this way wake in the morning feeling more dead than alive, unable 
to swallow any food, and perhaps actually sick ; the head throbs, and any move- 
ment or conversation is avoided, as the pain is increased thereby ; the patient 
begs to be left alone and should be kept quiet, as the only means of obtaining 
sleep. The sufferer looks ill and pale, has contracted pupils, and a dark line 
under the eyes. The head feels hot, and the application of cold is most refresh- 
ing. The appetite is gone, the mouth feels clammy, and there is a feeling of 
nausea. Hot tea and coffee seem to allay the nervous system and give relief, 
and a little wine or ammonia may be given. The only relief during an attack 
is to be found in a wet bandage round the head, profound quiet, and a darkened 
room. Medicines have been over and over again tried, and found useless, nor 
is it to be cured by remedies which act as purgatives or on the liver and stomach. 
Aconite and belladonna have been employed locally, but with no good result; 
sometimes relief has been obtained by giving bromide of potassium. During 
the intervals the general health must be kept up by quinine and tonics, but most 
good will be done by the sufferer carefully avoiding any of those causes which 
are found by his or her own experience to bring on an attack. Very recently 
guarana has been recommended for the cure of this affection. It consists of 
the seeds of the Pauttinia sorb/It's, a tree growing in Brazil, and belonging to 
the natural order Sapiadacece. The seeds are ground into powder, and contain 
an alkaloid which is said to be identical with that found in tea and coffee. 
The seeds roasted, bruised, and pressed into cylindrical masses form the guarana 
paste, which, when finely pounded, is then known by the name of Paullinia 
powder. It is light brown in color, has an odor faintly resembling roasted 
coffee, and a bitter astringent taste. It contains tannic acid, and a principle 
called guaranin, which has much the same effect on the nervous system as tea or 
coffee. It is given in doses of ten to fifteen grains once or oftener in the day. 

Intermittent Pulse is said to occur when each beat of the heart is not 
strong enough to be felt at the wrist, so that one beat is missed now and again ; 
it is generally a sign of a feeble, fatty, or diseased heart, but frequently accom- 
panies temporary indigestion. 

Intertrigo, or Erythema Intertrigo, is the name given to the common 
local condition known as a chafe or fret, and which cousists in redness and 
excoriation of a part of the skin. This condition is caused by friction and pro- 
longed contact of two adjacent surfaces of skin, by the friction of portions of 
dress, or by the contact of irritating discharges. It is met with generally in cor- 
pulent persons and infants, and in those who perspire freely. Its development 
is favored by the accumulation of sweat, and occurs in persons who pay very 
little attention to cleanliness. The most frequent seats of intertrigo are the 
inner surfaces of the thighs, the inner portion of the buttocks, the navel, the 
arm-pits, the back of the neck, and about the genitals. It may be often met 
with in the folds of the skin of fat infants, and especially in the flexures of joints. 
It occurs especially in warm weather. 



INT 391 INT 

Intertrigo may, in most persons who are liable to be troubled by the affection, 
be prevented by frequent ablution, followed by careful drying, and by occasion- 
ally bathing the most likely situations with diluted spirits of wine or weak 
lead lotion. When a raw surface has been formed, the patient should keep it 
at rest as far as possible, and prevent further friction. The excoriated portion 
of skin should be kept very clean, and be frequently dusted with absorbent 
powder, such as starch, lycopodium, or oxide of zinc. • Fuller's earth and a 
weak solution of lunar caustic or of alum are useful applications. Where the 
raw surface becomes much inflamed and is covered by a thick, ill-smelling dis- 
charge of pus mixed with blood, perfect rest of the patient becomes necessary, 
and the affected parts should be brushed over with a strong solution of lunar 
caustic, and then be treated by zinc or chalk ointment, attention at the same 
time being paid to the general health. 

Intestinal Worms are parasites which infest the intestines. See Entozoa 
and Parasites. 

Intestines. The intestines form a long, hollow channel from the stomach 
to the anus, and allow the passage of food along them. Different names have 
been given to different portions : the first part nearest to the stomach is called 
the duodenum, and is about twelve inches long ; in this portion the liver and 
the pancreas empty their secretions and mix with the food which has just left 
the stomach. The next portion is called the jejunum, and is about two feet 
long, and it is abundantly supplied with vessels ; this leads on to the ileum, 
which is several feet in length, and forms the greater portion of what are called 
the bowels ; these three parts make up what is known as the small intestines. 
The next portion is of larger calibre, but made of similar materials, and is called 
the large bowel or the large intestine ; it commences in the right iliac region 
of the abdomen as the caecum, and then making a large curve round the abdo- 
men, it descends by the left side of the abdomen into the pelvis and ends at the 
anus. In its course it is called respectively, the ascending, transverse, and 
descending colon, while the lower twelve inches are called the rectum. Al- 
though having different names, the intestines form one continuous channel of 
great length, but they are kept in position by a membrane called the mesentery, 
so that the different portions all lie coiled together and can move freely upon 
one another. The coats of the intestines are three in number: (1.) A serous 
smooth external coat, called the peritoneum, which allows the bowels to glide 
over each other smoothly and without pain. (2.) A muscular coat, by which 
contractile movements go on in waves, so that the food is propelled gently from 
one end to the other. (3.) Most internal is the mucous coat, a membrane lined 
with epithelium and richly supplied with vessels, so that all the soluble parts 
of the food can be absorbed as it passes along ; this coat is really much longer 
than the intestines, as.it is arranged in folds, like the tucks of a dress, so that 
the surface available for absorption of the food is thus vastly increased. In 
this coat are numerous glands, which empty their contents into the canal. The 
movements of the bowels caused by the contraction of the muscular coat are 
called peristaltic, and when abnormally increased in force and frequency they 
cause griping pains and diarrhoea. At the lower end of the cascuin is a 
curious little tail or appendage, known as the appendix vermiformis ; its func- 
tion is not known, but serious effects have ensued from foreign bodies, as pins, 
cherry-stones, etc., becoming lodged there on their way down the bowels. The 
intestines are very liable to disease. 

(a.) Flatulence occurs in those who have flabby abdominal walls, as in 
women who have borne many children ; also in those who live on broth and 



INT 392 INT 

vegetables and drink much hot and weak tea, because here the muscular coat 
is badly nourished, and the bowel becomes over distended with air. 

(b.) Enteritis, or inflammation of the lining membrane of the intestines, 
may come on from eating indigestible food, from excessive drinking, especially 
of raw spirit, and from swallowing various corrosive or irritant poisons. (See 
Enteritis.) Typhlitis, or inflammation of the csecum, is a similar affection 
of the first portion of the large bowel. See Typhlitis. 

(c.) Cancer may affect the intestines ; most commonly the rectum is the seat 
of disease ; the symptoms are much the same as when this disorder affects 
other parts ; there is great pain, loss of flesh and strength, and a peculiar 
cachectic look ; in addition there may be diarrhoea, alternating with constipa- 
tion, blood in the stools occasionally, and great pain during defecation, and 
especially if the mischief is in the rectum. As the disease advances other 
organs and tissues become involved, and it is rarely that the patient dies of 
cancer of the bowels alone ; the liver and the stomach are generally impli- 
cated. In time the growth of the cancerous mass may be so great as to pre- 
vent the passage of any food down the canal, so that the intestines become 
enormously distended with food and gas, and add much to the distress of the 
patient ; and so great may be the distension that in some cases the intestines 
have burst above the obstruction in consequence of the pressure. To obviate 
this, and to make an inevitable death at any rate easier, an operation may be 
performed by making an opening into the bowel above the seat of disease, so 
as to make an artificial anus ; this is a hopeful procedure only if the disease is 
low down in the large intestine, or in the rectum, and then the surgeon can 
make an incision in the left lumbar region into the colon ; the operation is 
. called colotomy ; great relief is at once given, and enormous quantities of faeces 
and gas will come away, but since cancer will finally kill, the relief is all that 
can be hoped for. 

(d.) Ulceration of the intestines occurs in many diseases. (1.) In typhoid 
fever, where the lower portion of the ileum is the part chiefly affected. (See 
Typhoid Fever.) (2.) In some forms of consumption, and generally in 
those which run a rapid course, persistent diarrhoea is the chief symptom ; 
many ulcers form, and these are scattered about in different portions of the 
large and small bowel. (3.) In cases of dysentery, where the lining mem- 
brane of the large bowel is chiefly, if not altogether, implicated. (See Dys- 
entery.) (4.) Ulceration may be met with in children, where it seems to 
begin in disease of the small glands in the intestines, and it is the cause some- 
times of the persistent diarrhoea which carries off so many badly nourished 
infants. (5.) Ulceration may occur without any apparent cause, and then only 
one large ulcer is generally found ; it is a not uncommon disease of the rectum, 
and may be found about six to nine inches from the anus ; great pain, consti- 
pation alternating with diarrhoea, sickness, loss of flesh and strength, and pain- 
ful distension of the bowels are the chief symptoms. 

(e.) Constipation arises from a sluggish condition of the muscular coats of 
the intestines; it may come on from persons not accustoming themselves to 
have a motion habitually every morning, for habit is a very important factor 
in these cases ; it is not uncommon in women after a confinement, from pres- 
sure on the intestines by the enlarged womb. It occurs also in those who are 
careless about their diet, and in those who lead idle and sedentary lives. The 
constant use of aperient or opening medicines is also a frequent cause ; the 
best treatment for habitual constipation will be to take active exercise every 
day, a glass of cold spring water the first thing in the morning, and a diet con- 



INT 393 INT 

sisting of brown bread, stewed or baked fruit, figs, prunes, etc. See Consti- 
pation. 

(f.) Diarrhoea is a symptom met with in many diseases, and consists in a 
too rapid motion of the faeces along the intestines, and in some cases of an in- 
creased secretion of mucus poured out from the walls ; for a description of the 
various kinds, and for the treatment of each, the reader must refer to the arti- 
cles on Diarrh<ea and Cholera. 

(<?.) The intestines may become strangulated, as in some forms of hernia, 
where a knuckle or bowel may pass through some weak points of the abdomi- 
nal wall, known as the inguinal and femoral rings. When this occurs a rupture 
is produced ; generally it can be pushed back by gentle and skillful handling, 
but sometimes an operation has to be performed for the purpose. See Her- 
nia. 

(/?.) The bowels may be wounded by a gun or pistol shot, or the individual 
may be stabbed in the intestines by a sharp instrument ; such injuries are ex- 
tremely dangerous, and generally fatal, because, when the bowel is perforated, 
the contents escape into the abdominal cavity and set up a serious inflamma- 
tion of the peritoneum ; surgical aid in such cases must at once be resorted to. 

(i.) Rupture of the bowels has occurred where persons have been run over, 
or where a sudden and severe blow has been given to the abdomen ; death in 
these cases generally takes place very soon after the injury, and nothing can 
be done to save life. 

(k.) Obstruc'ions in the bowels occur in cases of accumulation of faeces and 
in cancer and ulceration, as above stated, but this subject will be treated of 
under the article on Obstructions. 

(I.) The intestines are a favorite resort for parasites. The entozoa, or ani- 
mal parasites living within the bowels, are (1) the tape-worms, which infest 
the small intestines chiefly ; (2) the round or earth-worm, which often lies in 
the upper part of the canal, and may be vomited by the mouth ; (3) the thread- 
worms, which infest the rectum and are so common in young children. For 
a full description, and for the treatment of these pests, see the article on 
Entozoa. 

Vomiting generally consists in expelling the contents of the stomach by the 
mouth, but if it be prolonged, the contents of the duodenum may be brought 
up, as evidenced by the presence. of bile in the vomit. But in some cases 
where there is great obstruction in the bowels and no faeces can pass down- 
wards, the current is reversed, and the patient may vomit faecal matter by the 
mouth ; the sufferer is then said to have stercoraceous vomiting. Foreign 
bodies may be met with in the intestines ; the most common are cherry or 
other fruit stones, pins, gall-stones, and curious accumulations of hair, called 
bezoars. Piles or haemorrhoids are painful vascular tumors, which form at the 
anus or lower part of the rectum. (See Hemorrhoids.) Pus or matter 
may flow from the intestinal canal, but in such cases it is generally due to 
some abscess in another organ having burst, as an abscess in the liver or kid- 
ney, or the contents of a cyst, or the pus in a case of pelvic cellulitis, or in- 
flammation of the tissue which surrounds the womb. Intussusception is the 
name given to a condition in which one portion of the bowel becomes invagi- 
nated, something like the finger of a glove half turned inside out ; it often 
occurs in the process of dying, but sometimes in children during life, and then 
it may set up serious symptoms. See Intussusception. 

Intoxication is used abroad in a totally different signification from what it 
is in America. In France and Germany the word means the manifest work- 



INT 394 INT 

ings of any drug or remedy ; here the word applies only to one substance, 
alcohol. Used in this wider signification the word applies to two sets of phe- 
nomena, those induced by a large dose of the drug — acute intoxication — and 
those induced by smaller doses acting over a longer period, or the ultimate 
consequences of repeated doses, large in quantity but not continuous in point 
of time — called chronic intoxication. Thus the symptoms of opium poisou- 
ing, or poisoning by aconite, nux vomica, belladonna, or the like, would afford 
us examples of acute intoxication. So, too, does the inordinate use of alcohol, 
though it is well to know that even of this form of acute intoxication there 
are two well-marked varieties. Ordinarily, intoxication by alcohol means the 
gradual imbibition of greater or less quantities of alcohol in some of its many 
forms, and a consequent approach to a condition resembling the action of 
a narcotic, when the brain, being supplied with impure blood, ceases to be- 
come cognizant of what passes, and at the same time responds less actively 
to the usual stimuli. Hence in turn the ordinary functions of circulation 
and respiration are imperfectly fulfilled, so that the heart beats slowly and 
laboringly, the finger-nails and lips are blue, and the breathing is loud and 
stertorous. Gradually, as the poison passes off by the lungs and kidneys, the 
blood becomes more and more pure, sensibility returns, and the breathing be- 
comes more natural. Most probably the effects of the poison remain behind 
in the shape of an irritable stomach, headache, and nausea. The other kind of 
acute alcoholic intoxication is rarer and more dangerous. It commonly occurs 
as the result of some foolish wager, or what dock-laborers call " sucking the 
monkey." That is to saw a man offers to drink so and so much within a cer- 
tain time, or he takes to drinking rum or some such spirit out of the puncheon. 
In either case a very large quantity of spirits is suddenly introduced into the 
system ; there is no correspondence whatever between imbibition and elimina- 
tion. The brain becomes paralyzed, and through it the heart; there is complete 
insensibility, pallor of countenance, and failure of pulse; very frequently this 
freak ends in death. The next variety of intoxication we shall describe is 
the chronic form. Of this there are likewise two forms : one of these is 
well illustrated by chronic lead poisoning. The workers in lead live in an 
atmosphere where the particles of lead are floating, if they will float, where 
everything they touch is covered with lead, where their nails get filled with 
lead, and their victuals contaminated with lead. The quantity they thus 
take day by day would produce little or no consequences itself, but not being 
eliminated it tends to accumulate, the bowels become obstinately confined, ex- 
cessively painful gripes affect the individual, appetite is lost, a blue line along 
the gums marks the presence of the poison ; presently the general nutrition 
begins to suffer, the muscles lose their firmness, especially those which raise 
the back of the hand ; by and by all power over these is lost, aud the individ- 
ual is at last compelled to relinquish a pursuit which is so baneful to health. 
This is chronic intoxication induced by small quantities of the poi>on acting 
continuously over a long period. In certain of the forms of chronic alcoholic 
poisoning we see the other form of chronic intoxication. In this variety of in- 
toxication we have not small quantities of the poison acting continuously for a 
long period, but we have repeated attacks of acute intoxication without a suffi- 
cient interval for perfect recovery between each. As a consequeuce the sys- 
tem is saturated with alcohol; the stomach suffers, becoming the subject of 
chronic gastric catarrh ; the liver tends to be affected, as do the brain and 
blood-vessels. The nervous power is lost, the hand shakes, judgment fails or 
is not to be depended on ; appetite is lost, as is the power of digesting food. 



595 




Fig. eziv. 





Fid. cxn« 




Fig. exui. 



Fig. zxv. 



INT 397 INT 

If this condition is not arrested, graver conditions of malnutrition may arise, 
and death may follow. This form of chronic alcoholism is altogether different 
from delirium tremens, already spoken of. Delirium tremens is more the re- 
sult of subacute alcoholism if long continued and suddenly broken off, or it 
may be induced in the form of which we now speak by an accident. Brewers' 
draymen would by many be looked upon as perfect specimens of wholesome 
humanity ; they work hard and long, and they are usually very strong. They 
seem pictures of health, yet from their habits of constantly keeping up a kind 
of subacute intoxication, never amounting to actual drunkenness, yet con- 
stantly under the influence of alcohol, they acquire a condition of chronic alco- 
holic intoxication (in the sense we here use the word intoxication), which to 
them is full of danger. If they hurt their finger, it does not heal kindly ; if 
they break their legs, they are almost certain to Have an attack of delirium, 
similar in all intents and purposes to delirium tremens, yet essentially pro- 
duced by the accident, that is to say, it would not occur without it. Such 
injuries in these patients heal very badly, and sometimes prove fatal by the 
onset of erysipelas or some such disorder, which would have passed by a 
health}^ man ; and all this without any absolute sign of intoxication, in its 
common acceptation, being seen about them. 

Intussusception of one or more portions of the small intestine is very 
frequently met with in children, and it seems wholly independent of any symp- 
toms of disorder of the bowels during the patient's lifetime ; sometimes only a 
single intussusception is found, but oftener there are several, and as many as ten 
or twelve have been found in the same subject. Tliey are generally confined 
to the small intestine, and are most common in the ileum, and they consist in 
an invagination of a portion of the bowel, somewhat resembling the finger of a 
glove half turned inside out. The great frequency of this occurrence, the ab- 
sence of any symptoms during life, or of any indication of disease about the 
intestines after death, lead to the opinion that this invagination may often oc- 
cur in the process of dying. Although this form of intussusception is so com- 
mon, yet there are some rare cases in which a portion of the large intestine 
majr become invaginated, and cause a serious, if not fatal obstruction. This 
accident takes place generally in infants under one year of age, and often less 
than six months old. 

The previous history of these cases throws no light on the disorder ; it does 
not seem to occur in those who are specially liable to constipation or diarrhoea, 
nor in those who have taken any aperient medicine previously. Sudden and 
violent vomiting, followed by loud cries and signs of general uneasiness and 
pain, recurring at uncertain intervals, accompanied by violent straining and 
effort to empty the bowels, are the earliest symptoms of the mischief. At first 
some faeces may be voided by these forced efforts ; then mucus is discharged 
tinged with blood, or even pure blood in considerable quantities. If an injec- 
tion be given, the fluid generally returns at once, as its passage upwards is ob- 
structed, and the obstacle may be felt sometimes when the finger is passed up 
the rectum. Vomiting commonly comes on, and is renewed whenever any food 
or medicine is administered. The pain comes on in paroxysms, alternating 
with intervals of quiet; the child is often thirsty, and will take the breast or 
bottle readily, although the sickness is persistent. It is seldom that anything 
can be made out from the external examination of the abdomen. As the ob- 
struction continues there is exhaustion of the infant's strength ; its pulse grows 
more and more feeble, the face becomes anxious and sunken, and it falls in the 
intervals of pain into a quiet, sleepy condition. In many cases convulsions 



INU 398 INV 

come on a few hours before death, which takes place within a week, and often 
in two or three days. In some rare cases the symptoms abate, the pain and the 
sickness may cease, the bowels act of themselves, and a speedy recovery of the 
little patient occurs ; but this is a state of things which can be rarely hoped for. 

Treatment : As soon as the symptoms of intussusception occur, no aperient 
medicines must be given by the mouth, as they will increase the action of the 
bowels and make the obstruction worse than ever. Hot fomentations should 
be applied to the abdomen, and a little opium may be given to allay the pain ; 
but this drug must be given with the greatest caution, as even the administra- 
tion of two or three drops may prove dangerous to an infant under twelve 
months of age, and then the remedy will be as fatal as the disease. ' If the 
symptoms do not disappear within twelve or eighteen hours, injections of warm 
water must be given by the rectum, so as to unfold the invaginated intestine. 
Inflation with air has in some cases been effectual. Surgical interference has 
also been successfully resorted to, and the operation of gastrotomy has been 
performed ; this is, of course, a very dangerous operation, but it may be re- 
quired when there is no other chance to save life. For an account of intesti- 
nal obstructions in the adult, see Obstructions. 

Inunction. The remote and constitutional effects of certain remedial 
agents may be produced by rubbing into some parts of the surface of the body 
ointments containing these ageuts. Thus belladonna ointment rubbed into the 
skin of the forehead or temple will produce enlargement of the pupil and re- 
lieve the severe pain attending certain forms of inflammation of the eye, and 
friction with sulphur ointment will in some cases relieve the articular pains of 
rheumatism and rheumatic gout. The agent which has been most frequently 
administered in this way is mercury. The patient is ordered to rub in half a 
drachm or a drachm of strong mercurial ointment every night, or on alter- 
nate nights, until it is thought necessary to discontinue the use of this powerful 
agent. The most favorable parts to which the ointment can be applied are the 
arm-pits, the inner surfaces of the thighs and arms, the hams and calves, and 
the front of the abdomen. The ointment ought not to be rubbed into the same 
part on two nights in succession. The patient should keep up friction for 
twenty minutes, and then put on a thick flannel shirt or flannel drawers, and 
retire at once to bed. No attempt should be made to wipe away any of the 
ointment which remains on the surface of the skin after the friction. This 
mode of administering mercury is as effectual as any other, and for many pa- 
tients more convenient, but it has the disadvantage of being dirty and causing 
much trouble. 

Inversion of the Womb is said to have taken place when that organ is 
either completely or partially turned inside out ; it is of rare occurrence, but 
may come on after a labor, if there is an adherent after-birth and too forcible 
attempts are made to remove it. The only remedy is to push it back again 
into its proper position. 

Involution is a term, opposed to evolution, implying the return of an 
organ or tissue to its earlier state ; thus there is said to be involution of the 
womb after a confinement, when that organ becomes small again, after having 
expelled the child. In some cases this process does not take place properly, 
and, although the womb contracts a great deal, it may still remain much larger 
than it ought to be, so that the patient has a feeling of weight in the lower 
part of the abdomen, bearing-down pains in the back, and inability for any 
exertion. Menorrhagia or haemorrhage from the womb is also a very frequent 
symptom, and thus there is great, debility. When this takes place, sub- 



INW 399 IOD 

involution is said to have occurred. It is liable to be met with in women of 
delicate health, in those who get up too soon after a confinement, in those who 
do not suckle their children, and in those who are not properly attended to at 
the time of the birth of the child. Rest on a couch in a horizontal position 
should be enjoined, and especially when there is any bleeding ; no exertion 
should be taken, and even a carriage drive, unless upon a very even road, will 
cause distress. Tonics must be given to support the general strength, and the 
diet must be light and nourishing. An abdominal belt will often give great 
comfort, and enable the patient to take a short daily walk. 

Inward Fits are often caused in an infant by indigestion or by flatulence, 
and are relieved when the intestinal disorder is relieved and a great quantity 
of wind has been passed. The child thus affected lies as though asleep, winks 
its imperfectly-closed eyes, and gently moves or twitches the muscles of its 
face. This convulsive twitching is due to irritation in the course of the ali- 
mentary canal. 

Iodine is prepared from the ashes of sea-weed as collected on the west of 
Ireland and Scotland. It occurs in the form of scales, which have a metallic 
lustre, but have not the weight of a metal. They readily pass, when heated, 
into a beautiful violet vapor. The solution of iodine strikes a blue color with 
starch, which is very characteristic. It may be dissolved up either by alcohol 
or in a solution of iodide of potassium. The most important preparations are 
the tincture, ointment, and liquor, or strong tincture. When applied exter- 
nally iodine acts as an irritant, or, if its vapor be kept in, even as a vesicant ; 
at the same time, if well rubbed in, it is absorbed and affects the system. 
When given in large doses, iodine is said to affect glandular organs, and make 
them waste. This does not accord with modern experience. Certainly, if 
long continued or given in large doses, it produces sensations something like a 
cold in the nose, with smarting about the eyes and heaviness of the forehead. 
It is applied to the skin for a variety of purposes ; but its application is pain- 
ful, and sometimes can hardly be borne. The liniment or liquor is applied to 
the chest as a counter-irritant in chronic pleurisy, and it is painted on the 
collar-bones for the chronic pleurisy of consumption, giving rise to pain and 
cough. But, as a rule, other counter-irritants are preferable. It very often 
does good applied in the same way to the joints when enlarged and tender 
from chronic inflammation. As an ointment, iodine is a capital application to 
chilblains, if applied before the skin is broken. So, too, in certain neuralgic 
or rheumatic pains of the chest the ointment often does great good, especially 
if the part be tender on pressure, and yet due to the kind of malady above 
alluded to. If the skin be sore or tender on pressure, belladonna suits better. 
Iodine, in some form or other, is the great application for swollen and in- 
durated glands, and certainly no remedy applied locally does so much good. 
In the accumulation of fluid in the scrotum, commonly called hydrocele, it is 
usual to inject tincture of iodine after the fluid has been withdrawn. In 
chronic pulmonary consumption an inhalation of iodine of the strength given 
in the Pharmacopoeia, night and morning, will give relief. Similar inhalations 
have been commended in diphtheria and chronic bronchitis. Chronic inflam- 
mation of the nostrils and upper part of the air-passages often yields readily 
to a little iodine inhalation. Iodine is not nowadays given internally. As a 
rule, one of its compounds, most likely the iodide of potassium, is prescribed. 
This salt gives rise to all the constitutional effects of iodine, but is not nearly 
so irritating. Nevertheless it does irritate, and cannot in many cases be given 
very long without indicating some irritability of the stomach. 



IPE 400 IRI 

Both iodine and iodide of potassium, taken in excess, give rise to certain 
peculiar phenomena called iodism. These are the pain in the forehead, and 
smarting of the eyes, etc., already referred to. The disease in which iodide of 
potassium is most largely and with most benefit given is syphilis, but it is use- 
less until near the third or tertiary stage ; in it the drug works marvels, 
especially when the bones are diseased and nodes have formed on them. 
Other thickenings of the covering of the bone, not syphilitic, also yield to the 
same remedy. Some forms of rheumatism do so rapidly ; others not at all. 
Those do best which are worst at night, especially if there be any syphilitic 
taint in the system. Iodide of potassium is the best remedy for chronic lead 
poisoning after the bowels have been freely opened, and provided they are 
kept open. Certain forms of gout, too, yield readily to its influence, though 
others are not affected by it. Iodide of potassium given internally and iodine 
externally are the great remedies for goitre of the endemic kind. The ordi- 
nary dose is five grains three times a day. It is best given with a vegetable 
bitter; some like giving it in milk. 

Ipecacuanha, or Ipecac, is the dried root of a plant, Cephcelis ipecac- 
uanha, growing chiefly in the Brazils. It belongs to the same valuable group 
of plants as yields us cinchona bark. The root itself looks as if marked with 
rings, with a hard woody axis surrounded by a dark-brown woody substance. 
Its powder is pale brown, and is the preparation chiefly used. Its compound 
powder, also called Dover's powder, contains opium, ipecacuanha, and sulphate 
of potash. This is a powerful sudorific. Ipecac wine, which consists of wine 
in which a quantity of the root has been soaked, is also prescribed a good deal, 
especially for children. Given in large doses, of twenty or thirty grains, 
ipecac acts as an emetic, producing some sickness, but not so much as tartar 
emetic. In smaller doses it promotes the secretions of the alimentary canal 
and respiratory organs, and also upon the skin. It is therefore laxative, — 
though slightly, — expectorant and diaphoretic. Dover's powder has the last 
quality in the highest degree. Ipecac is often of great value in allaying ir- 
ritability of the stomach, as in the vomiting of pregnancy and imperfect men- 
struation. It also seems to do good in many forms of constipation. It is, 
however, mainly used, so far as the alimentary canal is concerned, in dysen- 
tery, especially that of tropical climates. In some cases it acts like a charm ; 
in others it does no good. Large doses of forty or sixty grains require to be 
given in this form of malady, and they may be given and repeated without any 
nausea being produced. In some cases of dysenteric diarrhoea in children, the 
wine, given in small doses frequently repeated, often cures the malady very 
speedily, especially if the stools be slimy. In asthma, — hay or common 
asthma, — ipecac wine often gives great relief. In whooping-cough ipecac 
is a great remedy. It may be given to lessen the severity of the paroxysms 
as well as their frequency. Tpecac acts best as an emetic, given in small doses 
frequently repeated, and with plenty of water. 

Iris. The iris is that portion of the eye which, to outside view, gives to 
the eye its peculiar color ; anatomically, it is a structure, partly vascular, partly 
muscular, and loaded with pigment, which separates the anterior from the 
posterior chamber.; it may be considered as a prolongation of the choroid coat ; 
the pigmentary element is wanting in Albinos. The black portion in the 
centre of the iris is an opening; in man circular, called the pupil, which is 
capable of contraction or dilatation, according as light is required for the illu- 
mination of the retina. It acts under the stimulus of reflex nervous action. 
The muscular fibres are of the involuntary or unstriped variety, and are ar- 
ranged in directions both circular and radiating. 



IRR 401 IRI 

Irregular Heart is a term applied to the condition in which there is a 
tumbling, too-frequent action of the heart ; it often occurs with palpitation of 
that organ, and is most commonly met with in disease of the mitral valve. 
See Heart. 

Irrigation. This term is applied by surgeons to a mode of local treatment, 
in which the temperature of an injured or inflamed part is kept reduced by the 
continual dropping on its surface of cold water or some cooling lotion. It is 
practiced for the purposes of preventing or relieving inflammation, and of 
cleansing wounds and ulcers. It is especially useful in cases of severe sprains 
and injuries to joints, and for suppurating wounds in connection with fracture. 
The most ready way of applying irrigation is the following : A wide-mouthed 
bottle filled with iced water is suspended over the injured part ; a long skein 
of cotton or an ordinary lamp-wick, having been dipped in water, is so placed 
that one end rests in the wide-mouthed bottle, whilst the other hangs over and 
almost in contact with the surface which is to be irrigated. A kind of siphon 
is thus formed, from the outer end of which there is a continual dropping of 
fluid. 

Iritis. Iritis, or inflammation of the iris, may be divided into acute and 
chronic, and its constitutional modifications into syphilitic, gouty rheumatic, 
and scrofulous. The general sequence of symptoms of iritis are that, in the 
first place, the fibrous texture of the iris loses color, becomes confused, the 
pupil loses its movements and becomes contracted and irregular ; next, lymph 
is effused, in some forms in small nodules, in others as a film over the pupil. 
There is intolerance of light, and frequently deep-seated pain or aching about 
the brow and orbit, with great dimness of vision. In a typical syphilitic case 
we notice that it is distinguished by effusion of lymph on both surfaces of the 
iris, in reddish or brown nodules, causing the pupil to become irregular ; pain 
most severe at night ; generally associated with other secondary syphilitic af- 
fections. In the rheumatic variety, there is less tendency to the deposit of 
lymph on the iris, and what deposit there is is not nodulated, and there is a 
haziness of the cornea absent in the syphilitic variety. The pupil is contracted, 
and more or less irregular, in consequence of the effusion of the lymph taking 
place between the edge of the pupil and the capsule of the lens. The surface 
of the eyeball is often very much inflamed and injected, so that the well-de- 
fined vascular ring, seen in syphilitic iritis, is not so evident ; another great 
characteristic is its tendency to return. Scrofulous iritis signifies either idio- 
pathic iritis occurring in a scrofulous habit, generally combined with corneitis, 
or else a deposit of cachectic lymph in the iris, which leads to scrofulous sup- 
puration of the eyeball or atrophy. Traumatic iritis signifies an inflammation 
of the iris set up by a penetrating wound of the eye. 

Treatment : The bowels should be well cleared out, the diet be unstimulat- 
ing, and blisters should be applied when the most acute stage is over. To ar- 
rest the effusion of lymph, mercury seems of the greatest value, given in the 
form of calomel, one to two grains with one quarter or one half grain of opium 
every six or eight hours. If the patient be very debilitated or scrofulous, iron 
(the potassio-tartrate), quinine, or cod-liver oil is preferable. The pupil may 
be kept dilated by dropping a solution of sulphate of atropine upon the eye 
of the strength of one grain to one ounce of distilled water. Extract of bella- 
donna smeared round the orbit is of great use also in relieving pain. In gouty 
iritis, colchicum should be administered in small doses. Pure air or sea air, 
good animal food, and warm clothing, with careful attention to diet and the 
general mode of life, are most important adjuncts to treatment. 



IRO 402 IRO 

Iron is used medicinally in a great variety of forms, commencing with the 
metal itself. Of metallic iron two forms are used in medicine, namely, iron 
wire, soft, easily flexible, and non-resilient, and reduced iron. Iron wire is used 
for the preparation of the aromatic iron mixture, a very valuable preparation, 
and the wine of iron not the less so. The vinuin ferri, or iron wine, is made 
by macerating iron wire in sherry. Reduced iron is the metal prepared by 
passing hydrogen gas over the peroxide of iron in a red-hot state. Iron enters 
into the composition of the living body in considerable quantity. Especially 
is it present in the red blood-corpuscles, into whose coloring matter it enters. 
When, from whatever cause, this proportion of iron is deficient, or the color- 
ing matter itself is not present in sufficient quantity, ill-health, accompanied 
by pallor, weakness, shortness of breath, and various other signs of imperfect 
nutrition, is seen to follow. And though it is by no means clear that the giv- 
ing of iron internally alters this directly, it certainly does indirectly, favoring 
nutrition and the formation of more healthy blood, bringing back strength, 
color, and mental and bodily vigor. This iron acts as a tonic apparently di- 
rectly on the blood, but indirectly on other tissues, especially the nervous sys- 
tem, when deranged. Most preparations of iron are astringent, some more so 
than others, hence they do good by restraining discharges, when these have 
grown chronic and the parts whence they are derived flabby. When, on the 
other hand, certain normal discharges, as the menstrual, are in abeyance, no 
remedy is so useful, provided the stoppage arises from weakness, for bringing 
them back as iron. Almost all preparations of iron in passing through the 
bowels become blackened, so that the motions of one taking iron may seem 
unnatural, where they are perfectly natural. For the same reason the tongue 
and teeth are colored black by them. 

Metallic Iron, being tasteless, is probably one of the pleasantest forms in 
which to take iron. It is best taken in doses of from two to five grains dur- 
ing a meal, or in the intervals it may be given between a sandwich. It is a 
very valuable preparation when the stomach is irritable and there is anaemia. 
The wine of iron is a favorite prescription for children. It contains a combi- 
nation of tartar aud tartrate of iron. 

The Carbonate of Iron is another very valuable compound; unfortunately, 
though easily prepared, it will not keep, but passes rapidly into the condition 
of rust. The most important preparation of this salt is the compound iron 
mixture, also known as Griffiths' mixture. This, though it contains certain 
ingredients which might be dispensed with, is perhaps the most available and 
cheapest form in which we can prescribe iron to an irritable stomach. Sugar 
is added to it to make it keep ; still it will not keep long. Its chief repute io 
in the malady of young females, who are pale and bloodless, and in whom the 
menstrual function is deficient. Some purgative, as aloes, is well given along 
with it. 

The Iodide of Iron, which is made by combining iodine and iron directly, is 
a greenish preparation. It. too, keeps badly. Its properties partake partly 
of those of iodine, partly of those of iron ; but those of the former are pre- 
dominant, so that it is commonly given rather when iodine is to be admin- 
istered without the irritant effects of the simple substance or the weakening 
influence of the potass. Hence it is prescribed generally as syrup of the iodide 
of iron, in scrofulous diseases, in some forms of rheumatism, in syphilis happen- 
ing in broken-down subjects, and perhaps best of all in children of a scrofulous 
tendency, who are threatened with brain disease. The dose of the syrup is for 
adults twenty minims to a drachm ; for children from two to fifteen minims. 



IRR 403 IRR 

The Sulphate of Iron is made use of in two forms as ordinarily sold, — dried 
and granulated; the first of these being most commonly exhibited. It is green 
in tinge, and crystalline, but the crystals are imperfect. These also tend to 
break down and assume another hue from the formation of a persulphate. 
This salt is a powerful astringent, besides having the ordinary action of iron 
salts. It is therefore useful in chronic discharges and relaxed habits of body. 
Three or four grains may be given for a dose. It is usually given as a pill. 

Arseniate of Iron is a combination of arsenic acid and iron; it is not often 
given, but when so it is with a view to combine the effects of arsenic and iron 
as a tonic in skin diseases. 

Phosphate of Iron is of greater importance; it is a slate-blue preparation, 
and is chiefly used as syrup. This a really valuable remedy, especially for 
children, who readily take it. It is not astringent, does not bind the bowels, 
and it may be given usefully in certain maladies where the other preparations 
give rise to too much irritation. 

The Magnetic Oxide of Iron is an oxide intermediate between the green 
and the red. It is a brownish- black powder, and has not much taste. It has 
been used instead of reduced iron, but is not considered so good. It is not 
much used. Its dose is from three to five grains. 

The Peroxide of Iron is used in two forms, one moist, the other dry. The 
moist peroxide is chiefly in use in case of strict emergency, which rarely oc- 
curs, namely, poisoning with arsenic, for which it is a kind of antidote*- The 
dried oxide is more irritating, and is often given when not intended when the 
compound iron and other mixtures are long kept. 

The Perchloride of Iron is the preparation most frequently used as tincture 
or liquor. It is a powerful astringent preparation, somewhat inclined to irri- 
tate ; but if astringency is desired and the irritant qualities not objected to, no 
preparation of iron better fulfills its object. It is used in poisons, bleedings, 
and discharges, and applied locally for a similar purpose. Internally it is given 
in water with good effect in erysipelas, pneumonia, and other inflammations of 
a low type. 

The Ammonio-citrate of Iron is an exceedingly mild and very valuable 
preparation. It exists in beautiful red scales, and as it possesses little astrin- 
gency is often one of the best remedies of an iron kind along with a vegeta- 
ble tonic, when a patient is recovering from acute illness, especially if the 
stomach has been troubled. 

Tartrated Iron is in many respects similar to the ammonio-citrate. It may 
be given with effervescing alkaline preparations. The dose of these is from 
five to twenty grains. 

Citrate of Iron and Quinine contains both quinine and iron in a palatable 
and digestible form. It is unfortunately rather expensive, and cannot be 
given with alkalies. It is one of the favorite modes of prescribing iron to deli- 
cate patients. In some cases of neuralgia this preparation is invaluable, though 
the carbonate is commonly prescribed for that malady. Other nervous dis- 
eases may be benefited in the same way. 

Irritants are substances which, being applied externally or internally, give 
rise to marks of inflammation of a greater or less degree of activity. They in- 
clude all substances called rubefacient or reddening, epispastic or blistering, 
and pustulant or producing pustules. The chief are mustard, turpentine, caju- 
put, corrosive sublimate, iodine, croton oil, etc., which act both externally and 
internally, besides a great variety which act only internally. The blistering 
substances are mainly cantharides, or Spanish flies, in some form or other, or 



IRR 404 ISS 

glacial acetic acid. The pustulants are croton oil, tartar emetic, and nitrate 
of silver. They are used for various purposes, mostly for the relief of inter- 
nal inflammations, though sometimes for pain of a different character. They 
are supposed to have what is called a derivative action, their effect heing to 
neutralize the inflammation within ; more probably, however, their influence 
is much more closely connected with the nervous supply of the part, especially 
with the nerves called the vaso-motor. 

Irritation is a term employed in medicine to denote a variety of ill-defined 
conditions and actions. Health consists in a due balance of all our functions, 
whereby they are carried on almost imperceptibly ; but for the performance of 
each a certain stimulus, varying in different cases, is necessary to the action of 
the parts. When this balance is lost, and the stimulus becomes excessive, we 
call the action irritation. Suppose we apply an irritant substance, say an acid, 
to the surface of the body, the consequence is an excessive irritation of the 
part which is out of all proportion with that of any other in the system. The 
condition is called irritation if it stop short of that which we commonly call 
inflammation. Any action which stops short of this commonly goes by the 
name of irritation, though very often the cause is spoken of in the same way, 
and some morbid change is said to be the result of irritation. It might be well 
to define each of these more closely, or get rid of the word altogether. Mean- 
time it is too convenient as a cloak to ignorance, or as a substitute for exact 
knowledge, to be easily expelled. See Counter Irritation. 

Ischuria, a technical expression for suppression of urine. 

Isinglass is the swimming-bladder or sound of various species of sturgeon 
cut into fine shreds and dried. Many, other fishes yield a similar product. 
This consists almost entirely of gelatine, so that when plunged into hot water 
it swells up and forms a clear transparent shaky solution, which on cooling 
forms a jelly. Precipitated by tannic acid the substance forms the basis of 
leather. The solution is only introduced into the Pharmacopoeia for separating 
tannin from gallic acid. It is, however, also used for a totally different pur- 
pose ; it is dissolved in soups and other articles of diet, gelatine forming the 
great mass of the jellies so frequently given to invalids. This substance, gel- 
atine, readily dissolves in the stomach, and though its nutritive virtues are not 
well established, it undoubtedly adds to the feeling of satisfaction a decoction 
of meat conveys. 

Issues. An issue is an artificially-produced wound which is kept raw and 
open, so that there may be a constant flow of pus from the surface. It is em- 
ployed in surgical practice either as a counter-irritant in certain local affections, 
as caries of one or more bones of the spine, joint disease, and inflammation of 
the eyes, or to keep up a constant drain from the system in certain constitu- 
tional derangements. It is often thought necessary, whenever an old idcer 
upon the leg has been dried up, to substitute for it a smaller wound, from 
which a constant, though less abundant, discharge of pus may flow. An issue 
may be made either by transfixing a pinched-up fold of skin with a knife and 
cutting through this, by blistering the surface of the skin, or by making a 
slough by the application of strong caustics or the red-hot iron. Whenever 
the surgeon has a choice of situation, he avoids regions where the skin is thin 
and stretched over prominent surfaces and angles of bone, and selects such 
parts as the outer surface of the arm below the shoulder, the calf, and the inner 
surface of the thigh immediately above the knee, as here there is much muscle 
and a thick layer of cellular tissue between the muscle and the skin. The 
wound made with a knife is dressed for the first three or four days by a pad 



ITC 405 ITC 

of dry lint, which is lightly pressed upon its surface by means of sticking-plas- 
ter. At the end of this period a raw granulating wound is established, which 
resembles the issue-wound formed by the detachment of the eschar after the 
application of a caustic or the" red-hot iron. The issue is then kept open by 
keeping some foreign body in constant contact with its surface, in order to ir- 
ritate the granulations, and to cause them to dissolve into pus instead of form- 
ing scar-tissue. The bodies used for this purpose are either peas or small 
solid glass beads. The former cause irritation in consequence of their swell- 
ing ; but whenever the wound can be kept open without difficulty, the glass 
beads are to be preferred on account of cleanliness and the comparative ease 
and freedom from pain with which they may be worn. One or more of these 
beads, according to the size of the issue, are placed upon the raw surface, and 
then strapped lightly down by sticking-plaster. When there is free discharge, 
they should be removed and cleansed every clay, and the edges of the issue 
should be frequently bathed with some weak lead lotion or sj>irit and water. 
Over the plaster should be placed a thick pad of ordinary cotton wool, or of the 
chloralum wool. When the beads or peas are removed and changed, the sur- 
face of the wound should be syringed with a weak solution of carbolic acid or 
Condy's fluid. Sometimes, notwithstanding the presence of a foreign body, 
the issue-wound heals ; it then becomes necessary to prevent this by applying 
some stronger irritant to its surface in the form either of blistering fluid or of 
caustic potash, or by merely smearing the foreign body with a salve containing 
iodine or some other stimulating agent. 

Itch is a most troublesome skin disease, caused by the presence of the 
Acarus scabiei, or itch insect. (See Ectozoa.) These little creatures bur- 
row their way into the skin and the female deposits the eggs; at night time 
especially they crawl very actively along the skin and causes intolerable itch- 
ing; the patient, to relieve the distress, is sure to scratch the part, and so pus- 
tules are formed and numerous scratch-marks. Close by the pustules may 
be seen an oblique line in the cutis, which is the mark of the burrow. This 
disease is very catching, and is a frequent accompaniment of dirt ; the little 
animals readily pass from one body to another, so that children sleeping in the 
same bed or using the same clothes will readily transmit it to each other. It 
is more common in children than in adults, as the insect prefers a tender and 
delicate skin ; and while in old people the rash is generally confined to the 
arms and- between the fingers, yet in children it may be all over the body ; as 
a rule the head and face are rarely, if ever, attacked. A cure may be readily 
effected if care be taken to rub in sulphur ointment every night into the skin 
of the affected part : this must be done so as to make the part glow ; next 
morning wash the patient with coarse soap and hot water, and rub the soap 
well in with a flesh brush. At some places sulphur baths are given with ad- 
vantage, but this can only be done in hospitals or other large institutions. 
The clothing which the patient has worn next the skin may be kept on during 
the treatment and then it should be burnt to stop the spread of the disorder. 
Although devoid of danger, this disease is so liable to extend to other people 
that when one person is affected he should be kept separate from others until 
he is well. When this disorder appears in a school, isolation should be at 
once practiced, although those similarly affected may be kept together and 
placed under similar treatment. It is entirely a local disorder, and no in- 
ternal remedies need be given, although it is a popular impression that the 
itching arises from some impurity in the blood, so loth are people to admit the 
faults arising from uncleanliness. The treatment should be repeated every 
ni^ht for a week in order to insure a cure. 



JAC 406 JAU 



Jactitation is a terra applied to the unconscious movements of a patient 
when in the delirium of a fever. 

Jalap is the dried root of a plant growing in Mexico, mainly near the city 
of Jalapa, whence the name. The roots are somewhat egg-shaped and 
pointed, untinged, about the size of an orange. They are brown externally, 
and yellowish-gray internally ; sometimes they are sliced. There is also in 
use a resin procured from the jalap root called jalap resin. This is dark brown 
in color, and very bitter. It is produced by means of rectified spirit, in which 
it is freely soluble, but is not all soluble in water. This is the jalap of the 
shops. Jalap itself, as powder, has got a sweetish yet nauseous odor and 
taste. Jalap resin from the true plant contains a substance called convolvulin, 
which is strongly purgative. Jalapine is found chiefly in a false variety of the 
root, but is also found in the true one. The preparations of jalap mainly used 
are its powder and compound powder. The latter consists of jalap, cream of 
tartar, and ginger, and is a most valuable remedy in many forms of dropsies, 
when it is desired to pump the water out of the system. Jalap itself is a brisk 
purgative, producing watery motions. It is not so irritant as scammony, and 
seems to act more on the small intestine than on the large one. It has a 
tendency to gripe, and hence is seldom given alone ; usually some substance 
like ginger is given along with it to prevent the pain. Frequently it is com- 
bined with calomel, the two constituting the favorite purgative powder of 
many old practitioners. It is moreover frequently given to children to get rid 
of worms. The use of jalap as an habitual purgative is simply to be deprecated, 
as its use frequently gives rise to subsequent constipation. The dose of jalap 
powder is from five to twenty grains ; of the compound powder about half a 
drachm. 

James's Powder is a secret preparation long in vogue. It has been a 
good deal employed in fevers, but is most serviceable in incipient colds. It 
acts as a sudorific, and is suitable when Dover's powder, on account of the 
opium it contains, is not admissible. The preparation is generally understood 
to be oxide of antimony with phosphate of lime. There used to be a very 
uncertain preparation in the Pharmacopoeia to take its place called antimonial 
powder, the dose of which is five to fifteen grains. 

Jatropha Manihot is a euphorhiaceous plant growing in South America. 
The juice of this plant, and the plant itself when fresh, is violently irritant and 
poisonous, but when the juice is removed, the starch which is left behind is a 
valuable food, and constitutes the article tapioca. The cassava bread of that 
region is made from the same root in the same way. See Tapioca. 

Jaundice can hardly be looked upon as a separate disease, though as a 
symptom of disease it is so grave and important as to be ranked in nosologies 
as a distinct malady. The one essential of jaundice is a yellow color of the 
skin, due most frequently to an absorption of the coloring matter of the bile 
and its circulation along with the blood. By some it is also supposed that 
there are cases of jaundice due to non separation of the coloring matter of the 
bile from the blood and its accumulation there, but this is not generally taken 
as fact. Whatever, therefore, obstructs or prevents the flow of bile into the 
intestine will give rise sooner or later to jaundice. Chief among these are 
narrowing of the bile-ducts, from whatever cause. Thus inflammation of the 



JIG 407 JOI 

lining membrane of the ducts may cause it. Still more likely is pressure to do 
so ; this indeed is the most common cause of jaundice. In this way faecal 
accumulation in the colon may give rise to jaundice, tumors about the orifice 
of the bile and pancreatic ducts, abdominal aneurisms, and cancer of the glands 
in the great fissure of the liver. Again, we may and often do have obstruc- 
tion from gall-stones, plugs of thickened mucus, hydatids, etc., blocking up the 
ducts. These same ducts may be blocked up by ulceration from gall-stones 
and subsequent contractions, or in a variety of other ways. Within the liver 
any pressure on the main tubes containing bile may give rise to jaundice ; so 
too may inflammatory conditions extending to them. In certain degenerations 
of the liver jaundice is found, but by no means in all. It occurs in acute yel- 
low atrophy, and in cancer if the mass happens to press on a duct, but not 
otherwise. Yet again there are certain maladies, where the liver need not be 
specially affected, in which jaundice prevails; such is the case in relapsing 
fever, still more in yellow fever and ague ; whilst in not a few cases jaundice 
is entirely due to emotional causes, as fright or excessive anxiety, or the suffer- 
ings from wounded pride. The symptoms come on gradually or suddenly. 
If" gradually, then there is progressive loss of appetite, headache, and depres- 
sion ; there is also some nausea and a sense of weight in the stomach. If it 
comes on suddenly, the patient may make the discovery in the morning that he 
is yellow. This color is most marked in the whites of the eyes. At the same 
time the urine becomes of a rhubarb tint and stains the linen, whilst the fasces 
are whitish or clay-colored. The skin itches, and there is a bitter taste in the 
mouth. Digestion is interfered with, and sometimes every object seen seems 
of a yellowish hue. When the malady lasts long the brain power is weakened, 
and there may be stupor or delirium, whilst the nutrition of the patient suffers, 
and he becomes thin and weak. Sometimes there is a tendency to bleed from 
various parts, and most frequently there is some bleeding. All this may 
speedily pass away, or become more and more aggravated, till the patient be- 
comes almost black. At the same time there may be excruciating pain, par- 
ticularly if a gall-stone be the cause of the jaundice ; or pain may be entirely 
absent. The treatment to be adopted for the jaundice will depend entirely 
upon the cause of the obstruction to the flow of bile. But suppose we take 
a common case, obstruction from catarrh of the bile-ducts, or obstruction from 
some emotional cause. This last form of the malady will pass away sponta- 
neously, but both may be aided by medicine. Of all remedies adapted to the 
complaint, rhubarb and soda or potash seem best. Then, as there is ordinarily 
some stomachic derangement, a little ginger added is an improvement, and 
some spirit of chloroform aids to make the whole sit easily. Sometimes sul- 
phate of magnesia, with sulphate of soda, does good ; but the treatment must 
vary with each individual case. The food should be light and nutritious, and 
stimulants should be avoided. If any are required, claret and water or very 
weak brandy and water is best. Some recommend in these cases of chronic 
obstruction that pig's bile should be given about the period when stomach 
digestion has ceased. Doubtless this would aid in the transformation of the 
food and in the preservation of that which has to be discharged, for the faeces 
in these cases are not only colorless but putrescent. The fact that dogs can 
live long without any bile passing into the alimentary canal is hardly in point 
as far as the human being is concerned in jaundice. 

Jigger. See Chigoe. 

Joints, Diseases of. The most common affection to which a joint is 
subject is inflammation of the synovial or the thin, delicate lining membrane. 



JUN 408 JUN 

This membrane contains and secretes the synovia or joint oil which lubricates 
the joint. Now, if. from any cause, such as blows, strains, or other local in- 
jury, or from exposure to cold, rheumatism, gout, etc., a severe aching pain in 
the affected joint comes on, and great swelling very soon after the pain, at- 
tended with redness of surface and constitutional fever, a condition exists 
called Synovitis. The knee is the most frequently affected. The shape of the 
joint is altered, owing to the effusion into the synovial cavity, which conse- 
quently bulges at those portions of the joint which are least protected by the 
natural coverings, ligament, tendon, or muscle. In the case of the knee, the 
affection can be distinguished from the inflammation of the bursa over the 
kuee-cap, from the fact that in synovitis the knee-cap can be distinctly felt 
floating as it were upon the fluctuating swellings, which are situated on either 
side of the joint ; whereas in the latter case the swelling is in front of the 
knee-cap and of the ligament tying it down to the shin-bone (tibia). 

Treatment: Perfect rest is indispensable, and the joint must be confined 
either by splints or by a piece of gutta percha, or stiff leather, or card-board, 
made pliable in boiling water, and moulded over the joint. It should be lined 
with some soft leather, and capable of being laced up or let out as the condi- 
tion of the joint requires it. Leeches may be applied to the joint ; ice-evap- 
orating lotions, hot fomentations, or a linseed-meal or bran poultice (sprinkled 
over with laudanum), are the best local applications. A dose of calomel and 
afterwards a saline purge, with an opiate at night, form the constitutional 
treatment. In rheumatic cases, and when the urinal sediment is red, am- 
monia and potash, and afterwards iodide of potash, may be given. If the 
disease has been very acute, the joint, may become permanently stiffened. 
Chronic rheumatic inflammation of a joint (arthritis) is generally met with in 
old persons ; it is characterized by racking, gnawing, rheumatic pains in the 
joint affected, aggravated by changes of weather. The joint is stiff and swollen, 
very painful if touched ; the muscles become wasted, and on any attempt made 
to use the joint, either actively or passively, a sort of cracking or creaking 
sound is audible. The joints most frequently affected are the shoulder, hip, 
and articulations of the hand and the spine. The treatment is to give iodide 
potass, or ammonia, or guaiacum, with generous diet, anodyne embrocations, 
and vapor or Turkish baths, but rarely much relief is obtained. 

Loose cartilages in joints are occasionally met with. They appear as little 
hard bodies at the articulating edges of bones ; they frequently, during walk- 
ing or running, get pinched as it were between the surfaces of the articulation, 
causing intense pain, sickness, a feeling of faintness, and setting up considera- 
ble inflammation in the joint. The cartilage is removable by operation. All 
the other structures which enter into the formation of a joint, such as the lig- 
aments, cartilages, and bones are subject to disease, the most common of which 
is scrofulous or white swelling, most frequently affecting children and more 
rarely adults. The treatment consists in perfect rest, cod liver oil, iron, and 
sea-air ; but as most of the cases which come under observation require opera- 
tive interference, they will not be entered upon in any detail here. See Knee 
Joint. 

Juniper (Juniperus communis) is a common enough plant all over America. 
It has berries, which, being distilled when green, yield a colorless or pale green 
oil, having in a high degree the odor and warm taste of the fruit. The berries 
themselves are about the size of black currants, of a dark purple color, with a 
bloom on the surface. Their interior is filled with a brownish-yellow pulp. 
Their odor somewhat resembles that of turpentine, but is more agreeable. 



KAM 409 KET 

The oil usually contains a little resin from its own change by oxidation, and, 
mixed with rectified spirit, constitutes spirit of juniper. This is largely used 
in medicine on account of its action on the kidneys, which it stimulates, and 
causes to pass through them a larger quantity of urine than natural. This 
property is valuable in certain forms of dropsy, and in these the remedy is 
used. It is sometimes given alone, but most frequently it is combined with 
other remedies, especially broom tops and cream of tartar. A capital combi- 
nation for country use is thereby formed. The same ingredient is found in Hol- 
lands, and in less quantity in English gin. For this reason Hollands may be 
substituted for the ordinary spirit of juniper, and, added to broom tops with 
cream of tartar, will be found a most efficient diuretic and stimulant in slow 
cases of heart 



K. 

Kamela, or Wurrus, is a drug comparatively recently introduced into 
medical practice as a remedy against worms. It is an orange-red powder 
which adheres to the capsules of the Rottlera tinctoria, an euphorbiaceous tree 
growing in India. The powder hardly mixes with water, but is almost en- 
tirely soluble in alcohol. It has long been employed in India as a remedy for 
tape-worm, but has not been much used in this country. It usually purges 
severely, and this may in certain cases be an objection. It is best given in 
doses of thirty grains, or a drachm in some thick substance or in spirit. 

Keloid is the name given to a disease of the skin in which there is harden- 
ing or thickening of that tissue, so that the part very much resembles that seen 
after a burn. It occurs on the back and upper' extremities chiefly, and seems 
to be an incurable disorder. The word " keloid, " or "kelis," is derived from 
a Greek word signifying a crab's claw. There seem to be two kinds or vari- 
eties of this disease. The one appears as hard, shining tubercles or small 
nodules of a dusky or deep-red color, and generally attended with itching, 
pricking, shooting, or dragging pain in the part. These tubercular elevations 
gradually increase in size until they are as large as a horse-bean, or even an 
almond, and about one-tenth or one-sixth of an inch above the general level of 
the skin. They are hard, firm, and elastic, but after a while they become 
broader and more irregular. Some delicate whitish, glistening lines appear on 
the surface, and from each there is a claw-like process from a quarter of an 
inch to an inch in length, which appear to cause a piickering of the skin. 
Growth may go on for months and even years, but they only cause local in- 
convenience and do not impair the general health. The other form of keloid 
does not begin with tubercular elevations, but as white, roundish patches of 
skin, very slightly raised and surrounded by a zone of redness. At first there 
is no pain nor uneasiness ; afterwards there is itching and pain, with a feeling of 
tightness in the part ; at length the part becomes hide-bound, and the skin is 
hard and rigid, so that the movement of the part is impaired. The fingers are 
very liable to be affected in this way. After a time the skin shrinks, becomes 
red or yellowish, and may go on to ulceration. If the affected part be extir- 
pated the disease often returns, aud no treatment known to the profession 
seems to be of any avail. 

Ketchup. A condiment and sauce obtained from the mushroom, by the 
addition of salt and spices, and by boiling off the excess of water. An inferior 
ketchup is made from the outer rind of the walnut and other vegetable sub- 
stances. See Mushroom. 



KID 410 KID 

Kidinga Pepo is a peculiar form of exanthematous disease which occurs in 
an epidemic form in some tropical countries. In the year 1870 it hroke out 
in Zanzibar on the southeast coast of Africa. The natives of India there res- 
ident were quite unacquainted with it in their native country, and they named it 
" homa magnu," or leg fever, because severe pains in the lower extremities 
formed one of its most prominent symptoms. The Arabs from Oman and the 
Persian Gulf confounded it with "bardiabis," or rheumatism, but admitted that 
many of the symptoms had been previously unknown to them ; and the Arabs 
from Ilydramant, in the Gulf of Arabia, spoke of it as a disease with which 
they were well acquainted in their native country, and they named it " udefu," 
a word which seems untranslatable in our language. This word was speedily 
changed by the Suaheli of Zanzibar into the familiar word " madifu," meaning 
'"beards;" but the name was used only by the slave population. The natives 
of the mainland seem to have been entirely unacquainted with the disease, as 
no native term was applied to it. Those inhabitants of Zanzibar who were 
pretty well advanced in life at once recognized it as a disease which was epi- 
demic on the east coast of Africa about forty-eight years ago. and which was 
then called " kidinga pepo." In regard to this, all the old inhabitants, whether 
Suaheli, Hindiees, or Arabs, were agreed, and their nomenclature, "kidinga 
pepo," was at once adopted as the proper name of the disease. The word 
'• pepo " was soon changed into " popo," which made its significance more ob- 
scure, as " pepo " means an evil spirit, and " popo " signifies a butterfly or a 
bat. The word " kidinga " is now obsolete in general conversation in Zanzi- 
bar, but in signification it is nearly allied to that of " gauzi," or cramp. Many 
diseases are supposed by the vSnaheli and negroes to be originated through the 
agency of evil spirits, and are named accordingly. This mode of nomenclature 
is almost invariable in the case of diseases in which the seizure is sudden. The 
term " kidinga pepo " properly means " cramp-like pains, produced through 
the agency of an evil spirit." "The disease most allied to it, if not identical 
with it, is that called dengue or dandy fever, a peculiar febrile disease, con- 
joined with severe pains in the small joints, which swell, succeeded by general 
heat of skin, intense pain in the head and eyeballs, and the appearance of a 
cutaneous eruption on the third or fourth day/ This disease has been epidemic 
in many tropical countries — in the East Indies, in the West Indies, in the 
Southern United States, in New Orleans, Savannah, Charleston, Philadelphia, 
and New York. There was an epidemic of it in the United States in 1824-28 ; 
it then disappeared until 1847 and 1850, when it again visited the South- 
ern States; then in 1861 it broke out in Virginia, while in 1872 it was very 
prevalent in Calcutta, and in other towns in India. (See Dengue.) The dis- 
ease ''kidinga pepo" is not ushered in by any observable premonitory symp- 
toms, but there is always a sudden seizure ; the first symptoms are pain and 
stiffness of the muscles, chiefly in the palms of the hands and soles of the feet, 
and increased when any attempt at motion is made. This is followed by a 
general febrile state, varying greatly in intensity; the skin becomes hot and 
dry; the tongue red and spotted, but generally clean; the face of a bright 
scarlet color, "disappearing on pressure, but returning when the pressure is re- 
moved. The discoloration is in every case peculiarly marked, extending from 
cheek-bone to cheek-bone across the bridge of the nose, and usually accompa- 
nied by a puffy swelling, indicating infiltration into the adjacent subcutaneous 
cellular tissue. This appearance much resembles that met with in an ordinary 
attack of erysipelas of the face, and it is a well-marked and invariable symp- 
tom. In addition to the stiffness above mentioned, there is pain over the whole 



KID 411 KID 

of the body, and chiefly in the shoulders, back, ankle-joints, and the soles of 
the feet; and towards the close of the first twenty-four hours there is often 
swelling of the smaller joints, and pain on pressing the joints of the fingers 
and toes. There is also obstinate constipation, so that it is necessary to ad- 
minister large doses of purgative medicines before the bowels can be made to 
act. The average duration of this, the first or febrile stage, is about forty- 
eight hours, and then the symptoms begin gradually to subside. The febrile 
stage is followed by a period of remission of from two to three days, during 
which all symptoms of fever are entirely absent, there being only general de- 
bility and occasionally slight muscular pains. The remission is usually so 
complete that the patient is with difficulty persuaded to keep within the house, 
and the natives, as a rule, return to their usual avocations. On the fourth day 
there is generally a slight return of the fever, but always much less severe 
than during the first stage, and in many cases there is no fever at all. On the 
fifth day the exanthematous eruption invariably appears. This eruption re- 
sembles neither that of measles, rubeola, nor scarlet fever. It is much more 
like that of erysipelas, but with this important exception, that the discoloration 
is much less intense, and spreads over the entire body within forty-eight hours. 
In regard to the wavy outline between the healthy and the diseased tissues 
there is much resemblance. This eruption, even in the mildest cases, is always 
observable on the palms of the hands and on the soles of the feet; but it 
never begins there, its course being always from the head and face downwards. 
When this eruption has reached its greatest intensity, the superficial lymphatic 
glands of the neck and face begin to swell, and invariably those at the back of 
the neck. Swellings of the glands, also, in the neck, arm-pit, and groin are 
general, but not invariable. At about the same time that these glands swell, 
the lining or mucous membrane of the mouth and nose become implicated, 
and in severe cases that of the throat. In mild cases there is merely redness 
and tenderness of the membrane, but in severe cases there is an aphthous erup- 
tion, giving rise to great swelling of the lips and nose, with excessive pain, and 
the mucous surface becomes quite raw. During the fifth and sixth days the 
muscular stiffness and pain continue, and there is severe pain in the joints on 
the slightest movement. On the seventh or eighth day the acute stage termi- 
nates, and the skin begins to peel. These symptoms are very much like those 
in dengue, but there are several important distinctions. In dengue the glands 
begin to swell at an earlier period of the disease, while in this affection they 
are not implicated until the erysipelatous eruption has reached its maximum 
intensity. The eruption of dengue is said to be variable: sometimes smooth 
and continuous, like scarlet fever ; sometimes in patches, rough, and of a dark 
color, as in measles ; occasionally either as papules or pimples, or vesicular, 
and in small blots, or pustular, or in furunculous, as in boils, and often with a 
mixture of two or more of these forms. In " kidinga pepo " the eruption is 
invariable in form. The affection of the mouth and throat and the pain in the 
joints is not invariably met with in dengue, while it is always present in 
this disease. The symptoms of " kidinga pepo " are well marked and very 
characteristic, but there may in addition be complications arising from consti- 
tutional tendency, Or from previous attacks of disease. The sequela? or con- 
sequences of dengue are much less severe and prolonged than in " kidinga 
pepo." In the latter the symptoms may be painfully severe for weeks and 
even months. The parts most painfully affected during the chronic stage are 
the shoulder, wrists, and ankle-joints, and the pains generally fly about from 
one joint to another, and are recurring. In some cases the pain is distinctly 



KID 412 KID 

in the joint, and friction is felt on moving it as if the surfaces were drier than 
usual. It is more common, however, for the severe pain to be complained of 
in the muscles, and in particular in the upper part of the arm. There is also 
swelling and tenderness of the superficial glands. The disease seems to he 
communicable, for, as a rule, all the members in the house suffer. The Euro- 
peans and Americans suffer more than the natives, and very few escape an 
attack. In no case does the disease recur in the acute form, and no fatal cases 
occurred in the last epidemic among either children or adults. The natives 
who remembered the last epidemic assert that it was much more severe, and 
that many deaths occurred, especially among children, and that the stiffness of 
the joint was in many cases permanent. 

Treatment : At the onset a purgative may be given, and then five-grain 
doses of quinine in the same way as one treats an intermittent or malarious 
fever. When the febrile symptoms have gone, iodide of potassium may be 
given with great advantage, and with the effect of stopping or checking the 
usual sequela?. This drug may be continued until peeling or desquamation of 
the skin has taken place, but even in chronic cases much relief is afforded by 
the use of this drug. The above description is taken from an interesting ac- 
count of the disease by Dr. Christie, physician to the sultan of Zanzibar. 

Kidneys. The kidneys are two in number, and lie in the back part of 
the abdominal cavity, one on each side of the spine. Each is about the same 
shape, but nearly twice the size of an ordinary sheep's kidney ; each is sup- 
plied with a vessel (the renal artery) which brings the blood from the aorta 
to the kidney, and with another vessel (the renal vein) which brings the blood 
to the inferior cava after it has passed through the kidney. Soon after the 
artery enters the organ, it breaks up into a great many small branches, and 
these again divide, and at length numerous fine tubes are formed, which have 
extremely delicate w r alls and enable the blood to come into the closest contact 
with the kidney tubes. There are two sets of these capillaries : the one, being 
arranged in an intricate net-work around the tubes ; the other, being arranged 
in clusters and surrounded by the dilated commencement of a tube ; thus one 
set is outside, and the other inside, the kidney tubes. In whatever way these 
different sets are formed they finally join and form the renal vein. The rest 
of the kidney is made up of tubes, or hollow canals, lined with epithelium, 
commencing at first in dilated extremities and inclosing fine blood vessels ; 
then they pursue a tortuous course, surrounded by capillaries, till, joining each 
other by degrees, the tubes open into a funnel-shaped opening called the pelvis 
of the kidney ; this in tnrn ends in a narrow tube which conveys the urine to 
the bladder. The kidneys are, in fact, so arranged as to form filters, which 
abstract from the blood water and various constituents which make up what is 
known as the urine. The kidney is the only organ in the body which takes 
away materials from the blood without giving anything in return, and hence 
the blood in the renal vein is probably the purest to be found in the body. It 
is essential for the proper performance of the renal function that a certain 
amount of healthy blood should pass through this organ in twenty -four hours, 
and so any alteration in the quantity or quality of that fluid will cause some 
derangement of the kidneys. In cases of heart disease, or of empyema, the 
circulating stream is obstructed and the venous system becomes too full ; the 
renal vein shares in this fullness, and hence the kidneys become over-distended 
with blood in their vessels, but the blood is more or less stagnant, and not re- 
newed as it ought to be, so that very little urine is passed, and that excreted 
is dark in color and deposits some sand on cooling ; often it contains also a 



KID 413 KID 

trace of albumen, because the serum of the blood escapes from the tense ves- 
sels into the tubes and so into the urine, and wherever serum is present albu- 
men will be found, for it is one of its constituents. Now and then blood will 
be seen also in the urine. This state of things generally comes on towards 
the end of the disease ; the patient suffers also from dropsy of the legs or 
abdominal cavity, or from jaundice, and shortness of breath and palpitation of 
the heart, or from a combination of these symptoms. An alteration in the 
quality of the blood will also induce kidney disease ; this is the case in many 
fevers, and more especially after scarlet fever, when acute Bright's disease is 
by no means an uncommon complication. Those who are scrofulous or rickety, 
and those who suffer from consumption, syphilis, or gout, 1 and those who have 
led intemperate lives, are liable to get disorganization and destruction of their 
kidney substance, and serious mischief may ensue, leading sooner or later to a 
fatal termination. For an account of these changes and the symptoms which 
accompany each variety, the reader is referred to the article on Bright's 
Disease. The kidney is also liable to various other diseases, which may here 
be briefly mentioned. A blow across the loins, a stab, or a gun-shot wound 
may cause rupture of the organ ; great pain over the seat of injury, with sick- 
ness and faintness, followed by the appearance of blood in the urine, are the 
chief symptoms. (See Hematuria.) Cancer of the kidney may occur ; this 
is a rare form, and generally associated with cancer of other organs ; a large 
tumor may be developed on one or the other side of the abdomen, blood may 
appear in the urine, or albumen may be present more or less persistently ; the 
pain, emaciation, loss of flesh and strength, are to be found in these as in all 
other cases of cancer, and finally lead to a fatal result. Death, however, takes 
place less rapidly than when the stomach or the liver is the seat of this malig- 
nant disease. Various poisons, other than the fever-poisons mentioned above, 
may cause disease of the kidney; in this way phosphorus, arsenic, turpentine, 
and cantharis or Spanish fly, have been known to cause blood in the urine, 
and even suppression of urine. The inhalation of arseniuretted or sulphuretted 
hydrogen has caused similar results ; these gases are evolved in the process of 
separating certain metals from their ores ; in their pure form they are rarely 
met with, except in the chemical laboratory. A stone, or calculus, may exist 
in the pelvis of the kidney without bringing about any untoward result ; at 
other times it may block up the channel so as to prevent the flow of urine, 
and then the kidney will become distended into a large cyst, and be rendered 
quite incapable of performing its functions ; or, again, the stone may pass down 
the ureter, or the canal which conveys the urine from the kidney to the blad- 
der, and cause great distress ; intense pain in the loins and down into the groin 
and thigh, faintness, and vomiting are the chief symptoms ; a hot bath to alle- 
viate the pain, and the administration of chloroform to diminish the spasm of 
the ureter, are the best means for relief ; tea, water, or any diluent drinks may 
also be given, so as to wash the stone down into the bladder. (See Obstruc- 
tions, Renal.) Cancer of the bladder, or the presence of a tumor or stone 
in that cavity, may cause also disease of the kidney, by pressing on the ureter 
and distending that tube, so that from this cause the kidney may become 
cystic or converted into numerous dilated cavities ; inflammation, too, of the 
bladder may exist in these cases (see Cystitis) and add to the mischief, for 
this process is apt to extend up the ureter to the kidney itself and cause the 
formation of pus and a total destruction of the kidney ; this change is often a 
cause of death in those persons who have long suffered from a stone in the 
bladder. Abscesses may form in the kidney in cases of pyaemia, but no 



KIN 414 KNE 

symptoms of any marked importance attend this change ; more frequently an 
abscess may form around the kidney, and burst either in the loins or in the in- 
testinal canal. If the state of things is known during life, and the abscess 
point in the loins, an opening may be made by the surgeon and the matter he 
let out; but these cases are very obscure and very difficult to make out ac- 
curately. Lastly, malformation of the kidney may occur, but give rise to no 
harm in consequence ; tbey may be joined together in front of the spine by 
their lower extremities, and so have the form of a horse-shoe, or, more rarely, 
both are developed on the same side of the spine ; these peculiarities, however, 
do not seem to interfere in any way with the healthy performance of the renal 
function. 

King's Evil. See Scrofula. 

Kino is the juice of a tree belonging to the leguminous group, the Ptero- 
carpus marsupium. The trunk is incised, and as the juice flows it hardens in 
the sun, forming brownish or reddish-black tears. It is generally seen, how- 
ever, in broken pieces, more or less angular, translucent, and ruby-red at the 
edges, shining and brittle. It has no odor, but its taste is powerfully astrin- 
gent and turns the saliva blood-red. Kino contains a kind of tannic acid, and 
another astringent principle called catechin, together with red gum. Its most 
important preparation is the compound kino powder, which contains kino, 
cinnamon, and opium, — one grain of opium in twenty of the powder. Kino 
is a very powerful astringent, and may be given for the tannin it contains. It 
is not so soluble as catechu. It is often, and perhaps chiefly, used in diarrhoea, 
for stopping which the compound' powder is a very excellent preparation. It 
may also be chewed for relaxed sore throat. These are the chief uses of this 
substance. It mainly differs from tannin in being less soluble. 

Kirschwasser. A spirit distilled from cherries in Germany, and re- 
sembling brandy. From the quantity of prussic acid it contains, extracted 
from the kernels of the cherry, it is dangerous to take any amount of it in- 
advertently, but when mixed with water it forms an agreeable stomachic, and 
is a good substitute for a better stimulant. 

Kleptomania is a form of madness, in which stealing is a prominent and 
singular feature. See Insanity. 

Knee-joint. This articulation is the largest in the body, and is composed 
of three bones : the thigh-bone (femur), shiu-bone (tibia), and knee-cap (patella). 
These bones are held together by a great number of strong ligaments, and the 
movements of the joint are controlled by numerous muscles. Like all movable 
joints, the articular surfaces are covered over with cartilage, and a large and 
complex synovial membrane is insinuated between the structures forming the 
joint. A remarkable feature about the articulation it has in common witli one or 
two more in the body, namely, the inter-articular fibro-cartilages, or as they are 
here called, semilunar ; their office is to defend the joint from severe and sudden 
concussions, and their mechanism is so adjusted that they are always between 
the ends of the bones when and at the point at which the greatest pressure is 
experienced. From the complex nature of this joint, its size, and exposed sit- 
uation, it is obvious that it must come in for a large share of injury, and it is 
peculiarly subject to disease. The natural movements of which this joint is 
capable are flexion, extension, and partial rotation outwards and inwards. 

Diseases of the Knee-joint. The several affections to which the knee-joint 
is subject are : (1.) Fracture. (2.) Dislocation. (3.) Synovitis. (4.) Bursitis. 
(.').) Scrofulous disease. (G.) Rheumatic affections. (7.) Loose cartilages. 
(8.) Maliguant diseases. (9.) Hysterical affections. (10.) Deformities. 



415 





Fig. xxvi. 



Fig. xxvii 




Fig. xxxi 



Fig. lxxh. 



KNB 417 KNB 

Fractures connected with the knee-joint are referred to in detail in the article 
Fracture, but it will be as well to allude to them in the present article. Fract- 
ure of one or both condyles of the femur, opening the joint, is usually met 
with in old persons, and is very serious, not unfrequently ending fatally, from 
the constitutional disturbance. The limb should be placed in splints as straight 
as possible. Compound fracture of the knee-joint, the result of gunshot wounds, 
or railway or machinery accident, generally requires amputation, although in 
some cases the operation of excision has been of use. Fractures of the patella 
may be regarded as fractures into the knee-joint, if the synovial membrane 
which covers its posterior surface be ruptured. This important and common 
fracture requires a separate notice. Fracture of the head of the tibia into the 
knee-joint requires the same treatment as fracture of the condyles of the femur. 
The limb should be kept straight, and the whole limb raised so as to relax the 
quadriceps extensor. The joint must be kept motionless, and in about five 
weeks passive motion may be commenced. 

Dislocation of the Knee. Dislocation of the tibia from the femur is an un- 
common accident, and is. generally partial. It can be recognized by the obvious 
deformity and impediment to motion ; it is to be treated by extension, and a 
straight, well-padded back splint. 

Dislocation of the Patella is not uncommon, especially a partial one, laterally ; 
it is easily reduced, if anaesthetics be administered, by extending the leg upon 
the thigh and returning it to its place by manipulation. A more uncommon 
form is where it is turned up on its edge, causing a very unsightly appearance ; 
and is sometimes very difficult to reduce; extension must be made, and the pa- 
tella forced back again into its groove. The semilunar cartilages are sometimes 
dislocated, from sudden twists of the knee-joint, so that they get wedged in 
between the tibia and the femur. The symptoms are sudden excruciating pain, 
inability to stand or straighten the limb, and a depression on the side of the 
joint. It may be reduced by bending the knee, and rotating the lower limb 
gently. Sometimes it will return of itself, under the influence of an opiate. 
The knee must be afterwards supported by a cap. 

Synovitis of the Knee-joint may be both acute and chronic. The general 
symptoms are in common with synovitis affecting any joint, but the chief feature 
with regard to the knee is that the patella is protruded forwards and there is 
great fullness at each side of it, and at the lower and front part of the thigh, 
the patella seeming as it were to float in the joint. Acute synovitis of the knee 
is very serious, owing to the large size of the joint, and it is certainly the most 
frequently affected of any. It is produced by injury, as a blow, or severe strain, 
or a stab into the joint, exposure to cold, or the various morbid conditions of 
the blood. Its progress is very rapid, commencing with severe pain, and al- 
most immediate swelling, redness, great tenderness, and severe constitutional 
symptoms. 

With regard to treatment, the limb must be kept perfectly motionless, and 
the best way of doing it is to make splints by moulding some very thick paste- 
board, or leather, or gutta percha, rendered soft by boiling water, accurately to 
the joint, the limb having been previously kept at rest by a long back splint. 
The joint should be leeched, or ice, hot fomentation, or evaporating lotions may 
be employed with great relief. A good dose of calomel should be given, fol- 
lowed up by salines Opiates should be administered at night. If rheumatism 
or gout be obviously connected with this condition of the joint, suitable reme- 
dies must be employed. Syphilis is a frequent cause. 

In the chronic form, which is frequently a sequel to the foregoing, there is a 
27 



KNB 418 KNE 

swelling of the joint, dull aching pain ; the swelling, however, generally comes 
on some time after the pain, and there is sudden starting in the joint. In cases 
caused by injury, the same treatment as that recommended in the acute stage 
may be employed, subject to modification. If the cause be some pne of the 
morbid conditions of the blood already alluded to, general treatment must be 
adopted. An attempt should be made to produce absorption of the effusion and 
thickening by counter-irritation. This consists in the first instance of blistering 
near but not on the joint. The blisters should be small, and applied in suc- 
cession ; next iodine paint or linimentum hydrargyri, with a hot-water douche 
and vapor baths. In many cases the dressing recommended by Mr. Scott is 
of great value. It is thus directed to be applied: "The surface of the joint, 
having been first washed with camphorated spirit, should be covered with the 
unguent, hydrarg. comp. thickly spread upon lint ; next, adhesive plaster should 
be evenly applied in strips, overlapping and crossing each other, so as to form 
a complete casing for the joint, and, lastly, a bandage. If abscess form in the 
joint, which it does sometimes in acute synovitis, and which may be expected 
if there be very much swelling, pain, shivering, quick-bounding pulse, and 
general constitutional disturbance, poultices and hot fomentations must be 
applied, and the pus evacuated by puncture with a fine trocar or narrow-bladed 
knife. 

Bursitis, or inflammation of the bursa? in connection with the joint, namely, 
the bursa patellae, the bursa on the. tubercle of the tibia, and those between the 
condyles of the femur and the gastrocnemius muscle, have been already treated 
of in the articles Bursa, Housemaid's Knee. 

Scrofulous Disease of the Knee-joint, White Swelling. This condition of the 
joint, or of the structures forming the joint, always occurs in those of scrofulous 
constitution. It is probably more common in children than in adults, and it 
commences with slight lameness, swelling of the joint, and from the pain or 
stiffness of the articulation the muscles are not brought iuto play, and so waste 
or atrophy. The general train of symptoms is much as follows: In the first 
place there is either history or evidences of scrofula ; occasional pains are no- 
ticed in the joint, becoming gradually worse, especially at night ; swelling is 
rarely noticeable at first, and the peculiar form subsequently taken by this 
swelling — a sort of globular enlargement — is owing to the infiltration of the 
structure surrounding the joint, rather than to effusion into it. If the disease 
proceeds unchecked, some disorganization of the joint ensues, and from having 
been kept so long bent, or becoming bent by the ham-string muscles, at last, in 
many instances, dislocation of the tibia backwards takes place. The morbid 
conditions occurring in the knee affected with scrofula are identical with those of 
other joints, and will be more fully discussed under the article Scrofula. 
The treatment in the early stages is, locally, to procure rest, and to endeavor 
to prevent deformity, leeching, fomentation, and poultices, if there be much 
pain. Counter-irritation — blisters, iodine, or issues, Scott's dressings, are all 
of value ; constitutionally, cod-liver oil, iodide of iron, quinine, good food, and 
sea air. In severe cases, operative interference is necessary, such as excision 
of the joint, or even amputation. The results following excision of the knee- 
joint are very satisfactory, provided a proper case for the operation be selected. 
There are many instances of a perfectly useful limb being retained, and fre- 
quently a shapely one, and one on which an individual can follow his ordinary 
occupation as well as formerly. 

Loose Cartilages. The knee, in common with other joints, is sometimes the 
seat of these bodies. They are usually of an irregularly oval form, but vary in 



KNE 419 KNE 

structure and density ; they vary also in size from a pea to a plum-stone. Their 
surface is generally smooth ; they seldom occur singly, usually two or three are 
found in the joint. They are attached by means of a delicate pedicle to the 
capsule of the joint. The symptoms of their presence are excruciating pain 
from their suddenly getting between the ends of the bones, when the limb is 
rendered rigid, and motion arrested suddenly, and these symptoms will continue 
until the substance has been manipulated back again from its position. If they 
do not cause very much inconvenience, palliative treatment is useful ; thus, an 
elastic bandage or a tightly fitting knee-cap should be applied, and the patient 
kept in a recumbent position. Should this fail, an operation for their removal 
must be had recourse to, and it must be borne in mind that no operation is ex- 
pedient except in troublesome cases, and considerable precaution must be taken, 
as, even in the most skillful hands, it has been fully shown that it is not alto- 
gether free from risk, by setting up serious inflammation in the joint. 

Malignant .Disease. Occasionally the knee-joint is the seat of malignant 
growths, particularly of cancer, and any soft tumor springing from the lower 
end of the femur, or head of the tibia, is to be viewed with anxiety. (Non- 
malignant growths, such as exostoses, fibrous or enchondromatous tumors, are 
sometimes met with.) 

Hysterical Neuralgia of the Knee-joint depends upon some morbid condition 
of the uterus, stomach, or rectum. The term " hysterical affection " is taken 
rather in a general sense, and it is often the custom to refer anomalous nervous 
affections of joints to hysteria. The treatment in these cases may be both 
constitutional and local. If there be emaciation and debility, iron, bark, and 
cod-liver oil are of service. In plethoric persons purging and low diet are 
indicated. Locally, hypodermic injection, aconite and belladonna liniments 
should be rubbed into the part affected Galvanism in a continuous cur- 
rent passed through the joint, and the application along the spine of Chap- 
man's ice-bags, are remedies which should be tried. Division of the main 
nervous trunk is not advisable, as, although the relief is instantaneous, the at- 
tack speedily returns as severe as ever. 

Deformities. The most common is knock-knee, or in-knee (genu valgum). 
This disease is met with in individuals of all ages, and consists of an in-giving 
of the knee-joint, in consequence of' the weakness of the ligaments and mus- 
cles connecting and surrounding the articular extremities of the ilium and 
tibia. The most common predisposing causes of this malady seem to be in- 
sufficiency or improper quality of food, or its imperfect assimilation. It is 
usually associated with rickets. " In many instances the earliest link in the 
chain of causation has been an error in the infant's diet, namely, the substitu- 
tion for an insufficient supply of breast milk, of farinacea, boiled in umter, 
with the addition of little, if any, cow's milk. Sometimes we may ascend a 
degree higher, and discover an hereditary pathogenetical influence. We have 
several times observed knock-knee in small, delicate, prematurely born chil- 
dren ; the limbs, in consequence of general weakness, having yielded to the 
superincumbent weight of the trunk." After a while the deformity increases 
so much that the child becomes incapable of walking without crutches or other 
support. Sometimes tall, rapidly growing lads are the subjects of knock-knee 
without having had any previous tendency to it ; too much exercise, or fatigue, 
with air breathed in a vitiated atmosphere, seem to be the causes. Slight 
cases will recover, with proper attention to diet and general health, and the 
discontinuance of teaching the child to walk prematurely. The recumbent 
position, at times during the day, a soft pad between the condyles of the femur, 



KOU 420 KOU 

and the ankles drawn towards each other by a bandage are useful aids. In 
more severe cases mechanical contrivances — splints or irons, such as are made 
by the instrument makers — must be employed. Care must be taken to em- 
ploy daily friction and manipulation, to prevent the knee becoming stiff in an 
extended position. Mr. Lonsdale treats knock-knee on the same principle as 
a crooked, rickety leg, " by adapting a long well-parlded splint to the outer 
side of each limb, fastening it below by straps and buckles at the outer ankles, 
and above by a broad belt, to which both splints are attached, and which is 
buckled round the body at the level of the hollow part of the loins. The 
splints should be hindered from coining too far forwards, and should bear well 
against the trochanter and outer ankle. Meanwhile the knee is to be drawn 
into its proper place by a band buckled over it, and wide enough to embrace 
both the head of the tibia and condyles of the femur." 

Knock-knee. This affection consists in an inward projection of the lower 
extremities of the thigh-bones, and a more or less considerable outward diver- 
gence of the legs and feet. Great deformity is thus produced, and the patient 
experiences much difficulty in walking. The knees constantly strike against 
each other, and the foot is turned outwards, so that the inner edge is applied 
to the ground. Knock-knee is caused by weakness and yielding of the liga- 
ments and sinews about the inner aspect of the joint, and the affection is in- 
creased by walking and standing. It is met with in workmen who carry heavy 
loads, or in those accustomed to wheel heavy barrows. It may also occur in 
youths who grow very fast, just before the age of puberty, but it affects most 
commonly weak, unhealthy children of the poor classes, who live in towns, and 
is due in those subjects to general weakness and poverty of the blood, engen- 
dered by bad quality or insufficient supply of food. It then often shows itself 
while the child is still in arms, but is made much more apparent and increases 
rapidly in extent after the child begins to walk. Knock-knee and rickets are 
often associated together. When undue use is made of one leg, and too much 
weight thrown upon it in consequence of disease or injury in the other limb, 
one-sided knock-knee may be produced. This deformity when it occurs in 
rapidly growing and overworked young people may be remedied by rest and 
cold douches. If discovered early in infants the best treatment is fresh air and 
good and suitable nourishment. The patient should not be allowed to move 
about on the floor until the unnatural prominences at the inner surfaces of the 
knees have disappeared. In severe cases, in older children, it will be necessary 
to apply to the outer surface of each limb either a padded wooden splint long 
enough to extend from the hip to the foot, to which the limb is to be band- 
aged ; or irons, furnished with a racket screw, and fixed by means of buckles. 
The treatment demands much care and patience, and, to be effectual, must in 
severe cases be continued for eighteen months or two years. The deformed 
limbs should be well rubbed and bathed with cold water every morning, and 
the child's general health should be kept up by good living, and, if possible, 
by a prolonged sojourn in the country or by the sea-side. 

Koumiss. Among the Tartars, fermented mare's milk. In this country, 
a preparation of fermented milk for weak or irritable stomachs. Taken by 
President Garfield in his last illness. 

Kousso is the flower of an Abyssinian plant, Brayera anthehnintica, long 
used in that country as a remedy for tape-worm. It is imported in masses, the 
general color of which is yellowish-green. Sometimes the drug produces 
nausea and vomiting. It requires to be given in gond large doses — half an 
ounce or so in hot water the first thing in the morning, to be followed some 
time thereafter by a purgative, such as castor oil. 



LAB 421 LAB 



L. 

Labor is the common term for a confinement or delivery. It usually takes 
place at the end of the ninth month, or at the expiration of 280 days from the 
time of conception. If the birth of the child takes place before six months 
it is called an abortion, or miscarriage, and when between six and nine months 
it is known as premature labor. A labor, as a rule, is a perfectly safe and 
natural process, and attended with very little danger to either mother or child, 
if properly conducted. It commences with pain in the lower part of the ab-' 
domen, gradually settling down in the back, and known as bearing-down pains ; 
this is accompanied by contractile movements of the enlarged womb, by which 
the child is gradually expelled and brought into the world. The duration of 
a labor varies from six to twelve hours, in most cases being longest in those 
who are having a child for the first time ; the pains may begin much earlier 
and may be of a grinding character, but in general these are not attended by 
any expulsive effort ; they are caused by an error of diet sometimes, and are 
removed by giving a purgative, followed by an opiate draught. In at least 99 
cases out of every 100 the head of the child comes down first, and is the part 
which emerges into the world the soonest ; the rest of the body soon follows, 
and the main object of care is to see that the womb well contracts as soon as 
the child is expelled. In from ten to twenty minutes, but sometimes longer, 
after the child is born the placenta or after-birth comes away, and then, seeing 
that the womb is still well contracted, a wide binder may be placed around the 
abdomen, and the mother should be allowed to rest quietly for a time, after 
removing the soiled linen around her. The child, when born, is generally for 
the first few moments rather livid in the face, but soon begins to cry out lust- 
ily ; after wiping the mouth and nose, it should be wrapped in warm and soft 
flannel until the nurse is ready to wash it in warm water and dress it. If the 
child do not breathe at first, it may be gently slapped on the back or held out 
for a minute in the open air, or hot and cold water may be alternately dashed 
over it, and efforts made to keep up artificial respiration. After-pains are 
usually the worst in those women who have had several children, and are 
very troublesome the first twenty-four hours ; an opiate is the best remedy. 
The mother's diet must be light and nourishing ; usually, the first day, gruel 
or tea is preferred, but afterwards a small chop or a piece of fish may be taken. 
The child should be put to the breast as soon as possible, but it is seldom able 
to suckle much the first day or two. The mother must be kept in bed for nine 
or ten days, and then maybe allowed to get up, still keeping the horizontal po- 
sition for a few days longer. The details of management in a midwifery case 
are obviously out of place in a book of this nature. Sometimes, instead of 
the head of the child presenting, the feet may come down first, but this is not 
of much matter, although it may prolong the labor. If, however, the arm or 
shoulder come down first, it is a sign that the child is lying in a wrong posi- 
tion, and there is then said to be a cross-birth ; in such cases skilled interfer- 
ence is at once to be sought. There are some cases of such great deformity 
of the pelvis that premature labor has to be induced, but this must be only 
done after consultation, as if done with a criminal intent the operator is sub- 
ject to severe punishment. In other cases operative interference is required 
to save the life of the mother or the child, or both, but for its proper perform- 
ance great skill and experience is required, and can be attained only by a 
proper education and practical acquaintance with the subject. 



LAB 422 LAC 

Laburnum is a beautiful ornamental shrub known to the botanist as Cyti- 
sns laburnum. It yields seeds of an acrid and poisonous nature, which may 
possibly be eaten by children, and produce vomiting, cramps, purging, and all 
the symptoms of an irritant poison. The remedy in such a case is to give an 
emetic of mustard and warm water, or ipecacuanha, or white vitrol, and after- 
wards to support the patient with ammonia and brandy. 

Lactation. This is the name given to the period of suckling a child after 
a confinement. After the birth of a child the breasts of the mother, which 
during pregnancy increase in size, secrete a large quantity of milk for the 
sustenance of the offspring during infant life. The process is a perfectly 
natural one, and it is by far the best means of rearing a child ; for the first 
day or two, especially after a first confinement, the milk flows in very small 
quantities, but after that time, when the secretion is well established, the pro- 
duction of milk goes on uninterruptedly in many cases. It is the duty of every 
woman, if in good health, to give the child the breast ; yet there are many, 
and those chiefly in high life, who, from indolence or apathy, or some other 
cause, prefer their children to be brought up by a wet-nurse or by the bottle. 
Manv, again, are incapable of suckling their children from ill-health, or by the 
cessation of the secretion of milk in the breast, and then, of course, other means 
must be taken to bring up the child. The mortality of infants not brought up 
by suckling is vastly higher than in those who are kept to the breast for the 
first nine or ten months of life. If the child die soon after birth there may be 
some trouble in checking the distension of the breasts, which may often be 
very painful. The breasts may be drawn by a syringe, or by another child 
being put to them; a popular method is to apply a soda-water bottle previously 
warmed to the nipple ; on cooling, the air within the bottle is more rarefied 
than that outside, and the difference of the atmospheric pressure will cause a 
flow of milk. The secretion may, in such cases, be generally stopped in a few 
days by applying a large belladonna plaster to each breast. and giving a saline 
purgative. Inflammation of the breast may take place during lactation, and 
end in an abscess ; the breast will be found hot, enlarged and painful, and 
perhaps a swelling, tender to the touch, may be noticed at one part; when it 
is clear that matter has formed, an incision must be made with a lancet to let 
it out ; the breast must be slung in a towel from the shoulder, so as to relieve 
the patient of its weight, and hot linseed-meal poultices should be often ap- 
plied. Unless the opening be a free one the matter is apt to accumulate 
again and require a second or even third incision. When an abscess forms, 
the health of the woman suffers ; she loses her appetite, becomes faint and 
weak, and loses color and strength. Tonic medicines must be given her, and 
a nourishing diet, and rest and quiet enjoined ; it is not always necessary to 
wean the child, as it can feed from the opposite breast. A child should be 
weaned at the end of nine months, as a rule, but this is very seldom observed, 
and many poor women go on suckling for a much longer period, until, per- 
haps, the child is eighteen months or even two years old. This is bad for the 
mother as well as the child ; to the former, because it is a great drain upon 
her strength, and to the latter, because when the teeth have appeared a more 
solid food may be given. Women who have a family fast, who wean their 
children at a late period, and who, perhaps, live badly all the time are very 
liable to suffer much in their health ; they lose their appetite and strength, 
and become low and nervous ; they are very liable to headache, pain in the 
back and left side, and very often they suffer from leucorrhoea. The proper 
treatment for such cases is to wean the child and improve the mother's health 



LAC 423 LAR 

by tonics, good diet, and rest ; stout is often recommended to mothers as being 
more nourishing than beer, but at such times all stimulants should be taken in 
moderate quantities, and reliance should be placed on a more liberal diet. 
Over-suckling is a vei'y frequent cause of ill-health in a woman, and lays the 
foundation of future illness by bringing on a state of debility. 

Lacteals are very minute vessels, or absorbents, which arise in small con- 
ical projections of the mucous ur lining membrane of the intestines ; joining 
together, they finally form larger branches, which pass up by the mesentery 
into the mesenteric glands, and then on to the receptaculum cliyli, a small 
chamber lying in front of the spine in the abdominal cavity. The function of 
the lacteals is to absorb various soluble portions of the digested food or chyme 
as It passes along the intestinal canal, and chiefly the fatty portions of the 
food ; the fluid, thus absorbed, is milky in appearance, is called chyle, and this, 
passing through the mesenteric glands, undergoes these various changes ; 
finally, it goes through the receptaculum chyli, and then on by the thoracic 
duct as lymph, to join in the blood current at the root of the neck. The lac- 
teals are to the intestines what the lymphatics are to the rest of the body. 
They are often diseased in children, and many cases of marasmus, or wasting 
away, are due to affections of the small glands and lacteals of the intestines ; 
•the mesenteric glands are also frequently associated in the change, and become 
swollen and enlarged, and add to the general mischief. Such children waste 
because the food cannot be properly absorbed, and the blood loses in quality 
and quantity because it does not i-eceive its due supply of lymph. Diarrhoea, 
too, is a common symptom, and this, with the emaciation and general weak- 
ness, often brings about a fatal result. The diet must be carefully looked to ; 
all solid or thickened food should be avoided, whilst milk and beef-tea or 
chicken-broth may be given. If there is any sickness, lime-water may be 
added to the milk ; but any error of diet may again bring on diarrhoea. Cod- 
liver oil is not well borne by the stomach in such cases, and therefore it may 
be rubbed into the skin night and morning. A little steel wine may be given 
daily, but no other medicine ; and no purgative should be administered. 

Lactucarium, or Lettuce Opium, is prepared from the common lettuce 
by pressing out the millsy juice of the flowering lettuce, and afterwards heat- 
ing gently till it forms little lumps of a brown color with an odor very similar 
to opium. It has been supposed to possess properties - similar to poppy opium, 
but for this there are no good grounds of belief. Nowadays lactucarium is no 
longer in the Pharmacopoeia : in its stead we have an equally useless compound, 
extract of lettuce. Both lettuce and lactucarium have been prescribed when, 
opium did not agree with the patient, but with no good result. As much as 
thirty grains of lactucarium have been given every four hours for some time 
without producing any marked effects. 

Lard is hog's fat deprived of its membranes and purified by heat. It is 
used in making ointments, and is often better for application to a blister or 
sore place than the more skillfully prepared and expensive ointments. A 
piece of ordinary lard put into boiling water and allowed to cool and settle, and 
then taken out free from all impurities and kept in a stone jar, is a very useful 
and pleasant application. 

Lardaceous Degeneration is another term for waxy degeneration ; it 
may affect the liver, kidney, spleen, and intestines. See Degeneration. 

Laryngeal Phthisis is a form of consumption in which the patient suffers 
from hoarseness and loss of voice ; it is very common in the later stages of 
phthisis. See Consumption. 



LAR 424 LAR 

L#aryngismus Stridulus, also known as spurious croup or child-crowing, 
is a spasmodic form of disease commonly afflicting children during the period 
of their first teething. A considerable number of children die of the malady, 
being mostly under one year old. This disease might be, and often is, mis- 
taken for croup ; but there is no fever, almost the only symptom being the 
interruption of the breathing. The first attack may often come on in the 
night, the child having been put to bed apparently well. There may only be 
one or two prolonged crowing inspirations, and the patient fall asleejj again. 
In other cases ihe child may have been irritable and restless for a day or two, 
when suddenly it is seized with difficulty of breathing, and kicks and struggles, 
unable to draw a breath. Presently, however, it is enabled to draw in a 
breath with a long crowing or shrill whistling sound, the chink or opening into 
the wind-pipe being much narrower, from spasm, than usual. This may end 
the attack, but it may return shortly in a few hours, or sometimes in a day or 
two. In other cases the attack resembles epilepsy more than croup, the face 
being swollen and flushed, the veins starting out with convulsive movements 
of hands and feet. The child may even seem dead for a few moments, until, 
by and by, there is a gasp, and then a thin-sounding breath, the patient gradu- 
ally recovering. This is not always the case, for not unfrequently the little 
patient does die in one of these paroxysms. The cause of this spasm undoubt- 
edly lies in some irritation acitng through the nerve which supjjlies motor 
power to the larynx. It has been supposed to be due to enlarged glands 
pressing on and irritating this nerve. In reality it may originate in a variety 
of ways, being most of them reflex, but all unite in acting through this nerve. 
It may originate in teething, indigestion, constipation, or the reverse condition, 
catharsis, which, acting through the brain and spinal cord in subjects whose 
nervous system is easily put out of gear, is thus manifested as spurious croup. 
Fortunately much may be done by way of treatment, especially if it is done at 
once ; and there is no disease in which a general knowledge of the principles 
of treatment are more important to the public. The best thing is promptly to 
put the child in hot water up to its chin, and pour cold water on its head. 
Some propose the same remedies as when a child seems still-born, such as 
slapping the nates, or even artificial respiration ; but the conditions are totally 
different. When the child is born so, the only difficulty is to induce its 
muscles of respiration to act ; there is no obstruction to the entry of air. 
Here it is quite the reverse ; the muscles of respiration are ready to act, nay, 
are acting; but the air cannot enter, the way being barred by the closure of 
the entrance to the air-passages. Before any good can be done, these must be 
relaxed, and, accordingly, such treatment as we have recommended, or a few 
drops of chloroform swallowed, will do what is necessary. It is useless to 
think of the inhalation of chloroform when the air itself cannot make its way 
into the lung. Afterwards the child's bowels should be carefully looked to, 
and the teeth and mouth examined. Change of air is of the utmost benefit. 
Belladonna, in very small doses, is sometimes useful, but the great thing is 
careful nursing. The child should have nourishing food, but it must not be 
overstuffed. Overstuffing and improper food is a very important cause of the 
malady. The best food for a young child is its mother's milk, but sometimes 
they will not suck, and then the best substitute must be procured, — a good 
wet-nurse, if possible ; if not, asses' milk, or the milk of a healthy cow diluted 
with water. 

Laryngitis, or inflammation of the upper part of the wind-pipe, is a 
troublesome and even dangerous affection ; it may be produced by exposure 



LAR 425 LAR 

to cold, and also by inhaling any irritant gases, as ammonia, chlorine, or hydro- 
chloric acid. There is more or less of a croupy noise during inspiration, the 
breathing is short and hurried, the patient can only speak in a hoarse whisper, 
and will point to his throat as the seat of distress. The symptoms are much 
the same as if a foreign body were accidentally to get into the air-passages, 
and there is a feeling of impending suffocation. When occurring in children 
it is commonly called croup ; but every case of croujyy breathing does not 
show that laryngitis is present, as it may be only spasmodic. This disease is 
liable to come on in those who are subject to phthisis or bronchitis. Steam 
must be at once inhaled ; hot sponges must be applied to the throat, and a 
warm moist atmosphere must be kept up. In some cases it may be needful to 
perform the operation of laryngotomy or tracheotomy ; but in all cases it is 
imperative to have medical aid at once. See Croup, Laryngismus Strid- 
ulus. 

Laryngoscope. This is an instrument used by surgeons to explore the 
larynx and upper part of the windpipe. In its simplest form it consists of a 
small reflecting mirror, which is mounted on a long and slender stem so that it 
can be passed to the back of the throat. Upon this are thrown rays of strong 
artificial light, reflected from another mirror, which is carried on the forehead 
or over the right eye of the surgeon. In the latter case the second mirror is 
perforated at its centre by a small hole, so that the rays reflected from the 
mirror at the back of the throat may pass through to the surgeon's eye, placed 
at the centre of the reflection. The surgeon sits in front of the patient, and 
on introducing the mirror into the mouth pulls the tongue well forward. The 
light is placed behind and to one side of the patient. The laryngoscope is 
used for investigating the nature and extent of disease affecting the larynx, 
and also as an aid in applying remedial agents directly to the lining membrane 
of this organ, and in removing by operation warty growths, polypi, and other 
tumors. 

History of the instrument. Prototypes of the laryngoscope have existed for 
ages. Paulas GEginceta describes an instrument under the name of glosso- 
tochus for inspecting the mouth and pharynx. It consisted of a concave blade 
to keep the tongue depressed, and of a limb like a horseshoe that fitted beneath 
the chin. Fabricius Hildanus (164G) mentions in his requirements for a mili- 
tary chest a speculum oris integrum, probably like that described by Scultetus 
(1655) ; this was " a strong speculum oris, with which not only the tongue is 
depressed, but also the lower jaw, thus affording a correct view of the dis- 
eases or vices which destroy the throat ; likewise allowing, during its introduc- 
tion, of the use of such instruments and medicaments as may be necessary. 
It affords the power, in the first place, of preserving and keeping the teeth 
open in obstinate and cataleptic persons, who are astonished to find that they 
swallow the food which has been introduced into the mouth." Levret, in 
1749, published an account of a pharyngoscope which held the mouth open, 
and by means of a polished plate of steel, which formed its body, reflected 
catoptrically the rays of light upon the point required. Bozzini, in 1807, de-- 
scribed a laryngeal speculum, consisting of a tube divided by a vertical septum 
or partition, and having at its curved extremity two mirrors, directed upwards 
or downwards, according to the situation of the part to be examined. When 
introduced the light was reflected into the mouth by means of a tin lantern in 
the form of a vase-shaped box, in the opposite sides of which were circular 
openings, — a larger and a smaller, — to the larger one of which was fastened 
the speculum, and to the smaller an eye-piece. In the centre of the lamp was 



LAR 426 LAR 

a receptacle for a caudle, which, when lighted, allowed the flame to reach the 
level of the two openings in the lamp, parallel to one another and in a line 
w T ith the tuhe. On applying the eye to the eye-piece, the reflected image was 
seen in one of the mirrors at the end of the speculum, and the other mirror 
conveyed the light, both passing through the different channels divided by the 
vertical septum. In 1827 and 1829, Senn, of Geneva, and Babington, of Lon- 
don, invented laryngeal mirrors, and the latter may be legitimately consid- 
ered as the inventor of the modern laryngoscope, although he never em- 
ployed artificial light. Beames, of Lyons, in 1838, invented a speculum for 
examining the throat, larynx, and back of the nostrils. Liston, the great sur- 
geon, was iu the habit of using a speculum for the examination of the larynx. 
In 1844, Dr. Warden, of Edinburgh, invented a prismatic speculum, by which 
he was enabled to see the vocal cords. In 1848, Mr. Avery, of the Charing 
Cross Hospital, used a laryngoscope with all the elements as now employed ; 
he used an artificial mirror attached to a stem, and employed artificial light, 
with the flame of a candle in front of a polished metal reflector. This reflector 
was attached to the observer's head, and was perforated to allow of vision 
through the openings. The light was thrown down the throat, and a small 
mirror introduced to the back of the mouth and the larynx examined. The 
perfection of the construction, use, aud application of the instrument is due to 
Turck and Czermak. 

Laryngotomy. The operation of laryngotomy should be performed only 
in cases where gnat urgency demands an opening of the windpipe, and when 
the proper apparatus for tracheotomy is at hand. The operation is thus per- 
formed : The patient is to be seated in a chair, with the head well thrown 
back and kept steady ; the finger of the operator is passed over the front of 
the neck, and the crico-thyroid depression felt for ; then a vertical incision, 
about an inch in length, is made in the mesial line over this spot, and the 
crico-thyroid membrane is divided sufficiently to allow of the introduction of a 
tube. The operation can be performed readily enough with a penknife, and if 
no tube be at hand a quill or a thin piece of wood, turned on its axis, will 
admit sufficient air to the lungs. Care must be taken not to mistake the thyro- 
hyoid space for the cricn-thyroid. The disadvantages of the operation are. that 
in cases of au inflammatory nature the proceeding is too near the obstructing 
cause, and more or less permanent injury is inflicted on the laryngeal appara- 
tus, thus increasing the probability of persistent aphonia. Laryngotomy may 
be performed in cases of lodgment of some foreign substance in the larynx. 
The only casualty in the performance of the operation is the division of the 
crico-thyroid artery, a small branch, which runs across the membrane, and 
might, if large, cause considerable trouble. In a young subject the chief dif- 
ficult v of the operation is the recognition of the parts, after the superficial 
wound has been made, from the smallness of their size, and this difficulty may 
be greatly increased if the skin and cellular tissue be inflamed aud infiltrated 
with serum. 

When the operation has been performed, it is of the greatest importance 
that the proper after-treatment be adopted. An experienced nurse or attend- 
ant, or at all events some one who can be trusted, should be left with the pa- 
tient. He should be placed in a room where the temperature is warm and 
equable, as the introduction of cold air into the trachea is very liable to set up 
inflammation of the air-passages. The warmth should be a damp warmth, best 
so rendered by steam. The bed should be surrounded with curtains or blan- 
kets, aud a jet of steam admitted from the end of a tube connected with a tea- 



LAR 427 LAR 

kettle. It must be borne in mind that blood and mucus very readily collect 
in the tube and obstruct it, and if no one be at hand to remove it the patient 
runs imminent risk of suffocation. The nurse or attendant should remove it 
carefully, as soon as any difficulty is noticed in the breathing, with a fine 
feather or camel's-hair brush. This collection of mucus is especially liable to 
occur during the first few hours after the operation ; and should the patient 
drop off to sleep, and the above precautions be not taken, he may be suffocated. 
If the patient desires to cough or to speak, he should be told to draw in a full 
breath, and then close the orifice of the tube with his finger, when expectora- 
tion can be performed, and the voice may be heard. Care must be taken that 
the tube be securely fastened round the neck with tapes, but not too tightly. 
The margin of the incision made in the neck very frequently becomes seri- 
ously inflamed ; a small poultice should be placed over the affected part. The 
attendant must be cautious in the administration of the patient's food, to give 
little at a time, and to take care that, in the increased difficulty experienced in 
swallowing, no morsels pass into the trachea. See Tracheotomy. 

Larynx. The larynx is a complicated structure, surmounting the wind- 
pipe, serving the double purpose of being an air-passage and of containing that 
mechanism which produces sound during expiration. The note is formed by 
the approximation of the divergence of two margins of membrane, which in a 
state of quiescence resemble in mutual relation the letter V. These membra- 
nous margins are called the true vocal cords, in contradistinction to two some- 
what similar folds placed some way above them, called false vocal cords. 
These true vocal cords are acted upon by a series of muscles, which place 
them in the proper position to make either sharp or grave tones. In order 
that these muscles may act upon the vocal cords they are themselves attached 
to the several parts of the frame-work of the larynx, which are formed of carti- 
lage. The prominent cartilage in the neck (Adam's apple) is the triangular 
front edge of the thyroid, or shield-like cartilage ; this cartilage expands behind, 
and at the inferior part of it are two little hinges, one on each side, which turn 
upon another cartilage placed partly within the thyroid and partly below it. 
This is very much like a signet ring, with the signet part of it backwards, and 
receives its name from this fact ; it is called the cricoid cartilage. Two mus- 
cles, one on each side (crico-thyroid), pull down the thyroid upon the cricoid 
cartilage, at the same time slightly advancing it. Within the triangular voice 
box, formed at the sides by the thyroid and below by the cricoid cartilages, and 
resting upon the upper part of the signet of the cricoid, are two little triangu- 
lar cartilages called arytenoid, from their supposed resemblance to an ancient 
pitcher. To these two arytenoid cartilages are attached the legs of the V, and 
the point passes across the larynx" to the inner surface of the Adam's apple 
seen in front. Now, as there are muscles which drag the thyroid down upon 
the cricoid, so there are muscles which draw the arytenoid cartilages apart, 
and also approximate them. The former, which are attached to the sides of 
the signet of the cricoid and to the arytenoid, are called the crico-arytcenoi dei- 
postici, and the latter, which are also attached to the same cartilages, but the 
fibres of which act in contrary direction, are called crico-arytcenoidei-laterales. 
The arytenoid cartilages have special muscles of their own, called arytcenoidei, 
which, according to some, draw their cartilages together, thus closing the 
opening of the vocal cords (rima glottidis) ; according to others, rotate them 
upon a pivot and so opening the chink. Immediately underneath and external 
to these true cords are two muscles, one on each side, attached to the thyroid 
and arytenoid cartilages, which approximate the vocal cords by shortening the 



LAT 428 LAT 

distance between the arytenoid and thyroid cartilages (thyro-arytcenoid). These 
vocal cords are not only employed in the production of sound for the object of 
speech or song, but can be completely closed, so that the air may be, as it were, 
imprisoned in the lungs during the phenomenon of effort. They, moreover, 
enter into vibration, in coughing, hiccup, sobbing, and laughing. The sound 
is always produced by the vibration of the lower, or true vocal cords, whether 
the air enters the larynx from above downwards, as in hiccup, or whether it 
passes from below, as in other acts. The larynx grows after birth, as do other 
organs, both in girls and boys. But at the time of puberty the larynx all of 
a sudden develops rapidly, more especially so in boys. In the male sex, in 
fact, the glottis is twice the size, both in length and breadth, and the Adam's 
apple (pomum adami) becomes conspicuous at this period. It is at this age 
that the voice " cracks," that is to say, it becomes deeper, correspondingly with 
the modifications of the glottis. But as the muscles of the larynx are not as 
yet accustomed to this disproportion of the vocal organ, they contract irregu- 
larly, with inability, so to speak, and produce those singularly inharmonious 
sounds which are peculiar to this period. 

Foreign bodies, such as morsels of food, sometimes get into the rima glotti- 
dis, and by sticking there may cause death speedily unless they be instantly 
dislodged with the finger in the pharynx, or the operation of tracheotomy be 
performed. Sometimes bodies, such as buttons, coins, or pebbles, may leave 
the rima, and remain loose in the trachea, causing violent fits of coughing and 
spasmodic breathing. Very often the substance is expelled in a violent fit of 
coughing ; if in a child it should be held with its head downwards, and be 
slapped on the back; in fact, inversion of the trunk, taking care that the 
windpipe is vertical, should be always attempted. Mr. Brunei, the engineer, 
had a half-sovereign in his windpipe, and he inveuted an apparatus by which 
he could be tilted up, and by this means the coin was ejected. 

The diseases of the larynx are laryngitis, croup, diphtheria, oedema of the 
glottis, chronic inflammation and ulceration, tumors, warty excrescences; and 
epithelial growths, polypi of a fibro-cellular, tibro-plastic, or epithelial nature, 
have been met with in the larynx, epiglottis, and trachea. For the detection 
and treatment of these diseases the laryngoscope is necessary. The glottis is 
sometimes scalded, from the effects of swallowing boiling water, such as in the 
case of a child, in the nurse's absence, putting its mouth to the spout of a tea- 
kettle. Leeches, ice to the throat, and opiates, or the administration of an 
anaesthetic, are of use, unless the symptoms are so urgent that tracheotomy be 
necessary. 

Lateral Curvature is an offection of the spine in which there is a curva- 
ture either to the right or to the left, so that one shoulder is lower than the 
other, and more commonly it is the left shoulder which is the lowest. It is 
often due to girls carrying children or any heavy weight at too early an age. 
Unlike angular curvature, which is a grave sy mptom of disease of the spine, it 
is a habit which may be overcome by drilling and gymnastics. As the curva- 
ture occurs in both sexes during the period of youth and childhood, means 
must be taken to remedy the defect, as it is of no use trying to alter it when 
the person is grown up. The carrying of any heavy weight on one arm should 
be avoided, while daily drill should be enforced at school, so as to make the 
individual erect. For boys dumb-bells may be used, or the elementary drill of a 
soldier ; if able and strong enough, he should go through the various gymnastic 
exercises so common now at all good schools, whereby he will not only gain in 
muscular strength, but he will expand his chest and improve iu health. For 



LAT 429 LAV 

girls the dumb-bells should be lighter, or they may use elastic bands, or even 
do gymnastics on a small scale. The great point in all these exercises is to 
begin it first very gradually, and never tire the muscles ; then every day a 
slight progress may be made, until, in the course of a few months, a marked 
improvement will be found. Too often, under the present system, such exer- 
cises are continued so as to tire the child, and even to give pain ; but this is a 
great mistake, and such exercise ought to be made pleasurable, instead of being 
looked upon as bad as a punishment. In this way girls would develop into 
much stronger women, and there would be less need of stays and other articles 
of dress which are required by women, not only to improve what they term 
their figure, hut to prop up a too feeble spine. See Gymnastics. 

Lateral Tetanus is said to occur when, in the convulsions, the patient's 
body is turned to one side or the other. See Tetanus. 

Lateritious Urine is urine in which there is a sandy deposit of lithates 
on cooling. See Urine. 

Latrines are the closets and privies on a large scale necessary for camps 
or large bodies of men. Their situation and construction are of the greatest, 
possible importance to the health of a camp, particularly if that is intended to 
be occupied for any length of time. In India, where there is a risk of cholera, 
they are, of course, still more important. They are best constructed on the 
dry-earth system, although disinfectants may, if necessary, be employed also. 
Where there is risk of disease spreading, disinfectants should always be em- 
ployed. For movable camps a long trench need only be dug in the soil, the 
earth removed from it being carefully preserved for subsequently covering the 
deposits. It would hardly be possible to get each man to throw a quantity of 
earth into this trench after being used ; so some one should be deputed to 
throw over the whole trench from hour to hour during the day a thin layer of 
the earth removed. This will suffice to prevent the spread of evil odors. In 
a permanent camp a similar plan should be employed, only it will be necessary 
to remove the deposits day by day, each time carefully covered up with earth 
and carbolic acid powder. 

Laudanum. See Opium. 

Laurel-cherry, the Primus lauro cerasus, is a plant which is a native 
of Asia Minor, but is cultivated in most gardens and shrubberies. The fresh 
leaves are the parts employed in medicine. These are four or five inches long 
and about two broad. They are leathery in texture, shining and smooth on 
the upper surface, dull and of a much lighter green beneath. When bruised 
they emit a strong ratafia odor. These leaves when distilled with water yield 
a volatile oil and some prussic acid, which, passing over with the water, im- 
parts to it certain properties. The prussic acid does not exist in the leaves 
ready formed, but is produced by a decomposition similar to that which takes 
place in bitter almonds when they give rise to the same substance. The only 
preparation of these leaves is the distilled water just alluded to, which unfortu- 
nately varies considerably in the proportion of prussic acid contained in it. As 
any mistake in the quantity of such a powerful drug would be highly danger- 
ous, this preparation is nowadays never used internally, the acid itself being 
employed, as a rule, instead. It may, however, be used externally for the 
prussic acid it contains, and as an agreeable vehicle for other remedies to be 
applied for the relief of itching, etc. It must be kept in a carefully stoppered 
bottle, or the prussic acid will soon evaporate and leave the preparation inert. 

Lavender, the Lavandula spica, is a plant of no great show, cultivated 
largely in Surrey, in the neighborhood of London. From it is distilled an oil 



LAX 430 LEA 

which gives fragrance to the plant. This is either colorless or, if it has heen 
long kept, pale yellow, and has a hot aromatic taste. This oil dissolved in 
water is much used as a perfume. In medicine two preparations are used, the 
spirit, which consists of the oil dissolved in spirit, and the compound tincture. 
This last, which is almost a liqueur, contains lavender, rosemary, cinnamon, 
and nutmeg, the whole colored with sandal wood. It is greatly used as a 
carminative and stimulant in hysteria and such like nervous affections. It is 
also employed in flatulence and colic. The oil may be given, a drop or two 
on sugar for a close ; the spirit, from half a drachm to a drachm, and the com- 
pound tincture in about the same quantity. Very often the oil of a French 
lavender is substituted for the English product. 

Laxatives are remedies which. gently open the bowels, so that they are in- 
clined to be loose, but no more. There is thus a distinction drawn between 
such and purgatives, which purge, and cathartics, which are supposed to act 
still more strongly. As it is highly desirable in all cases that the least power 
should be employed, laxatives should be given when it is necessary to open 
the bowels artificially, if this will suffice. In many instances, however, they 
will not, and something stronger will be necessary ; but powerful opening 
medicines are apt to be followed by the very condition they have been used to 
get rid of, and so the latter end is something worse than the first. Sometimes 
a change of diet will act as a laxative. Thus, if the food has been too concen- 
trated, that is to say, if there has not been a fair amount of indigestible matter 
in it, the bowels are apt to become confined. In this way the use of brown 
bread instead of white bread will often suffice to regulate the bowels and pro- 
cure a daily motion. Figs and prunes are inclined to be laxative, especially 
the latter; manna, tamarinds, and cassia, more so. But the most convenient 
for use are flowers of sulphur, castor oil, and magnesia, or its carbonate. 

Lead in the metallic form is not used in medicine, but as acted upon by 
water it not unfrequently gives rise to slow lead poisoning. 

The oxide of lead, or litharge, consisting of heavy orange-red scales, is never 
given internally : it is used only for the preparation of the plaster, which is so 
commonly employed for fastening up wounds, etc. Technically this is known 
as had plaster, but much more commonly is called mere sticking-plaster, or 
diachylon plaster. It is prepared by boiling together oxide of lead and olive 
oil ; these, after boiling some hours with constant stirring, form a thick tena- 
cious paste, which is applied to calico, and so the plaster is formed. The lead 
unites with the fatty acids of the olive oil, forming a kind of soap. It is due 
to the presence of the lead that this plaster blackens over putrid wounds. 
Some prefer a plaster made of less irritating materials, and certainly, were it 
not for its tendency to harden, isinglass plaster would be infinitely superior to 
the litharge plaster. 

The iodide of lead exists as a bright yellow powder, or in fine scales, which 
is soluble in boiling water, forming in it a colorless solution, which in cooling 
allows the iodide to fall as crystals. It alters and loses its brilliant color by 
exposure to light. Two preparations are in use, — a plaster seldom used, an 
ointment much more frequently employed. It acts when applied externally as 
a very mild stimulant, and is used as an application to scrofulous joints. It 
gives to these a yellow stain, which may be objectionable in an exposed part 
of the body. It is seldom used internally. 

Acetate of lead, also known as sugar of lead, is prepared by dissolving oxide 
of lead or litharge in vinegar or weak acetic acid, and afterwards evaporating. 
It is generally seen in white spongy masses, composed of interlaced needle- 



LEA 431 LEA 

shaped crystals. It has a sweetish, vinegary smell and a sweet metallic taste. 
It is readily soluble in water, and when exposed to the air tends to give off 
water, and fall down in the form of powder. The solution of sugar of lead in 
distilled water is clear, or almost so. Its main preparations are lea'd and opium 
pill, a very valuable preparation, consisting of acetate of lead, opium, and con- 
fection of roses, one grain of opium in eight of the pill mass; compound lead 
suppository, consisting of lead, opium, and benzoated lard, white wax, and 
cacao butter ; and lead ointment, composed of acetate of lead and benzoated 
lard. In small doses acetate of lead acts as a sedative and astringent, diminish- 
ing especially mucous discharges, drainage from relaxed vessels and surfaces, 
and the like. It produces constipation and thirst. This, as well as other 
preparations of lead, interferes with the normal condition of the blood, dimin- 
ishing the number of red corpuscles, and so giving rise to anaemia. It also 
paralyzes the muscular coat of the intestines. Lead poisoning, however 
brought about, tends to favor the production of gout, and gout in such cases 
is rather intractable. Acetate of lead is used as a remedy in internal haemor- 
rhages, and is one of the best we possess. It is also used in consumption, to 
check diarrhoea and perspiration. It is a capital remedy, especially as lead 
and opium pill, for diarrhoea accompanied by pain and a tendency to dysentery. 
It is also largely used externally as a sedative and astringent. Solution of 
the subacetate of lead is made by adding litharge to the ordinary solution of 
acetate of lead and boiling. It is a clear colorless liquid, which tends to be- 
come tinted on standing by the formation of carbonate on its surface. This 
solution, under the name of " Goulard water," has long been known and 
valued. It is chiefly used as an external application, and is so used more than 
the acetate. A combination of it with acetate of morphia is a singularly sooth- 
ing preparation to inflamed spots if the surface is not broken. Its use with a 
broken surface might be dangerous. There is also an ointment which is used 
in the same way. 

Carbonate of lead is mainly used in the arts ; not much in medicine. There 
is, however, an ointment of it which is applied to whole surfaces as an astrin- 
gent and sedative. Sometimes also it is used as a powder along with starch. 
It is the most poisonous form of lead salt. 

Nitrate of lead is employed only in the manufacture of iodide of lead ; it is 
not used medicinally. 

With regard to the general uses of lead salts, we may say, first of all, that 
lead applied to a raw surface forms a kind of precipitate on the surface which 
protects it from the air for the time being. Hence, when surfaces are raw or 
weeping, a lead lotion removes the burning and itching, and stops the dis- 
charge. It matters not where such a surface is, except perhaps the eye, for it 
has been found that prolonged applications of lead lotions to inflamed eyes, 
especially if the clear part or conjunctiva is affected, tend to form a deposit of 
the metal and to produce a permanent opacity. In summer diarrhoea acetate 
of lead acts as a sure and certain astringent, especially if a few drops of lau- 
danum, or, what is better, a fraction of a grain of morphia, is added. 

If the acetate can be looked upon as an irritant poison at all, it must be con- 
sidered as peculiar, inasmuch as it produces constipation rather than diarrhoea. 
Frequently acetate of lead may be given for weeks or months without pro- 
ducing any signs of lead poisoning. This is especially the case where lead is 
used to avert the wasting diarrhoea of consumption. 

From its peculiar properties it has been supposed that lead might diminish 
the quantity of albumen passed in chronic Bright's disease along with the 



LEA 432 LEA 

urine ; but the expectation has not been quite justified. Lead may, it is said, 
act upon the foetus through either the father or the mother, and destroy it, 
causing abortion. 

Lead Colic. See Lead Poisoning. 

Lead Poisoning may be brought about in a variety of ways. Painters, 
and other workers in white lead are its most frequent victims. It has been 
produced by sleeping in a newly painted room ; from taking snuff which has 
been wrapped in lead ; and it used to prevail extensively in some parts, its 
cause being the action of the apple juice on the lead used in forming the cider 
presses. From similar causes it used to affect the wine-drinking inhabitants 
of Poictou in France, where its most common manifestation, namely colic, used 
to be called Coh'ca Pictonum. 

Lead Colic, which is the primary symptom of lead poisoning, is a variety 
of colic characterized by intense twisting pains about the navel. Frequently, 
too, there is retraction of the walls of the abdomen and pain in the back. At 
the same time there is obstinate constipation, and if the gums be examined, 
there will commonly be found a blue line extending along the gum at its junc- 
tion with the teeth. These are the prominent symptoms of the first stage of 
lead poisoning. 

If, however, the malady is not arrested, but goes on, by and by the nutrition 
suffers. First so to suffer are the extensor muscles of the fore-arm ; those, that 
is, which lift the back of the hand, so that if an attempt is made to raise the 
hand that way the wrist drops. The muscles themselves waste, and though 
at first they respond to the stimulus of faradization, later on they do not. By 
and by the muscles of the upper arm also fail, so that the muscles which raise 
the whole arm, and even those which are attached to the shoulder blade, may 
waste and become useless ; the remedy for such a state of things is, first of all, 
to get rid of the poison, and, secondly, to restore the paralyzed parts to their 
several functions. 

In the stage of colic with or without palsy, the bowels must be well moved ; 
for that purpose nothing is so good as Epsom salts with some dilute sulphu- 
ric acid, given freely until the bowels are opened well. Half an ounce of the 
Epsom or Glauber salts should be given for a dose, and repeated in a couple of 
hours. Jalap is sometimes given, but it is a mistake. Castor oil may do good, 
but the best means is common Epsom salts. A warm bath frequently gives 
great relief, until the bowels have acted, and very likely aids in moving them. 
If not speedily moved, an enema of soap and water will help. After the bow- 
els are moved freely, a quarter grain of the extract of belladonna may be given 
to relieve the pain, but the salts must still be continued, though in smaller and 
less frequent doses. The application of electricity to the bowels often aids 
in opening them, and otherwise gives relief, but it is not to be trusted to 
solely. Neither indeed is Epsom salts, for as soon as the bowels are fairly 
open iodide of potassium must be given in good full doses, hoping thereby to 
remove the lead still remaining in the system. This must be continued for 
some time. 

If there is paralysis as well as colic, faradization must be freely applied to 
the weakened muscles, so as to exercise them, and aid in recovering their con- 
tractility. This should be applied at least once a day, and undoubtedly is of 
great benefit. Sometimes the patients make use of sulphur baths, but this is 
hardly needed, and is of questionable benefit. 

Leaping Ague is a name given in some parts of Scotland to a spasmodic 
affection resembling the convulsive movements of epilepsy and chorea com- 



LEE 433 LEE 

bined ; it has been noticed in the occasional vagaries of religious enthusiasts 
when an epidemic of " revivalism " is prevalent. 

Leeches (Jliriido officinalis and medicinalis) are species of the class An 
nelida, or worm-like animals. They are mainly imported from Hungary, 
Spain, and Italy. They are elongated, tapering to either extremity, and of 
black olive-green color. Another species, the speckled leech, is also employed. 
This has a greenish-yellow belly, spotted with black; either extremity has a 
muscular disc or sucker. This is larger in the hinder extremity. The mouth 
on the anterior extremity is tri-radiate. and contains three jaws, each furnished 
with two rows of teeth. These in cutting into the skin leave a permanent 
triangular mark, which is characteristic of their having been used. The in- 
testinal canal is straight, but has a number of chambers on either side, in which 
blood may be stored, and used up at leisure. Hence these animals, if fully 
fed, do not require another meal for a long period. 

Leeches are employed for the local abstraction of blood, but sometimes they 
are not easily made to strike. It is essential that the part be washed perfectly 
clean ; and some nurses then apply a sweet material like cream to the surface. 
Cupping, where it can be applied, is perhaps more efficacious. Each leech 
withdraws about a drachm and a half of blood, but if the part be well fomented 
with warm water about as much again may be abstracted. It is not easy to 
get a leech to draw twice. Either they are filled completely the first time, 
and do not care to strike a second, or they are killed by the process of empty- 
ing them, if these plans be adopted. 

Bleeding from leech bites may prove troublesome in a weakly individual 
or in children. When they do not stop, a little perchloride of iron or a little 
powdered matico may be applied to the spot with pressure. If that fail, the 
best thing is to melt some nitrate of silver on the point of a probe, and freely 
introduce that into the bleeding orifice. 

Leeching. In this, the most useful and most convenient method of local 
blood-letting, the blood is drawn from the capillaries or small vessels by the 
incision and subsequent suction of the leech. (See Leeches.) The part to 
which leeches are to be applied should be well washed with warm water, and, 
if hairy, shaved. If the leeches will not stick, the skin should be smeared with 
milk, sugar and water, or some saliva, or should be pricked at two or more 
points with a sharp needle in order that a few drops of blood may be shed. If 
the part to be leeched is on the body or one of the limbs, and no delicate struct- 
ures or natural cavities are close at hand, each leech may be taken by its 
hind part between the thumb and finger, and its head or thinnest part applied 
to the surface of the skin. When several leeches are to be applied over a 
small extent, they should be covered with an inverted tumbler or cupping glass 
until they are fixed. When two or three leeches are used they may be cov- 
ered by an inverted chip box. When the parts to be leeched are situated near 
to delicate mucous membrane, as on the face near the lips, nose, and eyelids, 
care must be taken to prevent the leech from wandering by placing it in a 
proper leech glass or in a cylinder formed by rolling up some pasteboard or 
thick paper. Leeches before being applied should be well dried in a clean 
cloth. When fully distended, the leeches usually drop off, but should they 
remain longer than is necessary the bodies may be sprinkled with a little snuff 
or common salt. A good leech will take about two teaspoonfuls of blood. 
When the leeches have dropped off, the bleeding may be kept up for some time 
afterwards by applying linseed poultices and hot moist flannels. In some in- 
stances, however, this after bleeding is too prolonged aud too excessive, and 



LEM 434 LEP 

with young children and weak and delicate persons becomes a source of danger. 
In a case of persistent haemorrhage from one or more leech bites the following 
plans may be successively carried out : to cover the wounds with small pled- 
gets of dry lint, taking care to apply the rough surface of the lint to the bleeding 
part, and then to keep these pledgets in position by pressure with the fingers ; 
to apply ice to the bleeding surface ; to press firmly into the bleeding orifices 
small pieces of lint or cotton wool dipped into the tincture of perchloride of 
iron ; to touch the wounds with a red-hot knitting-needle ; to transfix the base 
of each wound with a sharp sewing-needle, and to surround the skin beneath 
this by some stout silk thread wrapped tightly round in four or six turns. 
The needle should not be removed for twenty-four hours. 

Lemon is the fruit of the Citrus limoiium, or lemon-tree, growing in the 
more sheltered parts of Southern America and Europe. Its bark, its juice, 
and the oil extracted from its fresh peel are all employed in medicine. The 
rind contains a valuable oil, which gives the well-known fragrance to the fruit. 
The oil consists of two isomeric oils mingled. The juice contains a consid- 
erable proportion of citric acid, which has by some, but erroneously, been 
supposed to be the principle on which its value depends. It also contains 
a considerable quantity of the salts of polass. The preparations properly so 
called are the syrup and tincture. The peel is fragrant and stomachic, whilst 
the juice is cooling and possessed of most valuable acute scorbutic powers. 
The lemon juice has very frequently lime juice, the product of the Citrus li- 
metta, substituted for it. Lemon juice may be given effervescing along with 
bicarbonate of potass, and constitutes a very valuable and refreshing drink for 
patients ill and parched with thirst. Lemonade, too, made from the lemon 
sliced into hot water and sugar, is exceedingly refreshing, much more so than 
is the effervescing lemonade of the shops, which contains only oil of lemon 
and sugar, instead of the juice of the fruit. 

Lemon juice and lime juice are powerful agents for preventing or removing 
scurvy ; but as it is now plainly manifest that this malady, whether occurring 
on land or by sea, is dependent on improper food, it seems going the wrong 
way to work to prescribe the carrying of this, which is at best a substitute 
for* sound provisions, by merchant ships. The English laws, nevertheless, com- 
pel all merchant ships to carry lime or lemon juice, if going on a long voyage. 
Sometimes the captains take it concentrated, in the form of citric acid, which 
is useless. 

Lens. The lens is a transparent, doubly-convex, crystalline body, placed 
immediately behind the iris and in front of the vitreous humor, and is separated 
from both of them by a transparent capsule. The use of the lens is to enable 
one to distinguish the form or outline of objects, and act on the rays of light 
by concentrating them, or bringing them to a focus after they have passed 
through it, exactly at the surface of the retina, which may be regarded as a 
kind of sensitive screen upon which they fall. 

Lentigo is the name given to a disease in the skin in which the freckles 
are more permanent than usual. See Freckles. 

Lepoid is commonly seen on the face, nose, and forehead of elderly persons, 
usually males of a delicate, florid complexion, with tendency to congestion of 
the capillary vessels, and having light eyes and hair. It generally makes its 
appearance as a small speck about as large as a mustard seed, and of a dirty 
grayish color, soon becoming covered with a rough brownish scale resembling 
the bark of a tree. The first scale or crust falls off, and is succeeded by an- 
other, and so the disease may go on for years. At length ulceration sets in, 



LEP 435 LBP 

and a red glossy surface is left, secreting a thin pus. The disease is attended 
with itching, but not with pain. It is best not to interfere with the growth ; 
the crust may be softened by covering it with a mixture of one part of castor 
oil and two parts of collodion. 

Lepra is a dry skin disease occurring in circular red patches, and chiefly 
on the elbows and knees. See Psoriasis. 

Leprosy is a malady of great interest in many ways ; fortunately for us, 
however, not because it is common in this country, though some cases have 
actually occurred. These have been confined almost wholly to the Chinese 
population in California, and the disease was contracted abroad. The technical 
name of the malady is Elephantiasis Grcecorum, and it is of two kinds : one 
where the surface is marked with tubercles, and the other where the surface 
is smooth, but in which there are ordinarily a number of spots entirely devoid 
of feeling. They are anaesthetic. Leprosy does not begin at any particular 
age ; sometimes children are its subjects, sometimes old people. Of the two 
forms, the tuberculated and the anaesthetic, the tuberculated seems to kill the 
sooner, for it is stated to last but from nine to ten years ; the anaesthetic be- 
tween eighteen and nineteen. In both varieties, but especially in the non- 
tuberculated, the morbid action seems to be sometimes stationary for years. 
Many lepers die from other diseases, as chronic diarrhoea, dysentery, diseases 
of trie lungs, like bronchitis and pneumonia, or kidney disease. When the 
leprosy destroys life it does so by .attacking the opening of the windpipe, or 
by deep ulcerations, laying hare some important vessel, and causing haemor- 
rhage, or yet again by convulsions or coma. 

Leprosy is generally considered hereditary ; but sometimes it overleaps a 
generation, as in other hereditary maladies. What the maladies are which pre- 
vail in the intermediate generation are not noted. As usual, the influence of 
the mother seems greater than that of the father in giving a hereditary taint ; 
and it seems more inclined to spread among those of the same family than 
from parent to offspring. It does not seem, notwithstanding the loathsome 
sores it produces, to be able to spread by direct contagion. It prevails most 
among the lower classes of society, being greatly fostered by dirt, insufficient 
food, badly ventilated and damp dwellings, and especially by malarial districts. 
Generally the sufferers are most wretched in every way. The disease some- 
times approaches very gradually, sometimes more rapidly. There appear, with 
or without fever, one or more pinkish or purplish-red spots, which may be iso- 
lated or in patches. These may go, and nothing be seen for a time, but again 
there is a feverish attack, and the red spots again appear more extensively than 
before. This may happen several times ; but at length the spots begin to 
harden and to become prominent, so that they appear as hard semi-transparent 
tubercles. The skin at the same time becomes brawny and coarse-looking, whilst 
swelling of the tissues beneath makes it pit on pressure. Patches of brown 
appear here and there on the skin, and by and by some of its tissues waste, so 
that white patches appear, as if a wound had formeidy existed on the spot. 
The face, too, alters ; the cheeks, lips, and ears become swollen and bloated, 
and there is a copious watery discharge from the nostrils ; the eyes look wa- 
tery, and little nodules form on the edges of their lids, which are turned out- 
wards. The hair changes in color to a dirty white, and often falls in consid- 
erable quantity. The membrane lining the mouth and nostrils swells and looks 
flabby, pimples often forming on it. The glands in various parts of the body 
swell, especially in the groins, and a peculiar greasy sweat comes from all parts 
of the body. As the tubercles enlarge and spread over the body, the mind 



LET 436 LEU 

becomes torpid, and the extremities are swollen and useless. This is the pe- 
riod of complications, which often carry off the sufferer. 

The pain at first seems neuralgic, and after a time becomes very great. 
Rather, however, it is of the nature of over-sensitiveness, which frequently ex- 
ists before the loss of sensibility occurs. The non-tuber culated variety com- 
mences with a few small patches on the hand or face. These are shining, 
wrinkled, and paler than the surrounding skin. On these not even a red-hot 
iron can be felt. Ulcers often form, and heal after a time ; but the affection 
continues to spread. The mental faculties are dulled, the surface is cold, and 
the appetite voracious. By and by frightful ulcers form, without any pain ; 
sloughs form and fall off, exposing the interiors of joints, till bone after bone 
drops off, leaving behind only the stumps of the arms and legs. These by de- 
grees become useless, the patient being only able to crawl. The temperature 
falls, and the whole surface exhales a loathsome smell, which is more trouble- 
some to the spectator than to the miserable patient. 

Cases of recovery from leprosy are not unknown, but they are rare. How- 
ever, the first thing to be done to insure anything like a successful treatment is 
to remove the patient from an unhealthy to a health}' locality ; if an American 
or European abroad, to send him home. The diet, too, must be improved ; 
high-seasoned or long-preserved meat, especialty salted provisions and fish, are 
to be carefully avoided, and a plain nutritious diet, containing a due supply 
both of fresh meat and fresh vegetables, must be insisted on. Personal clean- 
liness is of the first moment, ami baths must be used regularly and frequently. 

As for internal remedies, these have been used of almost every kind ; none 
seem very decidedly to do good. Some have given aperients, some altera- 
tives ; arsenic has been largely used, and is now employed by the Arabs, es- 
pecially in the form of yellow sulphuret. Cupping glasses all along the line 
of the spinal cord have been used and recommended, but their value is more 
than doubtful. 

The latest treatment which has been reported on as moderately successful, 
or even more than moderately so, is one invented by Dr. Beauperthuy, and 
by him applied first in the West Indies, and after that in Guiana. One im- 
portant part of it, if not the most important, is the application of the stimulant 
cashew nut oil to the tuberculated parts on the lower extremities. At the 
same time the diet was attended to, and made more than usually nutritious. 
The results are reported as good. Unfortunately, Beauperthuy died before he 
had time fully to test the value of his supposed discovery. 

In certain cases among Europeans engaged in railway construction in mala- 
rial countries, the idea that it may be due to the malaria has been entertained, 
and large doses of quinine prescribed with alleged benefit. 

Lettuce. This plant, the Latuca sativa, is -well known as a spring and sum- 
mer salad, and is very wholesome and good in diet. It is remarkable, however, 
in yielding, when fully ripe, a quantity of sticky milky juice, which, on expos- 
ure to the air, becomes of the consistency of cobbler's wax, and possesses a nar- 
cotic principle resembling opium in its effects. Dr. Duncan, of Edinburgh, first 
discovered this drug, and for some time it was constantly used in practice as 
being less exciting than opium. It is now, however, seldom employed, being 
superseded by morphine. See Lactucarium. 

Leucoderma literally means white skin. It occurs very rarely in some 
people, and appearing in childhood remains throughout life, giving rise to no 
symptoms but merely a discoloration of the skin. In all people there is a cer- 
tain amount of pigment or coloring matter in the skin, and this is increased by 



LEU 437 LIC 

exposure to the sun, as when a person is tanned. In leucoderma, however, 
this pigment is absent over certain parts of the skin, so that a circular white 
patch is seen surrounded by skin of the ordinary color, or perhaps rather 
darker than usual. This singular change is found on each side of the body, 
and generally follows the course of a nerve ; it occurs most frequently on the 
arms and on either side of the spine; when occurring on the head, the hair on 
that spot becomes thin and white, or falls off. No treatment is of any avail, 
nor is any required ; the patches may increase in size slowly, or else leave 
smooth, irregularly mottled patches of pale skin. The skin of such people is 
generally fine and soft. 

Leucorrhcea, commonly known as " the whites," is a disorder frequently 
occurring in women. It is met with either as a thin, watery discharge, and is 
then merely an increased flow of the ordinary secretion of the vagina, or as 
a thick, vellow discharge, which generally comes from the womb. This state 
is accompanied by debility, pain in the back and loins, pain and difficulty in 
passing water, and anaemia, or pallor of the skin. It often occurs during preg- 
nancy, more often when the mother is weakened from having had a large 
family, and from over-suckling. Any disease which has a debilitating effect on 
the system may cause this complaint, so that it is not uncommon after a fever 
or a protracted illness. There are also local as well as constitutional causes ; 
many diseases of the womb, growths in the vagina, stone in or disease of the 
bladder, and many affections of the rectum will cause this symptom. The 
treatment must consist in keeping up the general health, and in removing any 
irritating cause ; the object in the first case may be maintained by giving ton- 
ics, of which iron and quinine are the most valuable ; moderate exercise, fresh 
air, and a generous, wholesome diet are also required. The removal of any 
irritating cause will in each case depend on the nature of the mischief, and for 
each a special course may have to be, adopted. Astringent lotions should be 
injected two or three times a day with a syringe ; lotions containing tannin, or 
alum, or sugar of lead are the best. The parts affected may also be freely 
bathed with cold water night and morning. 

Leukaemia is a disease in which there is an increase in the number of 
white blood corpuscles in the blood ; it is also called leucocythemia. 

Lichen is a skin eruption consisting of a number of small pimples or pap- 
ules grouped together in clusters, and occurring anywhere on the surface of the 
body ; the frequent rubbing in of zinc ointment is the best thing to do, but the 
rash is often very troublesome to heal. The patient should not scratch the 
heads off, or he may produce an irritable sore which may become eczematous ; 
when the rash is due to syphilis, the treatment will consist in taking iodide of 
potassium in conjunction with some tonic infusion, as gentian or sarsaparilla. 
The prickly heat of tropical countries is really au aggravated form of lichen. 
This disease is not contagious ; it is more common in women than in men, and 
in those of a nervous and excitable temperament. It i^ more common in'spring 
and summer than in autumn or winter. Lichen is a form of skin disease con- 
sisting of a hard, elevated body something like a pimple, but having no head 
to it, — what is technically termed a papule. These are not large, are hard 
and dry, and in color red. They may exist separately or in clusters. They 
tingle or itch, and disappear by scaling off. Several varieties are known and 
described ; none of them are at all dangerous, or, as a rule, troublesome, though 
for a time sore and itchy. 

Treatment is not of great moment ; it is best to see that the bowels are open, 
to have an unstimulant diet, and to wash the parts frequently so as to avoid 



LIG 438 LIM 

irritation from acid perspiration. The irritation, if great, may be combated by 
Goulard water. The more severe forms require more energetic treatment. 

Ligature. A ligature is a cord or thread employed in tying a blood-ves- 
sel or tumor, consisting either of silk or strong hempen twine, cat-gut, horse- 
hair, or other substance. In applying a ligature to a bleeding artery, its ori- 
fice is first laid hold of, and pulled out from the surrounding tissues, either 
with a pair of forceps or a tenaculum, so that a loop formed by the ligature 
may embrace it, and it alone. The length of the ligature for ease of applica- 
tion should be about a couple of feet. The knot used for an artery is what is 
known as a reef kuot, and, in bringing the bight tight, care must be taken to 
run the cord over the tips of the forefingers, so that all pressure is made at the 
bottom of the wound, and that the vessel be not ''tugged" at, to the imminent 
danger both of tearing it through and of pulling the ligature away from the 
vessel. One end of the ligature in the case of tying an artery should be cut 
off, and the other left hanging out of the wound, so that when the sloughing of 
the arterial coat has taken place, it may be readily withdrawn. The time that 
ligatures require to separate varies from a week to three weeks or a month. 

Light is as important to health almost as air. Its want is noticeable in 
those who work in dark workshops and underground kitchens. These have 
complexions as devoid of color as a piece of blanched celery or asparagus, and 
for exactly the same reason, — both have been deprived of light. In the veg- 
etable kingdom light is absolutely necessary to convert the white shoots into 
green leaves and branches. So, too, in the human being the circulating blood 
requires an exposure to light to give it its true vivifying qualities. Such in- 
dividuals, therefore, who have not a due exposure to light, are what is tech- 
nically called anaemic, and though in some the health seems tolerably good, in 
others there is a tendency to passive dropsies, owing to what is called thinness 
of blood, and want of breath when called upon to undergo exertion. The 
exact nature of the constitutional change is not known, but probably is con- 
nected with some change in the intimate structure of the red corpuscles or the 
chemistry of their coloring matter, haemoglobin. 

Lightning Stroke. A flash of lightning, or rather the so-called electric 
fluid, will generally strike the most prominent object near it, and if this chance 
to be a conducting body, it is carried off to the earth and may do no harm , in 
other cases it may strike the chimney of a house and do serious harm to the 
walls and inmates, and especially if there is a conductor, the supports of which 
are made of metal and inserted between the stones of bricks of which the wall 
is made. Death by lightning is instantaneous, and leaves nothing to be done ; 
there is generally a mark as of being burnt, and articles like a watch or coins 
may be partially destroyed. At times a man walking along a road is killed, 
and in these cases it seems to be due to what is called the " back-stroke," a 
condition in which the discharge of electricity having taken place, the man 
himself is a conductor of the earth's electricity, being the most prominent ob- 
ject at that spot on the earth's surface. A thunder-storm oftens frightens peo- 
ple most alarmingly, and sometimes temporary blindness will come on, after 
vivid lightning, in an individual who is not struck. 

Lime, the oxide of the metal calcium, is used for a variety of purposes. 
Quicklime is prepared by burning chalk or limestone, and so driving off the 
carbonic acid; quicklime is left behind, retaining something of the shape of the 
original blocks. If, however, water be added, the whole mass heats and breaks 
down into a fine powder, and this, which is slaked lime dissolved in water to 
saturation, constitutes lime-water. If suirar be added to the water the lime is 



LIN 439 LIN 

taken up much more freely, and a stronger solution — saccharated solution of 
lime — is produced. Lime-water and olive oil shaken together form a most 
useful liniment, which, being greatly used for burns in the Carron Iron Works, 
gets also the name of carron oil. The original carron oil had linseed instead of 
olive oil. Lime given as lime-water acts as a 'powerful antacid both on the 
alimentary canal and after absorption. It is also astringent and tends to dimin- 
ish secretions, and so is very useful in many forms of diarrhoea. Lime-water 
is also used with advantage to check abundant discharge in the skin disease 
called eczema. In some forms of vomiting, especially in children, lime-water 
is a most valuable remedy. It is, perhaps, of most use in chronic vomiting. 
It is best given mixed with milk. It prevents cow's milk from coagulating, 
and so obviates fertile risks of stomach ache and diarrhoea. If the bowels be 
constipated bicarbonate of soda should be used instead. 

Carbonate of Lime, precipitated from a solution of a lime salt, or prepared 
as well-washed chalk, is a useful remedy. Two preparations are available : 
chalk mixture and aromatic powder, or aromatic powder and opium. Chalk 
is an antacid and astringent. It is mainly used in diarrhoea, seldom alone, 
but generally with other remedies, astringent and aromatic. If given too long 
it is apt to cause concretions in the bowels, which may be troublesome. Chalk 
is also often used as a dusting powder, when sores form, as in the creases of 
fat children. Sometimes these are better dealt with by using greasy prepara- 
tions, but in a goodly number chalk does well. 

Chloride of Calcium is a remedy which is variously estimated by different 
observers. It is introduced into the Pharmacopoeia mainly as a drying agent, 
and as concerned in the manufacture of chloroform and ether. Some, however, 
esteem it highly because it is supposed to exercise a special influence on the 
glandular system in scrofula. 

Chlorinated Lime, though a preparation of that base, really owes its active 
properties to the chlorine which it contains. It is got by passing a stream of 
chlorine gas over slaked lime. Its only preparation is a solution of chlorinated 
lime, more commonly known as chloride of lime, which is used as a disinfectant. 
If a solution is used internally, chlorinated soda is substituted. 

Phosphate of Lime, or bone earth, is au important salt in the animal econ- 
omy, constituting the main basis of our bones. It is obtained from bones by a 
slight process of purification. This salt is necessary not only to the growth of 
bone, but also to the growth of other tissues. It is most useful in the anaemia 
of young and rapidly-growing individuals, and women weakened by frequent 
child-bearing. It is also a very good thing to give to women whilst suckling 
if they have been previously weakened in the same way. In rickets it is a 
most valuable remedy, giving hardness to the softened bones. The time best 
adapted for its use is just after the acute stage of the malady when the pain 
and tenderness of the bones have ceased. Not too much should be given for a 
dose, as taken in excess it hinders digestion. Most of it passes into the intes- 
tines, where, if much be taken, it is apt to form concretions. In various forms 
of chronic diarrhoea, especially in children, this remedy is of value. It may 
be given along with iron in the form of syruj). Most of the phosphates neces- 
sary for the welfare of the body are contained in the food. 

Liniments, from the Latin lino, I smear, literally mean those remedies 
which are smeared on the skin and left there. Nowadays we commonly in- 
clude in the term those also which have to be rubbed in, really embrocations, 
and the common idea of a liniment is something to be rubbed in. Liniments 
are made use of for all sorts of purposes, and many are included in the Phar- 
macopoeia. 



LIN 440 LIP 

Linseed, as commonly used, consists of the pounded seeds of the com- 
mon flax plant. These seeds contain a valuable oil obtained by expression, the 
linseed oil, which is also officinal. Not unfrequently the substance which re- 
mains after this oil has been expressed is ground down and the powder made 
use of as linseed for poultices. It is not, however, so good as the pounded 
seed, being deprived of its oil. Linseed is mainly employed for poultices, and 
it furnishes one of the best materials for these (see Poultices), and in this 
form is commonly applied to open and suppurating sores. Internally linseed 
is given as linseed tea or infusion of linseed. This is an old-fashioned and 
useful remedy, being employed when there is irritation about the bladder or 
urethra. It has also been employed with less benefit in diarrhoea and dysen- 
tery. The old Liniraentum Calcis or carron oil of the Edinburgh Pharmaco- 
poeia was made with linseed oil instead of olive oil. The compound thus 
formed was thicker and more tenacious, though less pleasant to the smell, and 
less elegant than the preparation now in use. 

Lips. Wounds. The most common cause of wounds of these structures is a 
blow or fall. The lip is driven backwards against the teeth, and laceration of 
its soft tissues produced. The injuries may vary, from a slight wound on the 
free margin or posterior mucous surface of the lip to a large cleft, involving 
its whole thickness, so as to expose the teeth and corresponding portion of the 
jaw. The lips are sometimes bitten by sudden closing of the lower jaw, and 
when any of the incisor teeth are sharp or broken at their free ends the wound 
may be deep and serious. Wounds of the lips generally bleed profusely, as 
their structures are traversed by large blood vessels, and the internal lining of 
red mucous membrane is very vascular. As there is usually much gaping, 
even in small wounds of the lip, it is almost always necessary to apply sutures. 
When the whole thickness of the lip has been involved, the separated parts 
should be brought together by sutures twisted round long needles, as is done by 
most surgeons in operating for the relief of hare-lip. Care must be taken to 
bring the corresponding portions of the wounded lip into contact, and to pre- 
serve the line of red margin. For the simple stitching together of the margins 
of superficial labial wounds, thin silk or thin silver wire is the best material 
to use. 

Cracked Lip. The most common form of this troublesome affection is a su- 
perficial crack at about the middle of the red portion of the lower lip. This is 
raw and painful, bleeds readily when touched, and is generally associated with 
a sensation of dryuess in the whole lip. It is met with in weak and unhealthy 
individuals, during the winter months. The upper lip may be affected, but 
cracks are much more common on the lower one. Deeper and larger cracks 
are occasionally observed on the lips of scrofulous children. The best and 
simplest treatment consists in applying blue-stone or sulphate of copper to the 
base of the ulceration, and then to keep the sore and surrounding portion of 
lip moist with glycerine, and to protect these parts from cold and external irri- 
tation by means of cotton wool. 

Ulcers. Non-cancerous ulceration of the inner surface of the lips is gener- 
ally due to an extension of some similar disease affecting all parts of the lining 
mucous membrane of the cheeks and gums and the surface of the tongue. Ul- 
cers on the lips are in most cases superficial grayish patches surrounded by a 
zone of inflamed and swollen mucous membrane. The following are the most 
frequent causes of oral and labial ulceration : dentition, rough and broken 
teeth, action of mercury, disordered stomach, venereal disease. The white 
spots called aphthae, which are so frequently observed on the tongues of un- 



441 





FIG. LI 



J J 'IQ. XXXV. 





J?IG LXXVII 




Fig lxxvii 



LIQ 443 LIT 

healthy and badly feci infants may also attack the lips. In the management of 
cases of ulceration of the mouth and lips, the medical man directs his attention 
in the first place to the constitutional origin of the disease. The best local 
treatment in most cases consists in the application of blue-stone to the surfaces 
of the small ulcers and in the patient's sucking frequently during the day small 
pieces of alum. Borax and honey is a well-known and useful application. 

Cancer. The lower lip is the most frequent seat of the epithelial or least 
rapid form of cancer. The disease usually commences as a warty growth or 
as a small crack near the margin of the red mucous membrane. The disease 
increases slowly at first, but after a time an ulcer is formed with uneven and 
dirty-looking base, and with hard and elevated edges ; this spreads and destroys 
a greater part or the whole of the lip, the glands in the neck become enlarged, 
and the patient finally sinks from pain and exhaustion. This disease occurs 
more frequently in men than in women. It is a disease of advancing or ad- 
vanced age, and is rarely met with before middle life. It is believed by many 
surgeons that the original warty growth or fissure is often caused by the press- 
ure and friction of a rough clay pipe, or by the irritation of bad and unclean 
teeth. See Aphtele, CancrumOris, Hare-lip, Salivation. 

Liquor Sanguinis is the opaque, straw-colored fluid or plasma in which 
the blood-corpuscles float when in the living body. See Blood. 

Lithates or Urates form the red or pink sandy deposit which settles from 
the urine on cooling; it is often found in cases of dyspepsia, or when too little 
water is passed, or when the urine is very acid. See Urine. 

Lithic Acid, a substance met with in the urine; it forms an important 
constituent of the concretions called stones or calculi. See Urine. 

Lithia is an alkali closely allied in its properties to potass. It has re- 
cently been brought into practice as a remedy in gout, it being supposed to 
favor the passage of uric acid from the system more than potass. Its prepa- 
rations are the carbonate and the citrate. It is somewhat expensive, and is 
not much better than potass. 

Litholysis. By litholysis is meant an attempt at solution of the stone 
within the bladder, which may be endeavored in two ways, — by medicines 
given by the mouth, and by injections into the bladder of a similar class of 
remedies. The alkalies are the most useful, especially the carbonates of soda 
and potash, given in copiously diluted doses, of the natural waters ; Vichy ap- 
pears to be the best. The oxalate of lime calculus, however, resists its influ- 
ence. The uric formations, however, are benefited in two ways by their ad- 
ministration : alkalies thus given tend to correct the diathesis, whereby the 
calculus has arisen, and, at the same time, they have an undoubtedly sedative 
and corrective effect on the urinary organs. These remedies should be con- 
tinuously given, and in small doses copiously diluted. In the case of the phos- 
phates, they seem to have the effect of gradually disintegrating the stone by 
solution of the animal matter, whereby its particles cohere. Solvent injections 
into the bladder have been in use since 1792, both acids and alkalies ; acid in- 
jections appear to be not without their efficacy, especially in phosphatic stones. 
Carbonate of lithia has been proposed for uric concretious, and the salts of lead 
in phosphatic. 

Lithotomy. The operation of the removal of a calculus, or stone, from 
the bladder has created the greatest interest from the earliest ages. Before 
entering into any description of the methods practiced in modern times, we 
shall proceed to give a short history of this operation from the earliest accounts 
we can obtain. 



LIT 444 LIT 

History : Extraction by dilatation and suction through the urethra was em- 
ployed from time immemorial by the Egyptians- There is no doubt that an 
incisional operation to extract the stone was practiced in the times of Hippoc- 
rates, more than two thousand years ago, and it is not improbable that the 
method employed by him was identical with that of which Celsus has left us 
a description. Amnion of Alexandria and Meges at Rome, Herophilus and 
Erasistratus, who flourished in the Augustine age, employed a cutting opera- 
tion. Celsus, who flourished in the first century, employed an operation in 
which the seat of incision was the neck of the bladder and a portion of the 
urethra; his method continued to be known under the name of Lithotomia 
Celsiana for a succession of ages. The Arabian school, although it held sway 
for so long, does not appear to have in any important way modified the Cel- 
sian operation, and it is not until the sixteenth century, so rich in improve- 
ments in surgery, that we enter on a new era in the history of lithotomy, and 
it was in this age that the groundwork of the operations we now perform was 
made good. The Celsian method of operating was as follows : The patient's 
bowels being emptied by an enema, he was directed to walk about, so that the 
stone might descend and enter the neck of the bladder; next, at the moment of 
operating, he was placed, sitting, in the lap of an assistant, and the surgeon 
introduced the fore aud middle fingers of the left hand into the rectum, with 
a view of hooking the stone forward into the neck of the bladder. As soon as 
it could be felt on the left side of the perinauim a semi-circular cut was made 
through the tissues, until the urethra was reached, and then a transverse one 
was made through this structure, by which the stone was exposed and the 
urine gushed out ; if this incision was not large enough for the extraction of 
the stone it was pulled out by a hook. Celsus imagined it was dangerous to 
wound the bladder, following the precept of Hippocrates, and it will be here- 
after seen that the free incision recommended by Celsus was departed from in 
the method that was afterwards to rival it. This operation was termed " cut- 
ting in the gripe," and a somewhat similar method is still used by the Hindu 
stone-cutters of our own day. who as a rule are remarkably successful. In 1524 
Johannis de Romanus introduced an operation of dilatation, on the presump- 
tion that, though cutting the bladder was dangerous, this method might not be, 
and his pupil, Marianas Sanctus, described and designated this proceeding by 
the name of the "apparatus major," from the number of instruments requisite 
for the performance. The incision was as before urethral, but the direction 
of the incision was changed, and an important improvement was made, hith- 
erto unemployed, namely, a grooved director. The operation was performed 
by making an incision with a razor along the perinajum, on one side of the 
raphe, from behind the bulb of the urethra to the side of the anus ; the mem- 
branous part of the urethra was then felt for and opened on this director or 
staff. A probe was now passed along the groove of this staff into the bladder 
aud the staff withdrawn, the urine gushing out through the wound. This 
probe in turn was withdrawn, and a probe-pointed staff was next guided into 
the bladder along the groove. These directors were now used to dilate the 
prostatic portion of the urethra and neck of the bladder, and through this 
stretching of the parts the forceps were introduced and the stone extracted. 
As may be imagined, the various complications of such an operation were 
likely to require numerous expedients for their relief, and a host of very barba- 
rous contrivances were made use of, whereby dreadful lacerations of important 
parts were induced. Clumsy and unscientific as these proceedings were, it will 
be seen that one important fact, at all events, was established on the road to 



LIT 445 LIT 

the perfection of the operation, and that was that it exploded the prejudice as 
to the fatal character of incisions into the bladder itself, it led to a more 
careful anatomical study of the perineal structures, incisions were substi- 
tuted for lacerations, and finely Franco (sixteenth century) introduced his 
lateral operation, so named from his dividing the prostate and neck of the blad- 
der by a lateral incision. Marechal, Mery, and others followed him, con- 
vinced of the superiority of incision over laceration. Franco, in his opera- 
tions, directed that a curved grooved staff be introduced into the bladder, the 
groove being for the purpose of guiding the knife, by which the neck of the 
bladder is to be divided from within outwards. This period may be conveniently 
called that of the introduction of prostatic lithotomy. Proceedings before this 
may be aptly termed urethral. Jacques de Branlieu, better known as Frere 
Jacques, who in the early part of his career was servant to Pauloni of Venice, 
and afterwards became a monk, began to operate for stone at Besancon in 
1695. His method of operating consisted of introducing a solid staff without 
any groove into the bladder, with which he pressed downwards the neck of 
the bladder, thus making it prominent on the left side of the perinamm. He 
then pierced from below upwards into the bladder with a long knife, between 
the ischium and the rectum. As soon as the urine gushed out he enlarged the 
incision by directing the edge upwards and inwards towards the symphysis 
pubis. He operated with considerable success, and subsequently availed him- 
self of proper anatomical instruction, and became convinced of the great im- 
portance of using the grooved staff instead of the solid one. His successor 
was Raw, of Baden, who, from being a barber's apprentice at Strasburg, be- 
came professor of anatomy at Amsterdam. As was usual in these times, 
methods of operation were kept secret ; but Raw's method has been since 
shown by Camper and others to be merely a return to the original proceedings 
of Frere Jacques, and this pretended secret was only a device of charlatanism, 
intended to mislead. About this period Cheselden, surgeon to St. Thomas's 
Hospital, was performing an operation termed the apparatus altus ; this he laid 
aside, and like Bamber, his contemporary at St. Bartholomew's, tried to per- 
form after Raw's plan, as described by his successor Albinus ; but he was led 
to return to, or in fact reinvent, the operation of Frere Jacques. The method 
having become established in London and Paris, a succession of modifications 
of instruments and methods followed, and the operation itself obtained the 
name of the lateral. During a period extending over more than half a cent- 
ury almost every lithotomist invented, or has called after his own name, some 
knife, gorget, or apparatus, and the most important was probably the cutting 
gorget of Hawkins, whose object was certainty in the execution of the lat- 
eral operation, and the protection of the rectum and pudic artery from 
being wounded. An innovation shortly appeared in the form of an instru- 
ment under the name of the Lithotome cache, invented by a monk named Frere 
Come. It consists of two parts, an open steel sheath, terminated at one end 
by a blunt point, and at the other having a handle adapted to it ; parallel to 
the sheath is a cutting blade articulated to it, also terminating in a handle. 
When the blade-handle is pressed against the handle of the sheath the blade 
starts out from the sheath, and there is a mechanism in the sheath-handle, 
which, by being turned on its axis, a certain fixed degree of eccentricity or 
opening is given to the blade, whereby the depth to which the prostate gland 
and neck of the bladder are to be incised is capable of being determined be- 
forehand. Ciphers engraved on the handle indicate the degree to which the 
blade will open when pressure. is made, being in each case that of the num- 



LIT 446 LIT 

ber which corresponds with the blade-handle. M. Charriere has simplified 
the instrument by substituting for this mechanism a movable screw that can be 
fixed at any number of a graduated scale on the side of the blade-handle, 
below the point where it is articulated. 

Of the multitude of instruments that have been invented, the cutting gorget 
and this lithotome cache are the only ones which have survived, and nowadays 
they can only be seen in very out-of-the-way collections. The instruments re- 
quired for the operation of lithotomy in our own time are remarkably few and 
simple, — a knife, a grooved staff, forceps, or a scoop. The patient having 
been previously prepared, and placed under the influence of an anaesthetic, the 
method at present in use — usually the lateral operation, as performed by 
Cheselden — is, by a skillful operator, a matter of a few seconds. After the 
stone has been extracted, a morphia suppository may be advantageously admin- 
istered, and the patient should lie on his back with the shoulders elevated, a 
napkin applied to the perinseum to soak up the urine, and the bed protected 
with macintosh draw-sheets. Pain is to be allayed by opium, the bowels kept 
open with castor oil, the wound perfectly clean, nourishing diet, and the wound 
made by the surgeon, generally speaking, heals entirely in four or five weeks, 
the urine commencing to flow by the urethra in about a week. Lithotomy is 
a preferable operation in the case of children, or when the urethra is struct- 
ured, or when irritability of the bladder or great erdargement of the prostate 
exists, and when a stone of great size is to be removed. 

Lithotrity is the proceeding whereby a stone in the bladder is crushed or 
broken by means of some piece of mechanism introduced through the urethra, 
so that its debris may either be extracted by the said instrument, or may pass 
with the urine in the act of micturition. 

History : Attempts at crushing, or at all events of diminishing the bulk of 
a stone, according to Paulus OEgineta, seem to date from the time of the Egyp- 
tians, who, finding that small stones could be passed by dilatation of the urethra, 
very probably had recourse to some mechanical means of reducing the size of 
stones too large to pass in such a manner. It is stated that Amnion of Alex- 
andria broke up with a statuary's chisel a stone too large to be extracted through 
the opening made for that purpose. Albucasis, an Arabian physician, who 
flourished in the eleventh century, alludes to the fact that if a stone be arrested 
in the urethra, the canal is to be tied behind it, so as to prevent it passing up 
again into the bladder, and it is then to be bored through with a drill, so that 
being thus weakened it may fall to pieces on pressure, and its fragments pass 
away with the urine. A method of reducing a stone in the urethra or bladder 
by the friction of a diamond set in a metallic staff has been ascribed to Aristotle. 
Karwing, an Arabian physican, who flourished in the thirteenth century, is said 
to have used a similar method. Ambroise Pare (sixteenth century), the father 
of modern surgery, has a drawing in his work on surgery of a sort of gimlet 
for boring the stone, and Fabricius Hildanus (sixteenth century) improved upon 
it by adding a clawed forceps working through acanula to hold the stone whilst 
the gimlet drilled it. Sanctorius (sixteenth and seventeenth century) and 
Alphonso Ferri (sixteenth and seventeenth century) made still farther improve- 
ments. A forceps with four branches was made by Franco, termed the quad- 
ruples vesicae. There are cases on record of individuals inventing apparatus 
for crushing stones, and using them upon themselves. A well-known case, that 
of Colonel Martin, in our own times, is deserving of notice : he used to pass a 
kind of file into the bladder to waste and detach portions of the calculus; and 
Mr. Salt, of Birmingham, states that Dr. Haygarth in 1825 devised an instru- 



LIT 447 LIT 

ment to break up a vesical calculus, and Mr. Hodgson, the eminent surgeon, 
adapted a screw to it. The next stage in it was proposed by Gruithuisen, of 
Munich, who imagined that the stone could be chemically decomposed by gal- 
vanism, and then held in position by a wire noose introduced by a canula, 
whilst a lance-shaped drill or trephine acted upon it through this canula. No 
good results were derived from this method. Sir Astley Cooper extracted 
several small stones per urethram by means of a two-branched forceps. In the 
year 1823 M. Civiale, as the result of his studies, published a very important 
work on the possibility of destroying a calculus in the bladder without having 
recourse to lithotomy. The instrument he used at this period was in some 
respects like its predecessors, only it was capable of applying pressure upon 
the stone by means of a screw, and arrangements were made for the prevention 
of the escape of water from the bladder during operation. When the stone was 
caught and rendered immovable by the screw, a drill was used, turned by a 
watchmaker's lathe, which pounded or bored the stone. The operations per- 
formed by Civiale with this instrument led of course to numerous imitators, 
and attempted improvements by Leroz, Amussat, Heurteloup, and others. Hith- 
erto, it will be observed, all the instruments used were as a whole straight, and 
a straight tube was passed through the urethra, which had a mechanism pro- 
truding from its extremity which caught and otherwise dealt with the stone. 
Several attempts had been made by Stodart, Haygarth, Weiss, and Retosi to 
construct a curved instrument ; and the first one favorably received was one 
by M. Jacobsen, of Copenhagen, in 1831. In 1832, M. Heurteloup contrived 
an instrument which he termed the percuteur courbe, or marteau, and which 
consisted in a curved blade sliding within an out-curved blade, and on the stone 
being seized in the jaws the inner one was hammered down upon it with a view 
of crushing it ; but the instrument in this form speedily went out of use, owing 
to many defects in mechanism. There is no doubt, however, that this instru- 
ment, and the several important modifications in its mechanical details and in 
the facility of introducing and using it, was the original and immediate model 
of the perfected lithotrites now in use. Heurteloup's instrument was modified 
and improved by Costello, and Mr. Oldham devised the oval slip in the female 
or moving blade to allow of the escape of the detritus during the crushing 
action of the two blades. In 1834, Sir William Fergusson devised the method 
of rack and pinion for communicating motion to the sliding blade, the advan- 
tages of which are that the degree of force can be felt by the hand, and that 
pressure can be alternated with percussion. But perhaps the lithotrite has 
found its most perfect development in the instrument devised and used by Dr. 
Henry J. Bigelow, surgeon of the Massachusetts General Hospital, whereby, 
in connection with an evacuating apparatus, the stone is crushed and the frag- 
ments are removed from the bladder at a single sitting. This operation is 
termed " litholopaxy." 

As may be surmised, lithotrity is an operation requiring, in the first place, 
great perfection in diagnosis, so as to determine when this operation is to be 
preferred to that of lithotomy or cutting ; secondly, it requires immense practice 
and a peculiar attention to detail. The operator must have originally great 
nicety of touch, so as to discriminate the tissue between the jaws, and to this 
gift must be added great experience. Each operation has its advantages. The 
advantages of lithotritry (which, of course, are determined by the surgeon), or 
rather the cases in which lithotrity should be resorted to instead of lithotomy, 
are when the patient is an adult with a full-sized urethra, when the prostate is 
not enlarged, and when the stone is single, not large or very hard. 



LIT 448 LIV 

Litmus or Lacmus is a peculiar blue coloring matter extracted from a 
variety of lichens. It is prepared extensively in Holland. As it is readily 
affected by acids and alkalies — turned red by acids and blue by alkalies — it 
is used as a test of acidity or alkalinity, but for no other purpose. Litmus 
paper is made by spreading the substance on a piece of ordinary paper, and 
afterwards cutting it up into slips. 

Liver. The liver is the largest gland in the body, and weighs generally 
between fifty and sixty ounces, being greater on an average in the male than 
in the female. It is situated on the right side of the abdomen, just below the 
diaphragm, in the right hypochondriac region. (See Abdomen.) It stretches 
across to the left also, crossing the epigastric region, and reaching as far as 
the spleen in the left hypochondriac region. It commences as high as the 
fifth rib in the line of the nipple on the right side, while its lower border comes 
down as low as the lower margin of the rib. Its length, however, varies a 
good deal even in health, and in women who wear tight stays it may come 
down an inch or two lower. In front of the liver, in the erect position, is the 
abdominal wall ; behind is the right kidney ; while above, there is the arch of 
the diaphragm. The organ is covered all over with a thin, smooth, serous 
membrane, called the peritoneum, by which it is held in its place. The liver 
can move up and down slightly with each movement of respiration, for during 
inspiration, when the diaphragm descends, the liver is pushed down also, re- 
turning to its old position, when the diaphragm ascends during expiration. 
It is of firm consistence and of a dark red color, smooth and convex in front ; 
the hinder surface is flattened and irregular ; the upper border is thick and 
rounded, while the lower edge is thin, and can be felt in thin people. The 
liver is divided into two main lobes or divisions, called the right and left lobes ; 
the division is marked by a deep notch in the lower border ; looked at from 
behind, the lobed arrangement is very evident, but from a front aspect the 
two lobes seem, and are, continuous. The right lobe is by far the larger 
of the two, while rhe smaller left lobe occupies chiefly the epigastric region ; 
its lower border, too, does not come down so low as that of the larger lobe. 
This gland contains various vessels, and also a secreting .structure formed of 
myriads of cells. The portal vein brings the blood to the liver, and then by 
means of a number of small branches the blood-stream is carried through very 
fine tubes known as the hepatic capillaries ; here the current is brought into 
the closest proximity to the liver cells, and the}' take from the blood the ele- 
ments necessary to form bile and glycogen. These hepatic capillaries next join 
together again, and finally form the hepatic vein, which carries the blood into 
the inferior vena cava, and so on to the right side of the heart. The portal 
vein collects all the venous blood just after it has passed through the stomach, 
spleen, and large and small intestines, so that this blood, highly charged with 
nutrient material from absorption of the elements of food in the alimentary 
canal, is at once carried on to the liver. The hepatic artery is a branch from 
the aorta and sends several branches to the liver, and probably is the nutrient 
vessel of that gland. The hepatic duct is a tube which conveys the excreted 
products of the liver away into the alimentary canal, and enters that channel 
in the duodenum. It has been said above that the hepatic capillaries form a 
very close network of thin-walled vessels, and among the meshes lie the liver 
cells ; these communicate readily with the commencing branches of the he- 
patic duct, which, uniting together, finally form branches of considerable size; 
along the ducts the bile flows in health and runs down into the intestine. 
Thus there are two curreuts, each in an opposite direction ; the blood is 



LIV 449 LIV 

brought from the intestines to the liver ; the bile, then formed, flows from the 
liver down to the intestines. In addition the liver is supplied with lymphatics 
and nerves, which play an important part with regard to the functions of the 
organ ; branches of the vagus, or pneumogastric, are the chief nerves which 
supply the liver. Opening out from the main hepatic duct is a dilated reser- 
voir, called the gall-bladder ; it forms a large oval sac, and varies in size ac- 
cording to the amount of its contents. The liver removes from the blood cer- 
tain substances, and also supplies that fluid with new compounds ; it is thus a 
source of loss as well as a source of gain. The blood loses, because bile is 
being constantly formed, and passing down the hepatic duct, aud experiment 
shows that there is a difference in the blood which enters the liver, and in that 
which leaves it, in consequence of this loss. The total quantity of bile se- 
creted in twenty-four hours varies, according to different authors, the probable 
average being between two and three pounds. It is a greenish-yellow fluid, 
slightly alkaline, and of an extremely bitter taste. It consists chiefly of water, 
holding in solution from 10 to 17 per cent, of solid substance. The solid mat- 
ter consists chiefly of bilin, a resinous substance, composed of carbon, hydro- 
gen, oxygen, nitrogen, and sulphur, in combination with soda. Chemists have 
separated this bilin, or biliary matter, into two acids, the taurocholic and the 
glycocholic, each of which exists combined with soda. In addition to this con- 
stituent, the bile contains, also, a substance called cholesterine, which is very 
soluble in alcohol, and crystallizes out in thin quadrangular plates ; it forms a 
great part of what are known as gall-stones. Of these bodies, the water, sa- 
line matter, and cholesterine have been found in the blood, and probably the 
liver cells simply abstract them from the stream as it flows along, and cer- 
tainly the blood in the hepatic vein is poorer in water than that in the portal 
vein. Bilin has not yet been discovered in the blood, and thus this substance 
must be formed in the liver itself. But the liver is also a source of gain to 
the blood. If the blood in the hepatic vein be examined it will be found to 
contain a large quantity of glucose, a kind of sugar formed in the liver, while 
the blood in the portal vein, or hepatic artery, contains a very much smaller 
quantity, and sometimes none at all. Experiment has shown that an amyloid 
substance called glycogen is formed in the liver ; this substance is made up of 
carbon, hydrogen, and oxygen, and much resembles starch, dextrine, and gum 
in chemical composition. Further, this glycogen, like starch, can be acted upon 
by ferments, and so is converted into hepatose or liver-sugar. This* ferment 
exists, under ordinary circumstances, in the liver. So that it would appear 
that the liver forms glycogen from the blood with which it is supplied, and 
also a ferment, which, at the ordinary temperature of the body, will convert 
the slightest soluble glycogen into very soluble sugar, and this is carried away 
by the hepatic vein on to the vena cava, and so through the right side of the 
heart into the lungs. The bile, as has been said, enters the duodenum, or that 
portion of the small intestine next to the stomach, and here it mixes with the 
chyme, or partially digested food ; the bile neutralizes any free acid, and, per- 
haps, aids in digesting any fatty matter ; it also increases the peristaltic action 
of the bowels, and thus acts as a purgative. If from any cause the flow of bile 
down the hepatic duct is obstructed, the bowels often become constipated and 
the motions are of a pale clay color. At the same time the liver becomes 
rather larger than usual, because the ducts are full of the retained bile, and 
the patient feels pain over that region, which is worse on pressure. Since the 
bile cannot flow in its usual course some of it is absorbed by the blood, and 
thus some kinds of jaundice are produced. Then the urine becomes much 
29 



LIV 450 LIV 

darker in color and has a dark olive-green hue ; the conjunctiva? also are tinged 
yellow, and in a short time the whole skin assumes a yellowish tint. Expos- 
ure to cold, indigestible food, and sedentary employment may set up an in- 
flamed condition of the bile ducts, and so cause temporary obstruction, but this 
form is very amenable to treatment ; any great emotional disturbance or fright 
also causes jaundice. Sometimes the jaundice is more permanent, as when 
a growth or tumor presses on the duct, and such cases may prove fatal ; or a 
gall-stone may become lodged in the canal and cause intense pain in the right 
hypochrondriac region, with sickness and faintness ; these symptoms are re- 
lieved when the stone has passed into the intestine. (See Jaundice and 
Biliary Obstructions.) Excessive drinking and the immoderate use of 
ardent spirits cause congestion of the liver, and finally produce profound 
changes in that organ, as in cases of cirrhosis and fatty liver ; inflammation of 
the liver, ending in abscesses, is uncommon in this country, but it is frequent 
in tropical climates ; abscess of the liver in this country is generally associated 
with pyaemia, or ulceration of the bowels. 

The liver, like the kidney and other orgaus, is liable to various acute and 
chronic diseases. Amongst the acute changes may be classed catarrh, or in- 
flammation of the bile ducts, acute atrophy of the liver, congestion and inflam- 
mation of the liver, and the presence of gall-stones in the hepatic duct. Ca- 
tarrh of the bile ducts has been briefly mentioned above ; there is, in addition, 
to the jaundice, a loss of appetite, a coated tongue, slight sickness, and a feel- 
ing of retching ; the motions are pale, the urine dark, the skin and eyes be- 
come yellow, and there may be in some cases a troublesome itching of the 
skin. Pain is not a very troublesome symptom, and it is generally felt in the 
right shoulder-blade and along the lower edge of the liver, being often worse 
on pressure. The best treatment is to open the bowels freely by means of 
purgative medicines ; a dose of calomel at bed-time with a rhubarb draught 
twice a day will generally suffice. The diet must be very light, and capable 
of being easily digested ; all rich food should be avoided, while milk, broth, 
beef-tea, toast, and biscuits, or a light pudding may be taken ; no stimulants 
need be given, as they would only tend to increase the congestion of the liver. 
Effervescing solutions may be given with benefit, as they allay thirst and 
sickness ; those containing soda salts are the best, and those also which have 
an aperient action. Iu three or four days a mixture containing extract of 
dandelion,' hydrochloric acid, and gentian may be given three times a day, 
and the bowels must be kept open daily ; active exercise should be taken daily, 
if the patient can bear it, and for some time care must be taken to avoid in- 
digestible food. This disease is not a dangerous one, and with early and 
proper treatment is easily cured. Acute atrophy of the liver is a very for- 
midable disease, and fortunately is of rare occurrence. The patient becomes 
hot and feverish, vomits often, and the skin assumes a deep yellow tint ; the 
liver rapidly shrinks inside, so as sometimes to lose half its weight. Head- 
ache comes on quickly, followed by delirium and insensibility; the patient 
lies in a prostrate condition, and there is picking of the bed-clothes and low 
muttering delirium ; bleeding may take place from the nose or mouth, and 
small hemorrhagic spots may be seen iu the skin. Death generally occurs 
in four or live days, and treatment is not of much avail. A " sluggish" or 
congested liver is generally associated with catarrh of the bile ducts, and 
arises often from want of exercise and eating or drinking too much ; but con- 
gestion may go on to inflammation in tropical countries, and end in the forma- 
tion of an abscess. This may be known by the pain over the region of the 



LIV 451 LIV 

liver, the swelling of the abdominal wall on that spot, and the frequent shiver- 
ings ; the patient loses flesh, strength, and appetite, and his skin becomes of a 
sallow tint ; such people generally come back to this country invalided, and if 
they get over the illness they seldom recover their former state of health. A 
gall-stone in the hepatic duct will cause great pain over the liver, chiefly re- 
ferred to one spot, much sickness and distress, and a feeling of faintness ; a 
hot bath and the administration of chloroform will ease the pain, while purga- 
tive medicines may be taken, and all means used to get the stone to pass on- 
wards to the bowel. Jaundice will come on from the obstruction to the flow 
of bile, but this will disappear when the stone has escaped. Sometimes the 
stone will remain in the canal for weeks and become imbedded there, but gen- 
erally there is a passage left by the side for the escape of bile. In some cases 
of hysteria very analogous symptoms are met with, but in such cases there is 
no jaundice ; the disorder occurs in nervous young women, and there is a dark 
areola under the eyes. Injuries to the liver may be classed as acute changes, 
but these are mentioned under the head of wounds of this organ. Amongst 
chronic changes may be enumerated cancer, cirrhosis, fatty and waxy degen- 
eration, passive congestion, syphilitic deposits, and the presence of hydatid 
cysts. Cancer of the liver is a most fatal and serious disorder, carrying the 
patient off within a year, or a year and a half, from the first appearance of 
any symptoms. There is at first loss of appetite and pain over the abdomen ; 
the latter begins to swell as the cancer increases in size, and becomes ex- 
tremely tender; rapid emaciation goes on, but the temperature is generally no 
higher than usual, and there is no attendant fever. The loss of flesh, the hol- 
low temples, the great prostration, the pain and swelling or enlargement of the 
liver, ai'e the chief symptoms, and these gradually become worse, and finally 
cause a lingering and painful death. Jaundice is not often present, nor does 
the patient suffer from shivering. Cancer of the liver may occur in both 
sexes, and be met with at any period of life ; more frequently, perhaps, be- 
tween thirty and fifty years of age. This terrible disease is not often confined 
to the liver, but may attack the stomach or parts adjacent, and so add to the 
distress ; sometimes the peritoneum is also implicated, and then there is more 
or less dropsy ; oedema or dropsy of the feet is also of common occurrence. 
The treatment must be directed to the relief of the patient, as no cure can be 
looked for. The pain may be alleviated by the administration of opium or 
morphia, and this may be given internally as a draught, or a small quantity 
may be injected under the skin with a syringe. Chloral is of much use in 
easing the pain. The diet must be light and nourishing, and must be varied 
from day to day to please the fancy of the patient, whose appetite will be but 
small and capricious. 

Cirrhosis of the liver comes on generally in middle life ; at first it may be 
mistaken for cancer, as there is loss of flesh and appetite, and pain in the ab- 
domen, but the symptoms come on more gradually, the liver does not increase 
in size but rather shrinks, and dropsy of the abdomen soon comes on ; jaundice 
also is very common, and the distended abdomen becomes marbled over with 
blue veins as the stream of blood through them is impeded. See Cirrhosis. 

Fatty degeneration of the liver is common in many disorders, and there is 
hardly any affection of the liver in which more fat than usual is not found ; to 
a slight extent it occurs in health, and especially after a meal. The liver may 
be very fatty and give rise to no symptoms, as in cases of consumption and in 
those who drink a great deal of beer. Fatty livers may attain a great age and 
become double the ordinary weight; they occur often in scrofulous people. 



LIV 452 LIV 

Not only is the liver larger than usual, but the abdomen may swell from the 
presence of dropsy, which is very common in these cases ; often, also, there is 
a similar affection of the kidneys, so that albumen is present in the urine, and 
there is less of that fluid passed than usual ; frequently, also, there is dropsy 
of the legs. The patients do not lose much flesh, at any rate at first, nor is 
the appetite much impaired ; there is no pain, or if present it is very slight, 
seldom any jaundice or shivering; the symptoms come on very gradually, and 
the liver is generally much diseased before any notice is taken of the mischief ; 
the disease is often very chronic and will last for years, unless there be much 
mischief in other organs ; dropsy is a bad symptom, and, when general, will 
frequently point to disease in the kidneys. Constant rest in bed is not re- 
quired, unless the patient be too we;ik to go about ; attention must be given 
to the diet, and any indigestible food should be avoided. Stimulants need not 
be given, but a pint of beer a day, or a glass or two of sherry or claret, will 
do no harm. If dropsy be present, purgatives must be given, so as to remove 
the fluid, and the general health must be kept up by tonic medicines, as iron 
and quinine. 

Waxy degeneration of the liver is a less frequent disease ; it rarely, if ever, 
occurs alone, and is generally associated with similar disease in the kidneys, 
spleen, and intestines. It occurs in persons who have long suffered from 
diseased joints and chronic abscesses, in the scrofulous, and in those who have 
suffered from syphilis or ague, and some other wasting disorders. As in the 
case of the fatty liver, there is seldom pain or jaundice, or loss of flesh ; in 
each the appetite is good, or but slightly impaired, and in each the mischief 
may go on for a long time and cause no symptoms. In waxy change, how- 
ever, dropsy seldom occurs, diarrhoea is often present, the spleen on the left 
side enlarges, and the patient passes a large quantity of pale, limpid water, in 
which is contained a good deal of albumen. The liver, also, attains larger 
dimensions than in the case of a fatty change, and its lower border comes 
lower down and can usually be easily felt. The treatment will consist in im- 
proving the general health by liberal diet, and by the administration of tonics ; 
and attention must be directed to any other disease on which the waxy change 
may depend. 

Passive congestion of the liver often occurs in heart disease and some dis- 
orders of the lungs, and depends upon the fact that since the course of the cir- 
culation is disturbed at those points the veins become too full all over the 
body ; now the hepatic vein shares in this fullness, and so the liver is stuffed 
with blood and the stream flows through sluggishly. From a similar cause 
the veins in the leg and kidney are full, and so there results dropsy of the 
lower extremities and a scanty flow of urine, which will contain a variable 
amount of albumen. There will be pain over the liver, but not of marked in- 
tensity, and frequently there is some yellowness of the skin from the presence 
of jaundice; after a time dropsy of the abdominal cavity will come on, and 
then a fatal result often follows. Since this state of liver depends upon the 
disease of the heart or lungs, the treatment must be directed to allaying any 
tumultuous or irregular action of the heart and removing any dropsy by pur- 
gatives or small punctures in the leg; then by diminishing the quantity of 
fluid in the circulation relief may be temporarily given. 

Syphilis will produce various changes in the liver, and cause a hardening of 
that organ and thickening of the capsule ; sometimes rounded masses, some- 
what resembling cancer, are met with in that organ ; the health in such cases 
must be improved by a visit to the sea-side, if possible, or a sea-voyage, by 



LIV 453 LIV 

liberal diet and regularity of living; preparations containing iron and quinine 
are valuable, and may be given in conjunction with iodide of potassium. In 
such cases the patient is generally of sallow complexion, feels low and nervous, 
and is in a feeble state of health ; to improve, therefore, the general condition 
of the constitution is the chief indication. 

Hydatid cysts occur more commonly in the liver than in any other organ, 
although they are by no means very often met with. They may occur in the 
liver either as small, round, and firm tumors, formed of a fibrous capsule, with 
putty-like contents, — ■ these are hydatid cysts which have undergone spon- 
taneous cure, and can do no more harm ; or as cysts with a tough, fibrous 
capsule, inclosing much fluid, and a greater or less number of smaller cysts 
floating about. The fluid is limpid, clear, of low specific gravity, and is, in 
fact, chiefly made of water holding common salt in solution. These cysts may 
attain a great size, from a walnut to a child's head ; they form a rounded, 
abdominal tumor, firm yet elastic, and giving a peculiar thrill when tapped. 
They are seldom attended with pain, unless there is inflammation outside set- 
ting up adhesions : the general health is seldom affected, so that the nature of 
the disease is chiefly recognized by the presence of a tumor in the liver, and 
the absence of any constitutional symptoms. The treatment will consist in 
having resort to surgical aid, whereby the contents may be evacuated and the 
cyst allowed to shrink ; in most cases this is very successful treatment, and, 
with certain precautions, it is not difficult to perform. If allowed to grow, 
such cysts may cause death by bursting into the abdominal cavity, or into some 
neighboring organ. See Hydatids. 

Liver, Laceration of. Laceration of the liver occurs occasionally as the 
result of an accident, such as being run over, a heavy blow on the abdomi- 
nal walls, or from a fall. If the laceration be slight, limited to the superficial 
aspect of the gland, the patient usually recovers ; but if extensive or deep, 
death ensues from the loss of blood. There is scarcely any definite symptom 
during life from which we can positively diagnose rupture ; in the case of a 
stab or gunshot wound the exposed position of the gland and the course of the 
weapon or shot point at once to the injured viscus. If the rupture be simple, 
merely a superficial crack, the symptoms will not differ much from an ordinary 
injury to the abdomen. There is, of course, great tenderness on pressure over 
the seat of injury, and in severe cases there are symptoms of collapse and in- 
ternal haemorrhage, loss of pulse, faintness, pallor, and distension of the abdo- 
men. It must be recollected that it is not necessary for any external wound 
to exist, and the same remark will apply to rupture of any of the abdominal 
viscera, and this has frequently been noticed in the most rapidly fatal cases. 
In the severer cases it is obvious that no treatment can be of any avail, as 
death invariably ensues sooner or later, according to the extent of injury. But 
in simpler cases, in the first place absolute rest in a recumbent posture must be 
insisted on, and if there is any suspicion that blood has escaped into the peri- 
I toneal cavity the patient must not be raised on any consideration whatever, as 
1 death may occur on the slightest exertion. Opium should be administered 
alone in small doses to quiet pain, or combined with calomel if peritonitis 
threaten. Fomentations and warm poultices over the abdomen give great 
relief. If pain over the injured part be felt after recovery, great care must be 
taken by the patient to avoid anything like exertion, as secondary inflammation 
may be thus set up. It must be borne -in mind in these cases that the treat- 
ment of the patient during convalescence is of as great importance as his 
treatment during the early days of either suspected or detected laceration. 
Wounds or rupture of the gall-bladder are invariably fatal. 



LIV 454 LOC 

Liver-fluke. The common liver-fluke of the sheep, Fasciola hepatica, has 
been now and then met with in the human body ; it is an animal parasite. It 
has been found in man in the liver, gall-bladder, and skin. It generally 
causes an abscess to be formed at the spot where it is situated. 

Lobelia Inflata is a plant growing in North America, where it has long 
been in use among the Indian tribes. The whole herb is employed in medi- 
cine. It is generally exported in oblong cakes. It has a peculiar odor and 
a burning taste, not observed until after the medicine has been chewed for a 
time. Two preparations are in use, a tincture and an ethereal tincture. In 
small doses it is expectorant and diaphoretic, in larger emetic and cathartic. 
In still larger doses it causes death. This has not unfrequently followed its 
use by a medical sect appropriately called Coffinites. It closely resembles 
tobacco in its action. It has been chiefly used for asthma and other diseases 
of the respiratory passages accompanied by spasm. It is sometimes smoked. 
If it is to do any good, lobelia must be given in large doses, and very carefully 
watched. Sickness and vomiting are often so produced, but pass away. It is 
also useful in whooping-cough. 

Lock-jaw. See Tetanus. 

Locomotion. The term locomotion is applied to those animal functions 
which are entirely mechanical in their nature, and comprises those of the bones, 
muscles, ligaments, tendons, cartilages, etc. The primary motive power lies in 
the action of the muscles, which, by their contraction or shortening of the 
muscular fibre composing them, draw together any two points to which their 
extremities are attached. The opposite condition, relaxation, is when the 
muscle returns to its former condition of rest, and exerts no effect upon its at- 
tached parts. Almost all the muscles in the body are to be arranged into two 
sets: those which flex {flexors), and those which extend {extensors), thus 
serving to balance every action of the body. The naturally erect position of 
the human body is maintained by the joint action of masses of muscles, which, 
on the one hand, prevent the various joints of the trunk from bending forward, 
and, on the other, from bending backward. The muscles are attached to the 
bones by tendons or sinews, generally long, narrow, rounded cords of white, 
fibrous tissue. These tendons are usually attached to the movable part of a 
limb, at a short distance below the joint, so that during the contraction of the 
muscles they act with great rapidity and move the farther extremity of the 
limb over a considerable distance. Most of the movements of the body and 
limbs are performed in this manner, whilst some are subject to variations, 
owing to some peculiar construction of a joint. The movements of walking, 
running, and leaping are performed as follows: The upright position of the 
body being maintained by muscular action, the line of centre of gravity passes 
through the vertex of the arch of the foot; now, in walking, the body leans a 
little forward at the same time that the weight is thrown forward, so as to rest 
entirely upon the toes. In the next movement the heel is lifted off the ground 
by the contraction of the great muscles of the calf, thus raising the ankle-joint, 
the principal part of the weight being still on the ball of the foot. Whilst the 
body is raised and inclined forward in this manner the other foot is lifted en- 
tirely off the ground and swung forward; as soon, then, as the body has been 
carried far enough forward, a similar series of movements takes place with the 
second foot. In running, the progression consists of a succession of leaps : 
thus, at the moment that the heel is about to be raised, the knee-joint and 
next the hip-joints are bent, and then straightened by the action of the exten- 
sors ; the second limb is then thrown forward to receive the weight of the body, 



LON 455 LON 

and to perform the same movements. Leaping differs from running in this 
particular : that the same motions are performed by both limbs together, each 
leap being performed by itself. It may be as well to mention that in describing 
the human body, or any part of it, reference is made to it conventionally as 
standing upright, with the heels together and the palms of the hands forward. 

Longevity. Threescore years and ten have for centui'ies been looked 
upon as man's allotted time on earth, but there are a great, many individuals 
who live a good deal longer. Amongst nearly all nations there are traditions 
of men having attained a fabulous age, but such alleged facts have been shown 
to be erroneous on careful inquiry ; yet, although some have doubted that it is 
possible to exceed 100 years of age, it seems that instances of this kind have 
occurred, and now that registration is more carefully carried out than it used 
to be, the proofs required will be easier to obtain. 

In England, on the average of the five years, 1865-69, no fewer than 191 
males were said to have exceeded 95 years at death, and of these one was re- 
corded to have reached 106 ; in the same period an annual average of 424 fe- 
males died over 95 years of age, and one was reported to have been 107. The 
number of such cases has much diminished within the last thirty years, and it 
is most likely that when registers were kept loosely, as they were a century 
ago, and when the hearsay evidence of old men themselves was relied upon, 
many mistakes occurred. Such instances have no influence, or at least a very 
slight one, in calculating the probabilities of life for insurance offices. The 
duration of human life has been calculated with great care by various people 
at different times ; the Carlisle and Northampton tables are well known, but 
the most accurate are the Government tables, prepared by Mr. Finlaison, and 
which will be found in the article on Expectation of Lifi<:. 

For the thirty years ending 1867 the mortality among males is as follows : 
Of every 1000 persons living under five years of age, 72.42 die annually; 
above five and under ten, 8.79 per 1000 die every year of those living at that 
age; above ten and under fifteen, 4.95 per 1000; above fifteen and under 
twenty-five, 7.90 per 1000; above twenty-five and under thirty-five, 9.93 per 
1000; between thirty-five and forty-five, 13.03 per 1000; between forty-five 
and fifty-five, 18.16 per 1000; between fifty-five and sixty-five, 31.53 per 
1000 ; between sixty-five and seventy-five, 68.54 per 1000 ; between seventy- 
five and eighty-five, 147.74 per 1000; between eighty-five and ninety-five, 
309.22 out of every 1000 die; while above ninety-five 446.87 per 1000 an- 
nually die of those who are alive at that age. 

For the same period the mortality among females is as follows : Of every 
1000 persons living under five years of age, 62.46 die annually; of those 
between five and ten years of age, 8.67 per 1000 ; between ten and fifteen, 
5.10 per 1000; between fifteen and twenty-five, 8.22 per 1000; between 
twenty-five and thirty-five, 10.15 per 1000 ; between thirty-five and forty-five, 
12.30 per 1000; between forty-five and fifty-five, 15.66 per 1000 ; between 
fifty-five and sixty-five, 28.56 per 1000 ; between sixty-five and seventy-five, 
57.52 per 1000; between seventy-five and eighty-five, 135.36 per 1000; 
between eighty-five and ninety-five, 283.07 per 1000 ; while of those who are 
upwards of ninety-five years of age, 432.05 per 1000 die every year. The 
average annual mortality for males of all ages during these thirty years was 
23.33 per 1000, and for females 21.51 per "l 000; thus the chances of a fe- 
male living a certain period are greater than those of a male. 

The following tables and observations, taken from Mr. E. Ray Lankester's 
Comparative Longevity, compiled from various sources, show the probable 
after life-time at different ages for various classes of the community : — 



LON 



456 



LON 





Laborers. 


Males. 


Healthy 


Bakers. 


Clerks. 




Persons of 


Age. 


Rural 


Rural 


Livers. 


All 


All 


Miners. 


Intemperate 




Districts. 


Districts. 


Both Sexes. 


Districts. 


Districts. 




Habits. 









49.00 










10 


56.00 


52.03 


51.08 


47.89 


39.98 


48.51 


_ 


20 


47.90 


43.89 


43.45 


40.02 


31.83 


40.67 


15.55 


30 


40 59 


37.22 


36.64 


32.25 


27.57 


33.15 


13.80 


40 


32.76 


30.09 


29.64 


24.47 


21.85 


24.92 


11.62 


50 


25.07 


22.79 


22.44 


19.09 


16.04 


17.53 


10.86 


60 


17.82 


16.23 


1537 


14.06 


12.42 


11.85 


8.94 


70 


1 1 .34 


10.81 


9.61 


8.76 


8.76 


8.70 


_ 


80 


6.95 


6.69 


5.51 


4.81 


4.80 


4.80 


- 


90 


3.80 


3.80 


3.05 


2.35 


2.34 


2.34 


_ 


100 


.50 


.50 


~ 


.50 


.50 


.50 


- 



The most degraded races have life shortened by starvation in old age, or 
even by being put to death by their fellows, while in civilized countries the 
aged are protected and looked up to with respect and treated with care. 

European lives, especially English (including American) lives, seem to have 
the longest duration. Excessive longevity seems traditional amongst most 
nations, but there is great exaggeration on this point. Females in advanced 
life have a better expectation of life than males. The Fuegians and other 
very degraded races rarely exceed forty-five years of age, being in some cases 
killed and eaten by their children at that age. Man differs from animals in 
this respect, for whereas animals die when they lose their physical power and 
are unable to defend themselves, it is the characteristic of all civilized nations 
to foster, cherish, and respect old age. According to Sir John Bowring the 
Chinese divide life into ten stages. 



10 years. 


Opening degree. 


60) 


ears. 


Cycle closing. 


20 " 


Youth expired. 


70 


" 


Rare bird of age. 


30 " 


Strength and marriage. 


80 


" 


Rusty visage. 


40 " 


Officially apt. 


90 


" 


Delaved. 


50 " 


Error knowing. 


100 


" 


Age's extremity. 



The following table, taken from Farr and Quetelet, gives the probable after 
life-time at different ages of males and females in England, and also the mean 
rate : — 







Males. 




Females. 


Both 


Sexes. 


Age. 


Mean 


England 


Mean 


England. 


Mean. 


England. 







37 


39.91 


43 


41.85 


40 


45 




10 


50 


47.05 


52 


47.67 


51 


51 




2C 


41 


39.48 


43 


40.29 


42 


43 




*0 


34 


32.76 


35 


33.81 


35 


35 




40 


26 


26.06 


28 


27.34 


27 


27 




50 


18 


19.54 


20 


20.75 


19 


20 




60 


12 


13.53 


13 


14.34 


13 


13 




70 


7 


8.45 


7 


9 02 


7 


8 




80 


3 


4.93 


4 


5.26 


4 


4 




90 


- 


2.84 


- 


3.01 


- 


- 




100 


_ 


1.68 


- 


1.76 


— 


— 



LON 



457 



LUC 



According to Dr. Guy, eminent men do not live so long as those who are 
not so distinguished in their profession ; collecting several instances, he found 
the following differences ta exist amongst professional men : — 



Medical men, more distinguished, averaged 67.04, 

Clergy, " " " 66.42 

Lawyers, " " " 66.51 

Literary and scientific, " " " 65.22 

Artists, " " " 64.74 



less distinguished, 67.31 

69.49 

" " 68.41 

67.55 

65 96 



Observations have also been made with regard to the longevity of those liv- 
ing in the country, in large towns, and in cities, the longest lives being found 
in rural districts : — 

PROBABLE AFTER LIFE-TIME AT ANY AGE. BOTH SEXES. (NEISON.) 



Age. 


Rural. 


Town. 


City. 


Age. 


Rural. 


Town. 


City. 


10 


53.05 


50.74 


42.63 


60 


16 61 


J3.12 


13.33 


20 


44.99 


42.75 


34.58 


70 


10.65 


9.13 


8.76 


30 


37.78 


35.03 


28.63 


80 


5.65 


5.43 


4.81 


40 


30.30 


27.64 


22.64 


90 


3.22 


2.76 


2.35 


50 


22.89 


20.74 


17.38 


100 


.50 


.50 


.50 



Married persons have longer lives than the unmarried ; a number of married 
persons gave a mean of 66.77 ; of unmarried persons a mean of 62.00. 

Dr. Guy has also collected the ages at which a number of persons died at 
different periods of history. 

Comparison of ages at death for three centuries : — 

Sixteenth century 1500 facts gave a mean of 64.25 

Seventeenth century 3400 " " 60.36 

Eighteenth century 2800 " " 63.41 

Long-sightedness. Most persons whose sight has been previously good 
find, as they advance in years and become aged, that although they can see 
distant objects distinctly, and can tell the time by church clocks, near objects 
become more and more obscure. They cannot read print with ease, and are 
obliged to hold it farther and farther from the eyes, and fail to distinguish the 
hands of a watch. This, which is one of the earliest signs of general decay, is 
due to increased firmness and diminished elasticity and flexibility of the crys- 
talline lens, in consequence of which it resists the accommodating action of the 
ciliary muscle, so that the rays of light are not brought to a focus on the retina 
at the back of the eye. This condition of long-sightedness or far-sightedness, 
or, as it is called by surgeons, presbyopia, is an inevitable physiological change 
occurring sooner or later, and with more or less intensity, in all individuals. 
It generally commences at an age between forty and fifty years. Long-sighted 
persons should avoid reading and working by artificial light. The disturb- 
ance of vision can be much relieved by using spectacles furnished with prop- 
erly selected convex lenses, which must be changed from time to time as the 
alterations within the eyeball advance. The glasses should be used only for 
reading, or examining near objects. 

Low Fever. See Typhoid Fever. 

Lucifer-match Maker's Disease. Lucifer-mutch makers are fre- 
quently affected with necrosis of the jaw-bones, especially the lower, owing to 
the action of the fumes of the phosphorus used in their trade. Thus " phos- 



LUC 458 LUC 

pliorus disease " was not known to have any existence until the extensive use 
of the modern style of match so much prevailed, and there cannot be the slight- 
est doubt that it is due to the introduction of phosphorus in some form, and 
that it is " applied to the periosteum, or what is equivalent, some raw surface 
in immediate connection with the nutrition of the bone, and that its application 
must be prolonged, and be under peculiar circumstances of temperature, and 
probably of oxidization." If the pulp of a carious tooth is exposed to the in- 
fluence of the poison, the resulting necrosis is that of the jaw-bone. It is a 
matter of speculation in what manner the phosphorus oxide may be absorbed, 
but I lie fact of phosphorus itself entering so largely as it does into the forma- 
tion of the skeleton is a suggestive circumstance ; and perhaps if it be accu- 
mulated by the periosteum, it may generate upon the bone's surface a condition 
of chemical superphosphate inconsistent with osteal vitality. Efficient sanitary 
measures should be adopted to prevent the disease, and it has been suggested 
that "there should be a periodic and rigid scrutiny of the mouths of all those 
employed. Those whose teeth are bad should be excluded from the rooms 
where the obnoxious fumes are being developed (the dipping and drying 
rooms). All carious teeth should be extracted or stopped, and a simple and 
effective respirator, having its centre composed of a porous diaphragm, such as 
a sponge or some woven fabric, linen or cotton, which should be daily dipped 
in a solution of one of the fixed alkalies or of their carbonates, should be worn 
over the mouth by those employed ; or the respirator devised by Mr. Graham 
for persons exposed to carbonic acid vapor would probably be as efficacious. 
It consists of a mixture of fresh slacked lime and sulphate of soda, through a 
cushion of which it is easy to breathe. The acid vapor might be neutralized 
or rendered innocuous, by keeping the atmosphere of the apartment ammonu- 
retted." (S. J. A. Salter.) The symptoms of this disease do not differ in any 
essential particular from ordinary necrosis not produced by phosphorus. They 
usually commence with a feeling of toothache, and the pain is referred to a 
decayed tooth, by which channel the poison enters. The disease takes a slow 
course at first, the gums become red and sore, and there is general pain and 
extreme tenderness. The mucous membrane of the cheek becomes involved. 
The teeth become loose, appear elongated, and cause intense pain when 
brought against those of the opposing jaw. After a great deal of suffering, 
matter forms, and points either internally, about the fangs of the teeth, or ex- 
ternally on the outside of the jaw. The matter is peculiarly fetid, and a probe 
introduced into the opening, made either naturally or artificially, is long, tortu- 
ous, and burrowing, leading to portions of dead bone, or sequestra. It is 
worthy of remark here that in necrosis of the lower jaw-bone, whether from 
phosphorus or any other cause, we have a wonderful exhibition of the vis 
medicatrix naturck; in fact that there is an immense amount of repair which 
does not exist in the event of a similar affection of the upper jaw. In milder 
cases, if the disease progresses favorably, the dead bone loosens and becomes 
detached, and the teeth fall out.; in very severe ca=es, and when the extent of 
the disease is great, the patient may have intense constitutional disturbance, 
the local condition being peculiarly distressing from the secretion of fetid mat- 
ter and loss of tissue ; oedema of the face and neck may supervene, probably 
accompanied by erysipelas, and terminating in an agonizing and long-delayed 
death. With regard to the treatment of this form of necrosis, the first indica- 
tion is obviously, in the early stage, or where it is anticipated, the abandon- 
ment of the work, pure air, cleanliness, attention to the bowels and secre- 
tions, and the removal of all bad teeth. If the disease has made any progress, 



LUM 459 LUM 

and the extreme pain, swelling and thickening of the soft parts show them- 
selves, active measures for the relief of the periosteum and bone should be re- 
sorted to, — leeching and general antiphlogistic treatment, free vertical incis- 
ions into the tender, soft places in the gums, carried clearly down to the bone, 
so as to afford relief to the loose overloaded periosteum. In advanced cases 
the treatment is that generally adopted in necrosis from other causes. Owing 
to the situation of this affection the power of mastication is of course dimin- 
ished, and this interferes in great measure with digestion, and consequently 
affects the duration of such cases ; suitable food, such as mashed meat, cod- 
liver oil, etc., is to be abundantly given, and iron. Attention has been called 
to a singular pathological fact exhibited in patients affected in this manner, 
that is, an enormous amount of pus is daily swallowed by them, many ounces, 
and this without any obvious detriment to health ; the patient's condition be- 
ing no worse than may be accounted for by the local symptoms. 

Lumbago is a form of chronic rheumatism specially affecting the lower 
part of the back and loins. The pain is sometimes muscular, but sometimes 
also seems located in the broad and strong ligament situated in that region. 
Chronic rheumatism is rarely a malady of youth ; it is a totally different com- 
plaint from, acute rheumatism, and mainly affects old people who have been 
exposed much to cold and wet. The pain sometimes called lumbago, which 
may affect young people who stoop much at their work, or who have to raise 
heavy weights, is merely the pain of tired muscles, and demands the same 
remedy, rest. True lumbago is quite different ; there is no feverishness with 
it, as in acute rheumatism, and it is not relieved by rest, as tired muscles are. 
The individual moves stiffly, as if he were tired, but night and day the pains 
continue. Sometimes the malady gets better from the application of cold ; 
much more frequently it is improved by heat, so that a roll of flannel means 
to such positive comfort. There is not much difficulty in the diagnosis, — noth- 
ing, iu fact, can well be confounded with it ; but the making of the diagnosis is 
no great comfort, for the malady is often a most untraceable one. Broadly, it 
may be said that internal remedies are of little use ; carbonate of potass is 
worse than useless, and not unfrequently the iodide is the same. Hot or tepid 
baths, applied locally, do good, especially if salt water is used ; local appli- 
cations are, in point of fact, the best remedies in true lumbago, and as a 
rule they are best applied hot. Turpentine, ammonia and oil, blisters, iodine 
paint lightly used, belladonna, and chloroform with opium, may all be tried. 
In a considerable number of cases, but these are neuralgic, the subcutaneous 
injection of a small dose of morphia will act as a charm. Sulphur is by many 
praised as a local remedy, wrapped up in flannel, which should be habitually 
worn. All exposure to damp and cold should be avoided, and the diet should 
be carefully regulated. 

Lumbar Abscess. In the region of the loins acute abscesses are not 
met with so frequently as slowly-growing and almost painless purulent collec- 
tions, which in the course of time acquire large proportions. The former re- 
semble acute abscesses in other parts of the body in being due either to injury 
or to acute inflammatory action. The chronic lumbar abscess generally has 
its origin in disease of the vertebras of the back and loins, or in suppuration 
in the loose areolar and fatty tissue about the kidney. The former, however, 
is the frequent cause, and the presence of a slowly-growing and fluctuating 
tumor in the right or left lumbar region, paleness and debility, and a peculiar 
sickening pain on tapping the sharp posterior spines aloug the lumbar portion 
of the spinal columu, are almost sure indications of vertebral caries. When 



LUN 460 LUN 

angular curvature is present, together with the above symptoms, there can be 
no doubt as to the cause of the lumbar abscess. Occasionally, though rarely, 
a chronic abscess forms in the loins of patients whose spine and kidneys are 
both quite free from disease. It seems to be due, then, as most spontaneous 
chronic diseases are, to general debility and a slow inflammatory action in the 
areolar tissue of the region affected. A lumbar abscess generally terminates, 
after it has been growing for some time, and has attained a certain size, in 
pointing and subsequent outward discharge of the contained purulent fluids. 
In some few instances the pus contained in the abscess becomes converted into 
a shrunken semi-solid or cheesy mass, and the external mass, subsides. Oc- 
casionally the pus contained within the lumbar abscess makes its way into the 
thorax and lungs, and is discharged through the air-passages. The treatment 
of lumbar abscess differs very slightly from that usually carried out in cases 
of chronic abscess in other parts of the body ; and whenever there is a suspicion 
of disease of the spine, it is thought advisable by most surgeons not to open 
the swelling until there is advanced pointing, and the integument over the 
most prominent part of the abscess has become very red and thin. 

Lungs. The lungs are the organs by which the process of respiration is 
carried on, and where those changes occur by which the carbonic acid is re- 
moved from the blood while oxygen is supplied to that fluid. The lungs are 
two in number, the right and the left ; they are seated in the closed cavity of 
the thorax or chest and occupy most of the space ; the right lung is subdivided 
into three lobes, while the left has only two ; each is surrounded by a smooth 
thin serous membrane called the pleura, which is reflected at certain points 
from the surface of the lungs and lines the chest wall ; this surface is kept 
constantly moist by the secretion of a small quantity of fluid, so that the lungs 
can glide upon the thoracic wall with the greatest ease and the least amount 
of friction. Each lung consists of a bronchus, which allows of the passage of 
air to and fro ; of an artery, which brings the venous blood from the right side 
of the heart; of capillaries, which surround the air-cells; and of veins, which 
carry the purer blood on to the left side of the heart. (See Am Passages.) 
The trachea divides into two branches, called bronchi, and one bronchus goes 
to each lung; as soon as it enters that organ, it divides into four or five main 
branches, and then again into very numerous subdivisions, too fine to be seen 
by the naked eye; finally, these very small branches end in dilated extremities 
with extremely thin walls, called the air-cells or vesicles of the lung. At first 
the bronchus has pretty thick walls, which consist of an internal mucous coat 
lined by epithelium, of a middle coat, made partly of muscular fibres and partly 
of cartilaginous plates, and lastly of an outer fibrous coat; these various 
coverings become thinner by degrees, until at last, when the ultimate ramifica- 
tions are reached, nothing is seen but a nearly homogeneous membrane of ex- 
treme thinness and lined by epithelium. The artery which supplies each lung 
is a branch of the pulmonary artery, which is a vessel of great size, and arises 
from the right ventricle of the heart ; in this way, all the blood which has 
passed through the various vessels of the body is carried to the lungs ; the 
arteiy, like the bronchus, breaks up into a vast number of branches which at 
length end in a fine network of capillaries surrounding the air cells ; so that al- 
though there is no direct contact in health between the air and the blood, yet the 
two are by this means brought as nearly together as possible, and all the neces- 
sary changes can take place through the moist and thin-walled air-cell. The 
wall of the artery in the first part of its course consists of an inner epithelial 
coat, of a middle coat chiefly made of elastic fibres and partly containing in- 



LUN 461 LUN 

voluntary muscular fibres, and thirdly of an outer coat of ordinary white fibrous 
tissue ; in its smaller branches there is less fibrous tissue, and the muscular 
coat is relatively the thickest, while in the smallest branches of all, these vari- 
ous structures disappear, and only a thin homogeneous membrane is left with 
a few oval nuclei in its walls. The veins are formed by the union of the cap- 
illaries, and then unite to form still larger branches, ending by forming four 
large trunks which carry the blood to the left auricle of the heart. In addi- 
tion to these various important structures, the lungs are supplied by various 
nerves and lymphatics, while the aorta gives off numerous small branches, 
called the bronchial arteries, which supply the lung-tissue with nourishment. 
It will thus be seen that the lungs are spongy, elastic bodies, and they are 
capable of much distension, as may be seen by inflating a lung after death. 
During life the chest-wall is constantly moving up and down with each inspira- 
tion and expiration, and corresponding movements at the same time take place 
in the lungs, which closely follow the chest-wall, so that there is always a vary- 
ing amount of air in the lungs. Inspiration and expiration follow each other 
in health with the greatest regularity, and the two actions make up what is 
known as respiration; each movement is repeated fifteen to eighteen times in 
a minute on the average, when the individual is sitting quietly ; but they occur 
much faster during a period of active exercise, as in running or rowing, etc. 
The structure of the lungs is such as to admit of a very large amount of blood 
being exposed to the air, and the movements of the chest in respiration are to 
enable fresh currents of air to be constantly brought in while the impure air 
is also removed. The expired air differs from the inspired air in these par- 
ticulars : (1.) Whatever may be the temperature of the external air, that ex- 
pired is nearly as hot as the blood, or varies between 90° and 100° Fahr. 
(2.) The expired air is quite or nearly saturated with aqueous vapor, however 
dry the outer air may be. (3.) Ordinary air consists of 79 parts of nitrogen 
and 21 parts of oxygen, with a trace of carbonic acid gas, in every 100 parts ; 
expired air contains more than A\ parts of carbonic acid gas, between 15 and 
16 parts of oxygen, and about 80 parts of nitrogen ; so that while the quantity 
of the latter gas is not materially altered, there is, on the other hand, a great 
loss of oxygen, and a great gain of carbonic acid gas. But carbonic acid is 
very prejudicial to health, and hence the need of a movement of the chest wall 
to expel it from the lungs ; in ordinary expiration, the normal elasticity is 
enough for the purpose, and very little muscular force is used. From three 
hundred and fifty to four hundred cubic feet of air are passed through the 
lungs of an adult man, taking no active exercise, in the course of twenty-four 
hours, and this amount must in that time become deprived of five per cent, of 
oxygen and be charged with five per cent, of carbonic acid. Thus it has been 
calculated that "if a man be shut up in a close room, having the form of a 
cube, seven feet in the side, every particle of air in that room will have passed 
through his lungs in twenty-four hours, and a fourth of the oxygen it contains 
will be replaced by carbonic acid." But carbonic acid is a compound of car- 
bon and oxygen in the proportion of thirty-two parts of the latter to twelve 
parts of the former, and hence the quantity of carbon eliminated every twenty- 
four hours, and calculated from the amount of carbonic acid given off, is 
equal to a piece of charcoal weighing eight ounces. The. amount of water 
given off varies very much in the twenty-four hours ; about half a pint is the 
average quantity, but it may be much more or much less. The lungs during 
life can never be emptied of air, however forced an expiration we make ; the 
amount of air which cannot be got rid of is called residual air, and varies from 



LUN 462 LUN 

75 to 100 cubic inches in amount. After an ordinary, but not forced, expira- 
tion, about as much more remains, and this is called supplementary air. In 
ordinary breathing, from 20 to 30 cubic inches of air pass in and out of the 
lungs, and this is called tidal air. Thus about 230 cubic inches of air are con- 
tained in the lungs after an ordinary inspiration, but this may be increased by 
another 100 cubic inches, if a very deep inspiration is made ; this extra supply 
is called complemental air. Since the lungs can contain 230 cubic inches of 
air, and the tidal air amounts to only 20 or 30 cubic inches, it follows that 
only one-seventh or one-eighth of the air in the lungs is renewed with each 
inspiration, so that the remaining air acts as a buffer between the incoming 
fresh air and the blood in the capillaries ; it plays, as Professor Huxley has 
shown, the part of a middleman between the parties, the blood and the fresh 
tidal air, who desire to exchange their commodities, carbonic acid for oxygen, 
and oxygen for carbonic acid. Experiments have been made by means of an 
instrument called a spirometer, with reference to the power of persons taking 
air into the lungs. The person first inspires to the full extent, and then 
breathes into the instrument as much air as he can ; and it seems that the 
height of the individual has much to do with the result. On an average a 
person of 5 feet breathes 174 cubic inches ; one of 5 feet 1 inch will breathe 
182 cubic inches, and for every inch of height up to G feet will breathe about 

8 cubic inches additional. Weight seems to have much less influence than 
height, and tends to diminish the respiratory power when beyond a certain 
limit. In males of the same height the respiratory range increases from 15 
to 35 years of age; but from 35 to 05 it decreases nearly H cubic inches per 
year. The activity of the respiratory process is far greater in children than 
in old age, and this activity is also modified by other circumstances. Cold 
greatly increases the quantity of air which is breathed, the quantity of oxvgen 
absorbed and of carbonic acid expelled ; exercise and the taking of food have 
a very similar effect. There is more carbonic acid excreted during the day 
than during the night; during the day, also', much more oxygen is given out 
than is absorbed, while at night-time much more oxygen is absorbed than is 
excreted as carbonic acid during the same period. Air may become unfit to 
breathe therefore in two ways, namely, by the deprivation of oxygen and the 
accumulation of carbonic acid ; both will give fatal results, but when acting 
together death is of course much hastened. Asphyxia will take place when 
the proportion of carbonic acid in tidal air reaches 10 per cent., provided that 
the oxygen is diminished in like proportion; life could be carried on with 10 
or even 15 per cent, of carbonic acid, so long as the supply of oxygen is simul- 
taneously increased; hence it will appear that carbonic acid is not of itself so 
poisonous, but that its fatal effects are due in a great measure to its taking up 
the room that ought to be occupied by oxygen. Thus it is most essential for 
health that every human being should have fresh air and plenty of air ; every 
man ought to have at least 800 cubic feet, a cubic space of rather more than 

9 feet to the side, and this air should be constantly renewed from the external 
atmosphere. Lassitude, uneasiness, and headache come on when the due 
amount of oxygen is by any means diminished, and there is in time a great 
loss of vital energy. Lastly must be considered the changes which take place 
in the blood in its passage through the lungs. The blood in the pulmonary 
artery is venous, as has already been stated, and is of a dark purplish color ; 
the blood in the pulmonary veins, on the contrary, is of a bright scirlet color, 
and arterial in character. Now it is known by experiment that when venous 
blood is mixed with oxygen it becomes brighter in color and resembles arterial 



LUN 463 LUN 

blood, and when the latter is mixed with carbonic acid it becomes darker in 
color and resembles venous blood. Now in the lungs the interchange can only 
take place in the thin-walled pulmonary capillaries, and here the carbonic acid 
is removed from the blood and fresh oxygen is supplied ; this oxygen in its 
turn combines with the carbon from the tissues, to pass away again as carbonic 
acid. It must not be supposed that all the carbonic acid is removed from the 
blood during its passage through the lungs ; on the contrary, arterial blood 
always contains a certain amount of carbonic acid, and all venous blood con- 
tains a little oxygen. The cause of the change of color during the process of 
respiration is not yet well made out ; the blood contains myriads of rounded 
bodies, called corpuscles ; these are rendered somewhat flatter by oxygen while 
they are distended by carbonic acid ; in this way, by reflecting more or less 
light according to the convexity of the surface, the changes may be due; on 
the other hand, it has been shown that solutions of blood-crystals free from 
blood-corpuscles change in color from scarlet to purple according as they gain 
or lose oxygen. In this way, those changes are constantly going on in the 
blood by which effete materials are carried away in part by the lungs, and 
other organs of the body, while fresh ox} r gen is constantly being absorbed and 
carried by that fluid to nourish every tissue and organ in the individual. See 
Blood. 

Lungs, Wounds of. Wounds of the lung are of course common enough 
in military practice, though somewhat rare in civil. When arising from exter- 
nal wounds they may be either incised, punctured, lacerated, or gunshot, or 
they may be produced by a fractured rib, which generally causes a lacerated 
wound. The simplest form of wound of the lung is a punctured one, such as 
a stab ; next in severity is the lacerated, the lung substance having great 
power of retractibility ; and the most dangerous is the incised, on account of 
the haemorrhage and escape of air. When a lung is wounded three conditions 
are observed : (1) haemorrhage ; (2) escape of air from divided vesicles and 
tubes; (3) collapse of lung. The symptoms diagnostic of wounded lungs are: 
(1) the escape of blood and air through the external wound, of a pale red and 
frothy character; (2) the issue of blood mixed with air and mucus from the 
mouth during the efforts of coughing ; this is always to be regarded as a dan- 
gerous symptom, as the blood accumulating in the tubes produces a choking 
sensation which may suffocate the patient ; (8) a deeply fixed pain in the 
chest, and a good deal of irritation of the larynx, producing a constant desire 
to cough ; (4) dyspnoea and difficulty of respiration. The constitutional symp- 
toms are, at first, collapse, though, unless this extend over any considerable 
time, it need not excite alarm ; inflammation, pleurisy, and pneumonia are 
next to be apprehended. In all cases the prognosis of wounds of the lung is 
unfavorable. Wounds from projectiles (gunshot) are exceedingly dangerous. 
They are fatal from haemorrhage, causing exhaustion and suffocation, from 
pleurisy, irritation, fever, or from accumulations of blood, pus, or serum in the 
pleural cavities. In the case of gunshot wounds the usual train of symptoms 
above enumerated as characteristic of this injury must not be always constantly 
expected to exist, and it is by no means easy to decide whether the lung is 
wounded in perforating wounds of the chest- walls. Serious bleeding rarely 
occurs from any vessels external to the cavity of the chest. Although haemop- 
tysis indicates injury to the lung, it does not prove penetration. Dyspnoea is 
a frequent accompaniment of penetrating wounds. It was formerly thought 
that escape of air by the wound necessarily indicated laceration of the lung 
tissue, but it must be remembered that external air may pass into the external 



LUN 464 LUN 

wound during contraction of the lung, and be expelled during inspiration, but, 
as was above stated, if air with frothy blood and mucus be expelled, there is 
no doubt that the lung itself is perforated. 

With regard to treatment, all haemorrhage from superficial vessels in the 
chest-walk should be first arrested ; these vessels are cutaneous, muscular, or 
most frequently intercostal, which lie under the Imver margins of the ribs, and 
are very liable to be. lacerated by some splinter of bone from an adjacent rib. 
All foreign bodies, dirt, pieces of clothing, or wadding, should be carefully re- 
moved, and the external wound closed as quickly as possible with some light 
dressing. The natural motions of the chest should be restrained by broad 
strips of adhesive plaster, or by broad bandages, passing round it. The patient 
should be left where he is found, or very carefully carried to some more con- 
venient place. In the first stage, that of collapse, no constitutional treatment 
need be attempted, but haemoptysis, dyspnoea, or chest complications must he 
carefully watched for, and total abstinence from food or stimulating drink must 
be enjoined for the first few days. Ice to the chest, or iced-water to drink, 
is useful in checking the haemorrhage, and in severe haemoptysis venesection, 
with a view of producing artificial collapse. Dr. M'Leod remarked that, dur- 
ing the Crimean war, he noticed that those cases of gunshot wound of the 
lung did best in which early, active, and repeated bleedings were had recourse 
to. Dilute sulphuric acid or acetate of lead is frequently useful in checking 
violent haemoptysis. There are frequent complications often associated with 
wounds of the lung which demand particular attention; these are: (I) em- 
physema, or an escape of air into the subcutaneous cellular tissue ; (2) pneumo- 
thorax, when air has escaped into the cavity of the pleura (usually associated 
with the foregoing) ; (3) hcemo-ihorax, or haemorrhage into the pleural cavity ; 
(4) foreign bodies, such as bullets, buttons, clothing, etc. Emphysema is 
caused by a broken rib penetrating the pleura and entering the lungs, thus al- 
lowing air to escape ; or from penetrating wounds of the bronchi or lungs, 
when, on inspiration, the air received into the lung escapes from its wounded 
part into the chest, and on expiration is forced out through the external wound, 
thereby getting into the cellular tissue. The symptoms of emphysema are a 
swelling of the integument, beginning at the seat of injury, and increasing in 
all directions. There is no change in the color of the skin ; the swelling 
crepitates or crackles under pressure, and there is no pain. The prognosis is 
generally favorable, except in cases of extensive wounds. With regard to 
treatment, if it be found that moderate pressure with the hands on the seat 
of injury afford relief, a roller-bandage should be applied ; and in cases where 
the air has diffused itself over a large surface punctures are useful. Constitu- 
tionally, for the relief of dyspnoea in such cases, antimony and ipecacuanha 
appear to be the most useful remedies, given in full and repeated doses. 
Bleeding may be resorted to if there is lung congestion and oppression of the 
circulation. In pneumothorax the symptoms would be distressing dyspnoea ; 
on percussing the chest a tympanitic resonance, amphoric respiration, and a 
ringing metallic resonance on auscultating the chest, supposing the lung is not 
too much compressed. The treatment consists either in enlarging the external 
wound so that the air may escape, or in puncturing the cavity with a small 
trocar or canula (as in paracentesis). In haemo-thorax the symptoms present 
depend in a great measure on the quantity of blood poured out in a definite 
period. If large quantities are effused suddenly, as in a wound of a large ves- 
sel, death speedily follows from loss of blood and pressure on the lung. The 
treatment consists in closing the external wound, and thus allowing the effused 



LUP 465 LUP 

blood to coagulate if possible, so as to form a plug to prevent further bleeding. 
Paracentesis is sometimes necessary. Some surgeons recommend the external 
wound to be kept open, so that the blood may escape, while others prefer en- 
larging the external wound to let the blood escape speedily, and in several 
recorded cases this has been successful. If the difficult}' of breathing be very 
urgent, the trocar and canula may be used, and the wound dressed with car- 
bolic acid dressing. 

Lupus. This name has been given to several forms of obstinate inflam- 
matory and ulcerative affections of the nose, cheeks, and lips, which give rise 
to much disfigurement, and often to destruction of soft parts and deformity. 
Some of these diseases are known by the name Noli, me tangere. 

The following are some of the chief varieties of lupus : In the affection 
called Lupus erythematosus, which is the least troublesome, the skin of the nose 
or face presents numerous deep red or livid patches slightly elevated above the 
general surface, and smooth and shining. These increase in size and run 
together, forming large purple patches, which, if not treated, become covered 
with thick crusts" of scarf-skin. This form of lupus is attended with but little 
pain or itching, and does not result in ulceration or loss of substance. It is, 
however, very obstinate, and often resists for a long time all kinds of treat- 
ment. 

In another form of the disease, called Lupus non-exedens, numerous small 
reddish-yellow and waxy nodules are set upon a dark red base of thickened 
skin. These nodules increase in number and size, and become capped by small 
horny-like scabs. No open sores are formed, but the disease leaves behind a 
very distinct scar, which is tense and depressed below the level of the sound 
skin. This disease has a tendency to heal at the centre of the patch whilst 
fresh nodules are formed about the circumference. 

The most severe form is that called Lupus exedens, or noli me tangere. This 
generally commences at the tip or edges of the nose, and often attacks simul- 
taneously the skin and the internal mucous membrane. Red or brownish-red 
nodules are first formed, which increase in number and run together, and then 
crack down into a jagged ulcer, which is covered by a thick adherent crust, 
under which pus collects. This ulcer, after a time, commences to heal at one 
part of its circumference ; but at the same time fresh nodules and ulcers are 
formed, and the disease, if not arrested by treatment, spreads slowly and in- 
sidiously, until a considerable part, or even the whole of the nose, with its 
bones and cartilages, has been destroyed. The subsequent disfigurement is 
made worse by the presence of large pale-red scars, traversed by tough bands 
of a white color, which "are very contractile, and cause by their shrinking con- 
siderable displacement of parts of the face. In lupus exedens there is gener- 
ally a tendency to an early relapse. 

Lupus is seldom met with in patients over thirty years of age, and occurs 
more frequently in the country than in large towns. It is more common in 
females than in males. Lupus in all forms is generally associated with scrof- 
ula, and occasionally with advanced or tertiary syphilis. The patients in the 
majority of cases have fair, delicate skin, and light eyes and hair. Like other 
local affections dependent upon a scrofulous or syphilitic taint, it is met with 
chiefly among the poor. 

In the treatment it is necessary first of all to attend to the general health, to 
support the strength by tonics, good diet, and wine or malt liquor, to keep 
the digestive organs free from irritation and disease, and to improve, if it be 
possible, the hygienic circumstances of the patient. In this disease, especially 



LYM 466 MAC 

the form of noli me tangere, the remedies used in cases of scrofula are espe- 
cially useful ; of these the best are cod-liver oil and the citrate of iron and 
quinine. In some cases it is necessary for the patient to take arsenic or 
mercury ; but those agents ought not to be administered except by medical 
advice. 

In lupus erythematosus and lupus non-exedens the safest local applications 
are sulphur ointment, tar ointment, and tincture of iodine, which may be ap- 
plied by means of a camel's-hair brush. Obstinate and severe cases of these 
two forms of lupus, and the slowly spreading ulceration of lupus exedens, are 
treated by the application of caustic potash, chloride of zinc, Vienna paste, 
lunar caustic and the actual and galvanic cauteries, powerful and very painful 
remedies, which necessitate in many instances the administration of an anaes- 
thetic, and in all delicate surgical manipulation and careful control. 

Lymph is an alkaline fluid which fills the absorbents or lymphatics ; it 
differs from the blood in containing no red corpuscles, and in having a very 
small proportion of solid constituents ; lymph may be looked upon as blood 
diluted with water and deprived of the colored corpuscles. 

Lymphatics are vessels distributed throughout the body, generally closely 
accompanying blood-vessels, but also pursuing a solitary course. They are 
intended to retain that portion of the nutrient fluid which lias poured out from 
the smaller blood-vessels, and which does not return by the veins. This fluid 
is colorless, and is called lymph. It consists of a fluid basis, containing float- 
ing particles — the lymph corpuscles. These vessels are of great importance 
in the spread of some maladies. Thus it is fairly established that cancer spreads 
from one organ of the body to another mainly by these means, and it is very 
likely that tubercle does so likewise. The lymphatic system is especially liable 
to invasion by inflammation when that seizes upon any part to which these 
vessels are richly supplied, and still more if the inflammation is of a bad kind. 
Thus a fresh wound of the hand, into which putrid animal matter has entered, 
speedily gives rise to an appearance resembling a number of irregular red cords 
running up the arm. These all seem to run to the arm-pit, and there enlarged 
lymphatic glands may soon be felt distinctly, resembling hard painful knots. 
Most likely these will suppurate, and may constitute a new form of disease. 
If the lower extremities are affected, the glands in the gums are affected in 
like manner. 

Lymphoma, or Lymphadenoma, is a name given to a disease in which 
there is great enlargement of most or all of the lymphatic glands of the body. 
The growth takes place gradually and without much, if any, pain ; the patient 
becomes pale and weak. Children and young people are most commonly af- 
fected ; the glands do not soften and form an abscess, as they do in scroiulous 
cases, but are firm and retain their rounded outline ; they are most easily seen 
at the root of the neck on either side, and sometimes large prominent tumors 
are in this way formed. 

M. 

Macaroni. A well-known Italian food, made of the best wheaten flour, 
and formed into long, thin, pipe-shaped lengths about the size of a quill. Until 
lately it was supposed that it could be made only in Italy, where it is chiefly 
prepared, but now it is manufactured in various countries. Macaroni is a 
highly nutritious and digestible article of diet, and if properly cooked may be 
eaten by an invalid with a delicate digestion with advantage. It is pleasant 



MAC 467 MAG 

either well boiled till it becomes quite soft, and served with gravy from roasted 
meat, or plainly boiled in milk and eaten with salt or sugar. 

Mace. A well-known spice, the product of a tree growing in the Molucca 
Islands, known to botanists as Myristica officinalis. The fruit of the tree is of 
the size and form of a peach, and when ripe the fleshy part bursts in halves, 
exposing the kernel, which is the nutmeg, surrounded by an arillus or scarlet 
net-work sort of fibre, which is the mace. It is a valuable and powerful spice, 
and realizes a high price. It contains a large quantity of aromatic oil, the taste 
of which is pungent and sharp. It is used in medicine as a stimulant, and is 
imported into this country for that purpose in considerable quantities. 

Maculae. This is a division of skin disease which is characterized by the 
presence of too much or too little pigment in the part affected. Freckles are 
a common example of the presence of too much pigment or coloring matter in 
the skin. During pregnancy there is an increase in the pigment around the 
nipple, so that a darkening of the skin takes place there ; during menstruation, 
there is also often a dark ring round the eyes. ' In Addison's disease there is 
a bronzing of the skin, and this is due to an excess of coloring matter. Moles 
are congenital spots or patches where from birth there is an excess of pigment. 
They vary from a pin's head to a diameter of several inches, and vary in color 
from brown to gray or black. In some other diseases the maculae are due to 
a want of pigment. Albinism is a condition in which pigment is wanting not 
only in the skin, but in the hair, eye, etc. ; such a person is called an albino ; 
the hair is white, and the pupils of the eye have a red color. Vitiligo is a 
disease of the skin in which there are small yellow or white patches from loss 
of pigment ; so also is leucoderma. Nothing can be clone for these affections. 

Madness. See Insanity. 

Magnesia. The oxide of magnesia occurs in two forms, one more bulky 
than the other. It is obtained by burning the carbonate, and then appears as 
a white powder with hardly any taste, almost insoluble in water, and slightly 
alkaline in reaction. When introduced into the stomach magnesia acts as an 
antacid, and its antacid properties are considerable. If not all neutralized, what 
remains passes on into the stomach, where, if given incautiously, it is apt to ac- 
cumulate. In the small intestine it acts as a gentle laxative, in very large doses 
having considerable power. It also passes into the blood and tends to render 
the urine clear if previously turbid from urates. It is given as an antacid in 
heart-burn, and is still more useful for the acidity of the intestines which gripes, 
and is beneficial along with rhubarb in the early stages of diarrhcEa. It is also 
useful when there is acidity with a tendency to constipation, as in gouty sub- 
jects. In these patients it does remarkably well. On account of alkalinity, 
too, magnesia is often given as an antidote to poisoning by mineral or vegetable 
acids, and for this it is well suited. It neutralizes the acid and protects the 
stomach from injury. Many metals are also precipitated by it and rendered 
nearly insoluble. Magnesia lias also been given as a remedy for vomiting 
when that has seemed to depend on excess of acid, but other remedies are more 
powerful. 

The carbonate of magnesia also exists in two forms — heavy and light. It is 
prepared from the sulphate of magnesia by precipitating by carbonate of soda. 
The powder so thrown down is white and almost tasteless, insoluble in water, 
and nearly neutral in reaction. A solution of the bicarbonate of magnesia has 
long been in use under the title of fluid magnesia ; it is an admirable prepara- 
tion. This may effervesce slightly ; when opened the liquid is clear and is not 
bitter. Carbonate of magnesia acts in much the same way as magnesia itself, 



MAI 468 MAL 

only, when introduced into the stomach, and it meets with an acid, it gives off 
its carbonic acid, which may be unpleasant. Sometimes, however, the carbonic 
acid gas so set free is pleasant to the stomach. The great disadvantage which 
these remedies labor under is their bulk, so much requires to be taken ; but 
the objection does not apply to the fluid magnesia. 

Sulphate of magnesia, or Epsom salts, is a well-known remedy. Usually, 
nowadays, the salt is made from dolomite limestone ; formerly it was made 
from sea-water. This salt occurs in prisms or needles, which should not tend 
to grow moist in the air, but rather have a tendency to throw off water. The 
only preparation is the enema, which is not much used. In ordinary doses it 
acts as a purgative, but in smaller doses it sometimes acts on the kidneys. 
Epsom salts are often used combined with senna; they constitute the common- 
est of all purgative medicines, — black draught. When given alone it often 
causes discomfort, rumbling sounds in the abdomen, and irregular movements 
of the intestines. Tlie dose i$ from two drachms to half an ounce, or more. 

Maize, or Indian Corn, is a plant indigenous in America, and now com- 
monly cultivated in the warmer parts of the world, where it answers to wheat 
in more northern countries. It is the Zea mays of botanists, a monoecious grass 
of vigorous growth, with stems not more than two feet high in some varieties, 
and reaching the height of eight or ten in others. The uses to which maize is 
applied are many and important. When green, the stalk is cut as food for cows, 
oxen, and sheep, and yields abundant fodder. When the ears are ripe, they 
are eaten fresh as a pleasant vegetable after cooking; or dried and carefully 
ground, and converted into any of the many varieties of corn-flour — oswego, 
maizena, etc. — all of which are more or less excellent as food. In America 
the maize is very largely consumed in several forms : when coarsely ground 
it is called samp or hominy ; a finer grade is termed corn-meal. It is largely 
used for the manufacture of corn starch and whiskey. When ground into Hour, 
it is made into corn cakes and bread. The seeds are roasted over a fire in a 
little machine for the purpose, and eaten as "pop-corn " either simply or with 
sugar or salt. See Corn-klour. 

Mal-de-pays is a condition of mind which assumes the form of a disease 
in people, who, having been born in mountainous countries, are removed from 
the scenes of their childhood. Jt is especially frequent among the Swiss, and is 
sometimes so uncontrollable as to prevent them ever settling in distant regions. 

Malaria is a term used for those badly-defined agencies which give rise to 
fevers of the remittent and intermittent type. There are commonly supposed 
to be certain effluvia or miasms given out from marshy ground, especially from 
salt marshes, which entering the system give rise to the well-known phenomena 
of ague. What, however, these effluvia are no one knows ; the air has been 
examined and nothing found, and as the malady is equally rife in the dry 
regions of Central India and the Sahara, it is plain that they do not depend on 
marshes. True they are most powerful in tropical regions, especially near the 
mouths of great rivers, or among mangrove swamps, where decaying vegetable 
matter and heat most abound, but the same phenomena are frequent far north, 
in temperate regions especially, in certain seasons of the year. Some have been 
constrained from the phenomena, and from the situations in which they are 
produced, to infer that these extremes of heat and cold are the main causes or 
constituents of malaria ; that is to say, great heat during the day and cold 
during the night are the concomitants of severe attacks of aguish maladies. 
Certain it is that the individuals who are attacked are more readily attacked 
during the night than during the day. Thus people can work in the Roman 



MAL 469 MAL 

Campagna during the day, but cannot remain in it all night without suffering. 
The poison lies low too,. for a man standing upright may escape it whilst one 
lying down will not. Another peculiarity of it is that it does not prevail at 
any distance from the shore ; even the intervention of a wide river interferes 
with the malarial influence, be it what it may. A row of trees, too, has been 
found to give protection when planted between marshy districts and inhabited 
places. All these facts seem to point to the conclusion that the poison after 
all is something material that is closely connected with the ground, and water 
of any extent interferes with its spread. It was supposed at one time that the 
real cause of the aguish condition had been found in a marsh weed called pal- 
mella, but this notion was supported by such puerile experiments and reasoning 
that it speedily lost credk. 

Malarious Diseases are those which are caused, or supposed to be 
caused, by poison either in the air or water of certain marshy or malarious 
districts. Many of the States of this country, the east coast of England, the 
marshes around Rome and Naples, and elsewhere on the shores of the Med- 
iterranean, are sources of this poison ; in India and tropical countries a more 
severe disease is the consequence of exposure to these various influences. In 
cold climates malarious diseases are not met with ; in temperate climates, 
agues or intermittent fevers are the result ; in tropical climates a more severe 
form of intermittent fever, and also remittent fevers, are produced. See In- 
termittent and Remittent Fevers. 

Malformation. During the development of the foetus in the womb it 
sometimes happens that some parts are not properly formed, and there is an 
arrest of growth or else an union of parts which ought to be separate. In 
this way many of those monstrosities are formed which excite the wonder of 
the ignorant. The Siamese twins were two individuals who were united 
together by a band of skin, and this change took place in the womb at an 
early period of foetal life ; sometimes the union is more complete, and may ex- 
tend along the whole length of the spine, as in the case of the " Two-headed 
Nightingale," twin sisters who were exhibited in this country some time ago ; 
of course this peculiar malformation can only exist when there are twins, and 
the union takes place along the middle line of the body, either in front or be- 
hind. There are, however, other cases of malformation which affect only one 
child, and these are always congenital, that is to say, are met with at birth, 
and produced at some period of foetal life. Malformations may result in 
various ways. 

A. Those resulting from incomplete development or growth of parts. 
(1.) Of the body generally. The head may be absent or rudimentary, and 
the foetus is then said to be acepktdic ; it is either born dead or lives a very 
short time ; the arms and legs may be defective, or the hands are joined to the 
shoulder-blade, and the feet to the thigh-bone, so that the arms and legs are 
absent; the fingers may be too many or too few in number. (2.) Of the ner- 
vous system. The brain and spinal cord may be absent, or exist only as rudi- 
mentary formations. (3.) Of the organs of special sense. The eyes maybe 
absent or imperfect, or the eyelids may remain united ; the ear may suffer in 
a similar way, and deafness is the result ; sometimes the nose is absent or de- 
formed, and resembles a proboscis. (4.) Of the vascular system. The heart 
may be absent, or the cavities of the heart may be deficient in number ; some- 
times two or more valves are joined together, or they are too numerous ; at 
other times the orifices between the different cavities of the heart are closed or 
unduly large, or the vessels which carry the blood from the heart into the 



MAL 470 MAL 

system are wrongly placed. Such cases generally die early, and the infant 
often suffers from cyanosis or blueness of the skin in consequence of the im- 
paired circulation. (See Cyanosis.) (5.) Of the respiratory system. The 
lungs may be absent or only one may be present, or the lobes may be deficient 
in number, or the air-passages may be absent or imperfect. (6.) Of the digest- 
ive system. The intestines may be deficient in various regions (see Artifi- 
cial Axus), or impervious, or the liver may be unduly small. (7.) Of the 
urinary system. The kidneys may be (one or both) absent or united together 
so as to form a horse-shoe shape. (8.) The organs of generation. These 
may be absent or malformed, so as to cause a doubt in some cases as to the sex, 
and giving rise to hermaphroditism. 

B. Malformation resulting from the incomplete union of lateral halves of 
parts which should become conjoined. The ordinary cases of hare-lip and 
cleft palate are deformities of this kind ; sometimes there is a fissure of the 
abdominal walls so that the bladder is visible, or there may be a fissure of the 
urethra, producing the conditions known as epispadias and hypospadias. On 
the posterior surface of the body, there may be a fissure of the skull, or. of the 
spinal cord, causing spina bifida. 

C. Malformation resulting from joining together of the lateral halves of 
parts which should remain distinct. Examples of this class occur when the 
fingers or toes are joined together so as to give a web-like appearance to the 
extremities, or the lower extremities may be joined together. 

D. Malformation resulting from duplication of parts in an infant. Ex- 
amples of this variety are seen when the child has extra fingers or toes. In 
addition to these varieties there are other occasional malformations, as trans- 
position of the internal organs and hernia? of the intestines, brain, heart, and 
lungs. Some of these malformations cause the death of the foetus in the 
womb, others are of such a nature as to prevent it coming to maturity, while 
some are so slight as not to give rise to any symptoms during life. It is in 
fact a matter of surprise, when the complex structure of the organism is taken 
into account, how seldom any deformities occur, but when malformations do 
happen they are -due to some defect of development in early life, and such 
monstrosities are capable of explanation on ordinary scientific grounds, 
although to the ignorant and uneducated they form food for awe and supersti- 
tion. 

Malignant Diseases. Diseases which are very rapid in their course, 
which always end fatally, and for which all human aid' seems powerless, are 
termed malignant. In an epidemic of typhus or scarlet fever it may happen 
that some persons will be attacked much more severely than others, and be 
overwhelmed or prostrated from the virulence of the poison ; thus a person 
may die of malignant scarlet fever in twenty-four or forty-eight hours. Either 
the individual has received an unusual quantity of the poison of the fever, or 
he may be in a bad state of health at the time, which has rendered him more 
susceptible of its influence. Such cases seem hopeless from the very com- 
mencement, but fortunately they are rare ; the usual symptoms of a disease 
are intensely exaggerated; there is great prostration, low muttering delirium, 
and sometimes bleeding from the nose and gums, or petechial spots over the 
body. Scarlet fever is the most likely one to become malignant, but it may 
occur in measles, typhus and typhoid fevers ; it generally is noticed at the 
commencement of an epidemic. The term '"malignant" is also applied to 
those tumors of which cancer is the best known example, where there is very 
little hope when the disease is internal, or has once made much inroad upon 



MAL 471 MAN 

the constitution ; such cases go on for some months, and finally die of exhaus- 
tion and emaciation. See Tumors. 

Malignant Pustule is a spreading gangrenous inflammation, commencing 
as a vesicle on exposed skin, attended with peculiar hardness and fetor, and 
derived from cattle similarly diseased. It is a disease, fortunately, of very 
rare occurrence as it is most fatal in its effects ; in France it is known under 
the name of charbon. Some believe that it is conveyed to man by the bite of 
a fly ; however that may be, the disease begins with a little raised blister on 
the skin, and usually on the cheek ; around this there is a red ring, and the 
skin becomes hard and brawny. Day by day the circle widens and the part 
first affected dies and blackens until a large hollow ulcer is formed, and this 
may perforate the cheek; still the edges go on sloughing and dying until a 
large circular hole is formed and a most offensive smell proceeds from it. In 
the mean time the patient suffers a good deal of pain, there is great prostration, 
inability to take much food, and much exhaustion ; the mind is, however, 
often clear, and death comes on in three or four weeks' time from gradual ex- 
haustion. This disease somewhat resembles cancrum oris, but it is much more 
malignant and fatal. The most hopeful treatment seems to consist in burning 
the diseased part very early with strong nitric acid, so as thoroughly to de- 
stroy the diseased tissues ; afterwards the general health must be supported 
with milk, beef-tea, wine, and eggs ; chlorate of potash may be tried, but at 
present no drugs have sufficed to check the disease. 

Mallow is the plant known to botanists as Malva sylvestris, belonging to 
the natural order Mahacece. It grows on waste places and roadsides in 
England, and is a native of most parts of Europe. The whole plant, but 
especially the root, yields when boiled a plentiful tasteless mucilage, which is 
useful in some cases of internal irritation. Decoctions of the leaves are em- 
ployed in dysentery, and they are used in fomentations, poultices, etc. The 
fruit of this and other species are eaten by children, and are called cheeses, 
and in France fromageons. 

Mal-nutrition is said to take place when the body is badly nourished, and 
supplied with impure air and food. It is a frequent cause of mortality amongst 
young children, and especially amongst those who are farmed out, but it is to 
be hoped that recent legislation on the subject may bring about improvement 
in this respect. The unhealthy state of the children in our great cities is 
largely due to this cause, and may be seen in the stunted and rickety condition 
which they present. The evils thus taking place in early life influence the 
future development of the individual, and are more likely to render him sus- 
ceptible to some forms of disease than those who are more healthy. For the 
prevention of such mischief the diet should be regulated according to the rules 
laid down in the article on Diet, and our sanitary officials should see that there 
is a plentiful supply of good water and air. In this respect it is very impor- 
tant that all adulteration of milk, bread, and other necessaries of life should be 
severely punished, that the water supply should be abundant and wholesome, 
and that in every large town open spaces or parks should exist for the chil- 
dren to play about in. As intelligence and education advance, it is probable 
that cases of mal-nutrition through ignorance will lessen ; when arising from 
willful neglect, the guilty parties are liable to the law ; when from poverty or 
misfortune, the poor-law relief steps in so as to prevent people from suffering, 
at any rate, from starvation. See Diet. 

Mamma. See Breast. 

Mandrake. A powerfully narcotic plant belonging to the genus Atropa, 



MAN « 472 MAR 

known also as Mandragora. It was at one time thought to have a sort of su- 
pernatural efficacy, and was gathered with great solemnity, with incantations. 
From the forked appearance of its roots and its fancied resemblance to a man, 
it was in superstitious times supposed to have an influence on the health of a 
person against whom it was used, so that, as the root withered away, the life 
of the doomed victim would gradually wane also. 

Manganese can hardly be said to be used in medicine. The black oxide 
is largely employed for the production of oxygen gas, and the sulphate has 
been given internally. In very large doses it gives rise to purgation, and in 
smaller doses it has been supposed to act in a fashion somewhat similar to iron. 
It has been given in anaemia, therefore, but it is not a standard remedy. 

Mania is that variety of insanity characterized by delusions of exaltation, 
with or without delirium. Sometimes such patients become very greatly ex- 
cited, very destructive and dangerous, but not so much so as do certain others. 
Mania has also been used as a generic word to imply all forms of insanity. 
See Insanity. 

Manna is the hardened exudation from the incised bark of various species 
of Fraxinus. These trees are cultivated for the purpose of giving rise to this 
substance in Calabria and Sicily. Manna of the best description forms pieces 
not unlike stalactites, about six inches long and one or two broad, hollowed 
out and discolored on one side where attached to the tree. This is called flake 
manna, and is porous and friable. It also occurs in smaller masses, or in 
broken and colored fragments. This substance, when pure, has a sweetish 
odor and taste, but is withal bitter. Manna is soluble in water and alcohol, 
and consists almost entirely of a kind of sugar called mannite, which differs 
from ordinary sugar in not fermenting with yeast. Manna itself is a very mild 
laxative, generally given to children or added to other purgatives, as senna, to 
sweeten them ; sometimes it gripes. The dose is from a drachm to half an 
ounce. 

Marasmus is a technical name given to the wasting disorders of children. 
It occurs as a symptom in cases of bad feeding, mal-nutrition, diarrhoea, con- 
stitutional taint, and in diseased conditions of the intestines and mesenteric 
glands. The term marasmus corresponds to the word emaciation or wasting. 
See Wasting Disorders. 

Marjoram, the Organum vulgare of botanists, is an indigenous plant 
yielding a volatile oil, and possessed of properties very similar to rosemary. 
It is not officinal, but is sometimes employed. Formerly it was contained in 
the Pharmacopoeia, but has been expunged. 

Marshes are spots where we find land and water imperfectly separated.; 
that is to say, wet land undrained. These are the main source of malaria, but 
not the only one. Land which at one time has been fertile and well culti- 
vated may become a source of malaria, whilst even salt marshes if drained may 
afford good and wholesome tillage and pasturage ground. The marshy dis- 
tricts of this country were at one 1 time frequent sources of ague, and even now 
a goodly number of cases do oc air, but not nearly so many as heretofore. 
The great means of improvement is the separation of the laud from the water 
by drainage and tillage. 

Marsh-mallow, the root of Althea officinalis, is no longer officinal. The 
plant grows throughout Europe, and is seen in small cylindrical pieces, the 
size of the finger. The outer covering is usually removed, so that the sub- 
stance looks yellowish externally and white internally. The syrup of marsh- 
mallow had at one time a great reputation for allaying coughs, etc., and even 



MAS 473 MEA 

now in France, under the title Gui?nauve, it is greatly used. Specific proper- 
ties it has none. 

Mastication is the process by which the food when taken into the mouth 
is chewed into small pieces by the teeth and thoroughly mixed with the saliva. 
Pieces of meat, etc., are thus finely divided, and are so rendered more easy to 
be, acted upon by the gastric juice when they are swallowed and enter the 
stomach ; further, since starchy foods, as rice, potatoes, bread, etc., when 
mixed with the saliva, become converted into sugar, it follows that if mastication 
is properly performed all the insoluble starch will thus be changed into the 
soluble form of sugar and made ready for absorption. It will thus be seen 
that it is a very important thing to eat a meal slowly, and not swallow the 
food hastily, as some are apt to do ; the latter fault is very apt to cause indi- 
gestion, and be a source of much distress if the habit be persevered in. See 
Digestion and Diet. 

Mastic is a resinous exudation flowing from a plant of the turpentine fam- 
ily, a native of the countries bordering the Eastern Mediterranean. The best 
mastic consists of small masses called tears, which are light yellow and friable, 
but becoming soft and ductile on chewing. The surface of the masses is often 
covered with a whitish dust, produced by rubbing one against the other. Larger 
masses are formed by the agglutination of several tears. It has an agreeable 
odor. Mastic is soluble in ether and chloroform, but scarcely at all in fusel 
oils. It is not much used save to give a pleasant odor to the breath when 
chewed and to stop teeth. 

Matico is the leaf of a kind of pepper plant growing in Peru. The leaves 
are oblong and pointed, marked on the upper surface, downy and reticulated 
beneath. Their color is green ; their taste aromatic, warm, and slightly astrin- 
gent; the odor is pleasant. Matico contains some tannic acid, and a peculiar 
substance called artanthic acid. The only officinal preparation is an infusion ; 
but a tincture is also in use. The leaf, in substance or in powder, applied to 
small bleeding surfaces, as leech bites and the like, acts as a powerful styptic. 
Given internally it is said to act as an astringent in the urinary ways and on 
the rectum, but this is by no means clear. Many think it only acts on sub- 
stances by virtue of the structure of its leaf. 

Matter. In a medical sense this word is synonymous with pus, and means 
the fluid humor which is contained in an abscess or sore tumor. 

Measles is a contagious febrile disorder, and forms one of the group of the 
exanthemata. It is nearly always more or less prevalent in this country ; but 
at times it spreads with great rapidity, and carries off a large number of victims. 
As a rule, children and young people are attacked, but the exemption of adults 
and older people probably depends on the fact that they have had the com- 
plaint in early life, and so are not subject again to the influence of the poison ; 
yet in a few rare cases persons have suffered twice from this disorder. This 
disease is more fatal in the autumn and early winter than in the spring and 
summer; thus, in the last quarter of 1871, 3763 deaths were registered from 
this cause, against 2075 in the preceding three months. Measles varies much 
in malignity ; in some years, although many are attacked, the mortality 
is moderate ; while at other times the disease is fatal in a much larger ratio. 
In the years 1670 and 1674 an unusually bad kind prevailed in London, and 
at the same time small-pox was very malignant and fatal. It may also be 
remarked that during the severe epidemic of small-pox in 1871 the fatal cases 
of measles were much more numerous than usual. Measles is essentially a 
contagious disorder, and often attacks all the members of a family one after 



MEA 474 MEA 

another. An interesting proof of its contagion was afforded by an outbreak 
which occurred in Faroe Islands some years ago. These small islands are 
situated between Shetland and Iceland, and from their geographical position, 
and by their having no external commerce, they are much debarred from inter- 
course with other nations. In this little group measles had been unknown 
from the year 1781 until 1846, when a man who left Copenhagen apparently 
well on the 20th of March of that year arrived at the island of Thorshavn on 
the 28th, and was taken ill on the 1st of April with measles. For sixty-five 
years had the inhabitants been free from this disorder, and yet in the six months 
during which the epidemic lasted 6000 people underwent the disease out of a 
total number of 7782 inhabitants. Such was the immediate and rapid diffusion 
on the introduction of the contagion. Old people, who had not suffered in the 
epidemic of 1781 took the disease in 1846; people of all ages were attacked, 
but in no cases did any one who had had measles in 1781 catch it a second time 
in 1846; this shows most conclusively that subsequent immunity is the rule, 
and that the protection afforded by one attack does not wear out as life ad- 
vances. These facts also show that the susceptibility to catch the contagion 
does not diminish as life advances, but that the reason why so few adults suffer 
in this country is due to the fact that they have had it in early life, and can- 
not take it a second time. 

In measles, as in other contagious disorders, there is a period of incubation ; 
and by incubation is meant the time which elapses between the exposure to 
the contagion and the first appearance of symptoms. This period varies in 
different fevers ; in the case of measles it seems to be ten to twelve days. 
Such a question as this is usually very difficult to answer, as there are many 
sources of fallacies when the disease is prevalent in a town, and a person may 
be exposed to contagion unawares. In the above-mentioned epidemic the 
period was made out as exactly as possible. As an example the following in- 
stance may be adduced: One of the small islands belonging to the group con- 
tained only eighteen persons, and these all belonged to one family. A few of 
them went in a boat to a neighboring island where the disease was prevalent, 
and stayed there some hours ; for ten days the voyagers seemed perfectly well, 
but on the fourteenth day the eruption appeared upon all of them, and fourteen 
days after that all the other members of the family had the complaint. 

Before the appearance of the rash there are some precursory symptoms : 
the patient feels languid and hot, and there is shivering, followed by a rise of 
temperature, a quick pulse, thirst, loss of appetite, and sickness. Such, in 
fact, are the usual symptoms which precede most febrile attacks. But in ad- 
dition to the above signs there is superadded an inflamed condition of the 
mucous or lining membrane of the air-passages; and this state is so marked as 
to be very characteristic of this disorder. The eyes become red and watery, 
and give the appearance of a patient having cried; the membrane which lines 
the nose, throat, larynx, and trachea is red and swollen, and pours forth a 
watery secretion ; thus the affected person seems to have a severe cold, with 
running from the eyes and nose ; hence there is generally much sneezing, with 
a slightly sore throat and a dry, harsh cough. In addition there may be 
diarrhoea with pain in the stomach, and a good deal of vomiting; but these 
cease when the eruption appears. Convulsions occasionally occur in children, 
and the younger the patient the more liable is it to have a fit. 

After these uncomfortable symptoms have lasted about three or four days, 
the rash appears. Although the rash may come out as late as eight or even 
ten days from the first appearance of the symptoms, the fourth day is by far 



MEA 475 MBA 

the most usual for it to come out. The rash begins in very small papules or 
minute pimples, which rapidly multiply, and then run together into patches 
which have a tendency to a horse-shoe or crescentic shape, while the portions 
of skin between are of a natural color. Commencing on the face and neck 
it spreads to the arms, then the trunk of the body, and gradually reaches the 
lower extremities ; this process takes two or three days. The same order is 
observed when the rash fades ; it is generally out fully for three days on the 
face, so that the whole duration is at least six or seven days, and it disappears 
on the upper part of the body, while a few faded spots may still be seen on 
the legs. At first the eruption has a dark pink or mulberry color ; but towards 
the end it becomes .browner. The face is generally bloated and swollen, and 
if the finger be passed gently over the surface of the skin the rash may be felt 
to be slightly elevated. When the eruption has disappeared, the part of the 
skin affected becomes covered with a dry scurf, and seems covered with a 
branny powder ; the cuticle does not come off in large flakes, as in scarlet 
fever. The fever does not diminish on the appearance of the rash, as in cases 
of small-pox, and there is no proportion between the abundance of the rash 
and the danger to the patient ; indeed, in some cases where the rash is late in 
appearing and uot very plentiful, the individual may be in much danger. 

This disease is known, then, by the catarrhal affection, or appearance of a 
cold with which it is ushered in, and by the peculiarity of the rash. Scarlet 
fever mostly begins with a sore throat, and the rash comes out earlier; and in 
small-pox there is more vomiting and much pain across the loins : these are 
the two disorders with which measles is most liable to be confounded, but if 
any doubt exist the case will be cleared up when the rash is seen. Of late 
years cases have been seen where the eruption has appeared without the fever 
and catarrh, and to this variety the name of rubeola sine catarrho has been 
given ; but it confers no protection from measles, and often the latter disease 
appears in its regular form a few days afterwards. 

In some cases a measle-like eruption comes out in the early stages of small- 
pox, and may give rise to mistakes ; but in two or three days the regular rash 
of variola will appear. A rose-colored rash sometimes appears in children 
while they are teething; but it is more diffusely spread over the body, and 
there are no signs of running at the eyes and nose, and the fever is but slight. 

The temperature in measles rarely rises to more than 103° Fahr., and in 
all mild cases may not be more than 101° or 102° Fahr.; this is a guide to 
the severity of the disease, for the higher the temperature the more dan- 
ger there is to the patient. To find out the temperature a delicate thermom- 
eter should be placed in the arm-pit, and the arm held closely to the side, 
so that the skin perfectly surrounds the bulb of the instrument ; it should be 
kept in this position for at least five minutes, and then the point to which the 
mercury has risen in , the graduated tube can be read off. The patient should 
be in bed, and have his arms covered up half an hour before the observation is 
made, or otherwise the skin of the arm-pit will be unduly chilled. Since the 
ordinary temperature of the body is 98°-98.5° Fahr., it follows that any 
degree of beat observed higher than that indicates a state of fever. 

The pulse at the wrist beats quicker than usual, but is usually not so high 
as in scarlet fever; from 120 to 140 beats in a minute is a common occur- 
rence. The tongue is generally furred, and has a moist, white appearance ; 
in very bad cases it may become dry and brown ; it begins to clean at the 
tip and edges from the fourth to the eighth day of the disease, and the rest of 
the tongue is clean in twelve or fifteen days, unless some other disease arise. 



MBA 476 MBA 

Small superficial ulcerations may in some cases be seen on the lining mem- 
brane of the mouth and gums. The throat may be red and swollen, and the 
act of swallowing rendered in consequence rather painful ; but this symptom 
is of very slight importance. Still more rarely there may be some difficulty of 
hearing. In some cases the glands behind the jaw, or down the neck, and 
even those in the groin, may become large, swollen, and painful ; but this 
varies in different epidemics, is rarely severe, and is far more common in scar- 
let fever. 

Vomiting is frequent enough at the outset of the attack, but is very sel- 
dom met with afterwards if care be taken with the diet. Diarrhoea, now and 
then, is very troublesome; in a moderate amount it is not injurious, but some- 
times it is very exhausting, and blood may be found in the stools; it is worse 
in those cases where the children are weak and sickly previously. 

The urine is generally scanty, and, in fact, in most febrile disorders less 
urine is passed than usual. On standing and allowing to cool, a light, yellow, 
sandy sediment is deposited ; this deposit need never cause any alarm, as it is 
merely due to certain salts in the urine being less soluble when cold, while 
when the water is first passed at the ordinary heat of the body they are 
soluble. 

More characteristic symptoms are the cough and expectoration. The cough 
is at first dry and hacking, very frequent and annoying ; in a few days it 
comes on in occasional paroxysms or fits, which give much distress, and even 
cause retching and vomiting ; it generally disappears when the rash fades, but 
in some cases it may remain for some time. At first there is not much ex- 
pectoration, and it is clear and viscid ; in a few days it is more abundant and 
frothy, or even of a greenish-yellow color. 

Complications are. very liable to occur, but these vary in their nature, in 
their severity, and in various epidemics. The rash generally disappears when 
the finger is pressed upon it, but in some malignant cases the spots turn a dark 
purple and will nut disappear; hence the name of black measles has been 
given to this variety, and this form is usually fatal. Or the rash may sud- 
denly disappear instead of gradually fading away, and this may indicate some 
internal mischief ; this also is a serious symptom. Convulsions at the com- 
mencement are usually without danger, but if they come on at the end of the 
disease they may lead to a fatal issue. Inflammation of the larynx or upper 
part of the air-passages may give rise to harsh, croupv breathing, and some- 
times the inflammation becomes chronic and very obstinate, being always 
liable to return whenever the patient takes cold. Inflammation of the lungs 
is very common in measles, and unless great care be taken may prove very 
dangerous; the breathing is hurried and the temperature and pulse rise ; the 
patient may lie in great distress, and in children there is often dilatation of the 
nostrils at each inspiration. Children under ten years of age rarely expec- 
torate, and so the bronchial tubes often become choked with phlegm. Wheez- 
ing sounds may be heard all over the chest if the ear is placed there, and may 
be felt when the hand is placed over the back or front of the chest. Bron- 
chitis often proves fatal to very young children, and in all cases adds to the 
danger. Whooping-cough is very frequently an accompaniment of measles ; 
indeed, an epidemic of each is generally prevalent at the same time. Any 
children who have just suffered from measles, and are living in a house in which 
or near which whooping-cough is prevalent, are almost sure to take it. Con- 
sumption sometimes follows measles, and especially in those wdro are liable to 
be subjects of it. Inflammation of the ear now and then occurs ; the child 



MEA 477 MEA 

then cries a great deal and puts its hand to the side of its bead ; at first nothing 
may be seen, but afterwards a discharge flows, and this will then give great 
relief. 

Measles, as a rule, is a mild disease, and the great majority of cases re- 
cover ; if children who were previously in good health are attacked the result 
is nearly always favorable. In those who have bad health, and chiefly in those 
who are liable to diseases of the chest, the danger is greater. Cold and damp 
weather increases the mortality by favoring the development of affections of 
the lungs. 

Treatment: Since there is no drug which can cure the disease, attention 
must be directed to those means by which we can relieve the patient and avoid 
any complications. In the first place the child must be kept in bed, as in this 
way a more equable temperature can be kept up, draughts can be avoided, and 
so any liability to inflammation of the lungs may be lessened. The room 
should be airy and well ventilated, but great care should be taken that the pa- 
tient is not exposed to any draught. All offensive excreta or dirty linen 
should be removed and disinfected, and the way to do this has been already 
fully discussed in the article on Fevers. A temperature of 60° or 65° Fahr. 
may be kept up by having a small fire in the room, but the heat should 
never be oppressive. It is as well to keep down the blinds and to allow the 
patient to lie with his back to the light, as the eyes are generally in- 
flamed, and a strong light causes much discomfort. Any feeling of dry- 
ness or tingling of the skin may be relieved by bathing the part with tepid 
water, but for this purpose do not expose the patient all at once, but 
bathe and then dry one part at a time. In all cases it is advisable to give the 
patient a hot bath at the very onset of the disease, then dry the surface of the 
body and put the child to bed directly ; no chill need be feared, and it may 
help to bring out the rash; if the children are dirty it is all the more needful, 
uot only for the sake of seeing the rash clearly, but to aid the skin in perform- 
ing its proper functions. All sources of annoyance or irritation and all noises 
should be avoided, and the patient should be kept quiet so as to try and in- 
duce sleep. Food of the simplest nature should be given, and this point is im- 
portant, as a favorable result much depends upon it. In all cases of fever care 
should be taken to give food which is at the same time nourishing and easily 
absorbed. At first no solid food will be cared for, and the thirsty patient may 
drink milk, or milk and water, or tea, chicken-broth, beef-tea, or toast and 
water. The quantity given should be moderate, and the child should only 
drink enough to quench its thirst. A pint and a half of milk, with half a pint 
of beef-tea, free from fat, will suffice for a child of three to five years old, and 
if more drink be needed some simple fluid, as barley-water or tea, may be given. 
The quantity, however, will vary with the age of the patient. As too much 
food should not be given at once, the meals must be given every two or three 
hours, and something should always be ready in the night or early morn- 
ing when the child awakes, as it is often much required then. Acid drinks are 
very grateful and agreeable ; lemonade with a little sugar or raspberry vine- 
gar may be given in moderation, but should not be taken at the same time as 
milk is taken, as they are apt to make the latter curdle in the stomach and be 
vomited. Stimulants arc rarely needed in children, and should only be given 
under medical advice. AVhen the fever subsides a small piece of chicken, or 
mutton, or fried sole may be taken ; toast or bread and butter, with a fresh 
egg, may also be given ; and so as the tongue cleans and the appetite returns 
the patient may return to his ordinary diet. If there is any inflammation of 



MEA 478 MEA 

the lungs a hot linseed meal poultice may be applied to the back and front of 
the chest, and in all cases the chest may be kept covered with cotton wool, and 
all exposure to cold avoided. But in case any complications should arise, 
medical advice should be taken, as it is impossible to lay down any rules for 
the treatment of what may occur in any individual case. Although children 
generally recover rapidly, yet there are times when much debility ensues and 
the general health becomes impaired, although the fever has quite left. Such 
children as are in bad health are liable to lumps or glandular swellings of the 
neck and under the jaws, or they may remain weak for a long time or be sub- 
ject to some skin eruptions. Steel wine and similar tonics may here be given 
with great advantage. If the child be growing fast, too much exercise should 
be avoided, and plenty of rest allowed. Should the weather be warm and 
genial, out-door exercise is beneficial, but the child should wear flannel next 
the skin and be protected from cold and wet. Regular hours, plain, nutritious 
food, and a very moderate amount of stimulant are necessary. A cold bath 
may be given every morning, but it should be discontinued if, after being well 
dried, the child should not feel a healthy glow ; salt water is the best for this 
purpose, but if not procurable a handful of rock salt may be put into the bath. 
Nor should the child remain long in the water, as depression and chilliness 
may ensue ; generally two or three minutes will suffice. A visit to the sea- 
side is to be recommended if possible ; and if there is any tendency to enlarged 
glands or discharge from the ears, a moderately bracing place should be 
chosen. If a child is timid and afraid to bathe in the sea, sea-water may be 
procured for its morning bath ; no child should be forced into the water, but 
should be coaxed and encouraged to bathe, and a sea-bath should be given to 
delicate children about two or three hours after breakfast, and not before that 
meal. Baths, to do good, should act as tonics ; if they depress and make the 
patient feel worse, they are doing harm. 

Morbilli and Rubeola are technical names which have been given to measles. 
The disease is contagious when the rash is out, but other children are probably 
safer to mix with affected patients a week after the rash has disappeared. Isola- 
tion is the only way to stop the spread of this affection ; if by legislative meas- 
ures a quarantine could be established round an infected house or district, the 
disease might become stamped out, or its spread vastly diminished. We cannot 
do much in the way of curing measles, but a great deal might be done to pre- 
vent its coming amidst the people and pursuing its ravages. 

Meat, Extract of. The substance commonly sold as Extract of Meat is 
also known as Juice of Meat, Liebig' s Extract, and in Latin. Extraction rami* 
Liebifjii. The name of the late Baron Liebig, the great chemist, is especially 
connected with this compound, as he undoubtedly was one of the first to call 
attention to it as a valuable article of diet. In his Familiar Letter on Chem- 
istry he devotes a letter to vegetable and animal food, and gives an account 
of their various chemical components. He shows that all animal flesh contains, 
besides fibrine, albumen, gelatine, and fat, certain other constituents, which may 
be separated from the rest by a simple process of infusion, straining, and evap- 
oration. The substance thus obtained is extract of flesh. This compound was 
not unknown to chemists before Liebig drew special attention to it, but they 
regarded it only as a remedy for disease and exhaustion, and recommended it 
as a resource for extremities of nature, especially for the sick and wounded 
soldier on the field of battle, with sinking and ebbing powers. That which 
at one time was considered to be a last resource is now an article of daily con- 
sumption in our hospitals and households, and is almost as commonly used as 



MBA 479 MEA 

tea, or any other beverage. A frequent inquiry is, in what consists the effb 
cacy or advantage of Liebig's extract ? and the popular idea is that, being a 
concentrated extract of pounds of flesh, it cannot fail to be extremely nu- 
tritious. But it is not so, and it will be surprising to those who believe in 
this doctrine to hear that the extract of meat contains little or nothing of what 
may be said to be at all nutritious. The substances which go to form nour- 
ishment for the body are fibrine, albumen, and fat ; but these are not present 
in the extract of meat. One hundred parts of beef contain the following con- 
stituents : — 

1. Fibrine 4 

2. Albumen . 4 

3. Gelatine , 7 

4. Fat 30 

5. Mineral Matter . 5 

6. Water , 50 

100 

Let us contrast with this the composition of a hundred parts of Liebig's 
Extract of Meat : — 

1. Creatine, Creatinine, Inosic Acid, Osmazome 51 

2. Gelatine 8 

3. Albumen 3 

4. Mineral Matters 21 

5. Water 17 

100 
The difference will be. at once seen. The water has diminished by half, the 
albumen is less, and there is four times the quantity of mineral matter, and a 
set of substances is introduced which occupy half the bulk of the compound, 
which are not noticed in the composition of beef itself at all. If, then, the ex- 
tract of meat differs from beef, and all other nutritious articles of diet, it is 
not in containing nutritious matters, but in the fact that chemical compounds 
and mineral matters just mentioned are found in large quantities. It is to 
these, therefore, that we must ascribe the marvelous powers which the extract 
of flesh exerts on the human system. The chemical action of these products 
on the human body are imperfectly understood ; but it is certain that when 
albumen and fibrine are partaken of alone they will not digest or support life ; 
hut when in combination with the mineral matters found in the juice of meat, 
and of course present in every pound of meat, they are digested and appro- 
priated to the nutrition of the body. It therefore follows that. Liebig's Ex- 
tract of Meat, if partaken of alone, would in no way support life ; but, if in 
combination with bread or eggs or any ordinary food, it enables the stomach 
to assimilate all the nourishment contained in these articles, and provides sus- 
tenance for the failing powers at a much less cost to the digestion than if it 
had, unassisted, to extract what nourishment the}" contain. Our own individual 
experience will illustrate this. If we are hungry and eat dry bread the ap- 
petite soon palls, and we soon give it up ; if we take some cold water we can 
consume more of the bread, and even with warm water, if flavored with tea 
and sugar, still more. The latter evidently acts as an incentive. If we add 
salt to the water the same effect is produced. But if we take a basin of soup 
— for soup is but a weak solution of the juice of flesh — we shall find that 
we can take into our stomachs with relish four or five times the amount of 
bread we could consume with cold or warm water alone. It appears as if the 
nervous system received a stimulant effect from the presence of these salts 



MEC 480 MEG 

and creatine, which enables the stomach to do its work with greater ease. As 
in the case of " a glass of wine," the exhausted nerves of the stomach are 
aroused to action, but with depressing after-effects ; these salts of flesh stimu- 
late the digestion, and produce no bad results at a future period. There does 
not appear to exist any evidence of the subsequent beneficial action of the or- 
ganic substances found in the extract of meat. They may, like theine and 
quinine, supply more readily materials for the manufacture of working muscle 
and nerve than can be readily obtained otherwise. The theory that these salts 
assist in nourishing the nerves was put forward, with his accustomed inge- 
nuity, by the late Professor Agassiz ; and as the flesh of fish is known to con- 
tain more creatine than that of other animals, he recommended a diet of fish as 
especially adapted for the food of philosophers and those who work with their 
brains. The juice of flesh, or extract of meat, it will be seen, contains no new 
product after its manufacture, but simply those constituents in a concentrated 
form which are ordinarily present in the flesh of animals. The great advan- 
tage it confers is that it is already fit for use. A teaspoonful of the extract in 
a pint of hot water is a stock for any soup, and admits of any variety of fla- 
voring. For the dyspeptic, whose stomach cannot bear tea or coffee, it is an 
excellent beverage, and assists materially in the digestion of any solid food that 
may be taken with it. But beware of relying on Liebig's extract as a sub- 
stitute for beef tea, which contains fibrine, fat, and albumen, all of them neces- 
sary to continue life. Liebig's extract alone will not supply nutrition to the 
body, but in combination with an egg, or bread, or toast, or anything that may 
be fancied, will enable the invalid with wasted powers to obtain all the good- 
ness or nutriment these other things may contain. Hence it is a most valuable 
adjunct to the invalid's table, or to the menage of the ordinary cook, in whose 
hands it may be made to form the basis of many rich and well-flavored soups. 
A mutton chop eaten alone, or even with tea or coffee, will frequently prove 
most indigestible, and the dyspeptic who seeks for nourishment will give it up 
as impossible. Let him, however, try with it, instead of tea or coffee, a cup- 
ful of Liebig's extract with salt and pepper, and he will find his chop nutri- 
tious and pleasant, and usually require no other addition besides a little bread, 
to his excellent meal. A portion of this preparation partaken of at proper 
times will often render recourse to alcoholic stimulants unnecessary and supply 
the needful refreshment to the system. 

Meconium. In pharmacy this word is used for the inspissated juice of 
the poppy, a substance resembling treacle. It is also, and more frequently, 
applied by medical men to the first dark slimy discharge from the bowels of a 
newly born infant, which generally passes within an hour or two of birth, hut 
is not entirely expelled till the babe has partaken cf the mother's first milk, 
which is in itself of a cleansing and slightly purgative nature, and is adapted 
to remove all these impurities from the infant's body. 

Medulla Oblongata is the name given to an important and central part of 
the brain which is situated at the lower and posterior part of the skull, just 
where the spinal cord joins the brain ; it is the centre from which emanate most 
of the principal cranial nerves ; an injury here causes sudden death. See Brain. 

Medullary Cancer is one variety of cancer. See Tumors. 

Megrims means a variety of headache to which women are often liable, 
especially if they have been subjected to weakening influences, such as pro- 
longed suckling or profuse menstrual flow. It is also common in women badly 
nourished, from whatever cause. Occasionally it will come and go almost 
like an aguish complaint; more commonly, however, it persists for a time. 






MEL 481 MEL 

The best means of getting rid of such a headache are stimulants, especially 
ammonia ; but unfortunately the relief is only temporary. Good food and 
tonics are necessary, therefore, for the relief of such headaches, and without 
these and the removal of the cause of the weakness little good need be ex- 
pected. Perhaps the remedies best adapted are bark and ammonia, followed 
by iron. But if these headaches have lasted a long time, something more is 
necessary. In such cases we have found the chloride of ammonium (sal am- 
moniac), combined with the perchloride of iron, both in full doses, the best 
remedy attainable. Tlie sal ammoniac must be given in doses Of twenty or 
thirty grains, and the iron in doses of thirty drops. At the same time the 
bowels must be attended to. See Headaches. 

Melaena is the name given to haemorrhage from the bowels. It may occur 
under various conditions ; sometimes from bleeding into the stomach, when 
some of the blood naturally finds its way down the intestines. (See ELemat- 
eiiesis.) Cirrhosis of the liver occasionally causes it, because the circulation 
through that organ is so obstructed, and the bleeding in such cases is a source 
of relief to the distended vessels ; more frequently piles are produced in the 
cour.se of this disease of the liver. (See Piles.) Melaena is not uncommon 
in the course of typhoid fever, and when very profuse may cause a fatal result, 
yet when the quantity is but small the danger to the patient does not seem to 
be greater in consequence. Turpentine in small doses is valuable at such 
times, but it should be given with great care ; iced milk, but no solid food, 
may be given. (See Typhoid Fever.) In some forms of B right's or kidney 
disease, melaena may occur in the early stage, but it seldom is profuse, and does 
not call for special treatment. (See Kidney.) Ulceration of the intestines is 
often accompanied by melaena, and may occur in cases of phthisis or in scrofu- 
lous disease. Rest in bed, cold drinks, light and nourishing food, should be 
given, and also some astringent medicine, as iron, tannin, or gallic acid, sugar 
of lead, and turpentine ; but the quantity to be given and the choice of the rem- 
edy must depend on the special peculiarities of the case. When the melaena 
proceeds from the upper part of the bowel, it passes away mixed with the ex- 
creta, and has a brown or coffee -ground color; when from the rectum or the 
lower part of the bowel, it has the usual appearance of clotted blood ; in these 
latter cases enemata, containing iron or tannin, are very useful, as then the 
astringent fluid can be applied directly to the part. When admissible, opium 
is often of service in keeping the patient quiet and in allaying nervous excite- 
ment, and also in preventing any undue movement of the bowel itself. Haem- 
orrhoids, or piles, are common sources of haemorrhage, and here local applica- 
tions only are needed. (See Piles.) In cases of melaena it is very rarely ad- 
visable to give purgatives, and they should always be taken with much cau- 
tion, as their presence may give rise to irritation and increase the flow of blood. 

Melancholia is that variety of insanity which is characterized by delusions 
of depression. Sometimes the patient becomes excited over these, but not 
very frequently. There are several varieties of melancholia, but the above def- 
inition applies to almost all of them. Melancholia attonita, as it is called, is 
somewhat different. See Insanity. 

Melanosis is a disease characterized by the deposition of black or dark 
brown coloring matter in various textures and organs. Almost any form of 
tumor may become melanotic, but one variety of cancer has a special tend- 
ency to do so. True melanosis has its site most frequently in the skin and 
tissue just below it ; but it is also frequently present in and beneath mucous 
membranes. In certain parts of the body pigment of this kind is normally 
31 



MEN 482 MEN 

present ; thus there is always some in the skin even of a European, much 
more on those of the darker colored races. So, too, it is present in certain 
parts of the eyeball, the lungs, and other internal organs. In general mel- 
anosis we have usually a number of masses scattered through different parts 
of the body. These are of very various sizes, from a pin's head to that of a 
walnut, and may invade even the tissues of the heart and the bones. It is com- 
monly supposed that these melanotic masses are malignant in their nature — 
cancerous, that is to say, and tend to shorten life ; but this is bv no means 
certain as yet. There are certain forms of false melanosis of importance. 
Thus, there is the lung of those who inhale large quantities of carbonaceous 
matter. These individuals often suffer from a form of consumption charac- 
terized by certain peculiarities. After death their lungs are found quite black; 
the bronchial glands, too, are blackened, though that is nothing unusual. The 
lungs of those who live in cities tend to acquire, in course of time, more or 
less pigmentation. Blood may be blackened. Thus the action of the gastric 
juice on the blood in the vessels of the stomach after death may give the 
stomach an appearance of mortification. Blood, too, which has been extrava- 
sated into the gut becomes quite black before it passes from the bowel, if. it is 
allowed to remain in it long enough. As to treatment little can be said. In 
true melanosis, if the mass can be reached it should be removed ; but if truly 
melanotic it is most likely multiple, and represented elsewhere. The treat- 
ment of miner's phthisis differs in no respects from that of the ordinary dis- 
ease. 

Meningitis signifies inflammation of the membranes of the brain. In the 
article Brain it has been shown that this organ has three coverings, in the 
following order, from without inwards: (1) a dense, fibrous structure, the 
dura mater; (2) a thin delicate membrane, the arachnoid ; and (3) a tissue 
full of vessels, the pia mater. The last two membranes are those usually af- 
fected in the process of inflammation. There are several varieties of inflam- 
mation of these coats, depending chiefly on the cause : (1.) Traumatic men- 
ingitis, or meningitis dependent on a blow or injury to the head, which may 
be also accompanied with fracture of the skull. In the course of two or three 
days after the accident, severe pain will be felt over the seat of injury, and 
the patient will be feverish and thirsty ; constant sickness and a moist white 
tongue are also very prominent symptoms. The pain increases in intensity, 
the head is hot, and the face often flushed, and the patient restless and dislik- 
ing the light; generally convulsions come on, or the limbs are affected with 
convulsive starts ; delirium at night is generally present, and the patient may 
lie on his back in a prostrate condition, moaning at times, and picking at the 
bed-clothes. By degrees he becomes drowsy and stupid, with sometimes a 
flushed face and suffused eyes, taking little, if any, notice of what is going on 
around him. As the drowsy state deepens, the pain is not felt, and gradually 
he passes into a state of coma or deep insensibility, from which he cannot be 
roused ; the pupils, at first small, generally become at this stage larger than 
usual, and squint may be also present ; now the face is pale, and the pulse fre- 
quent and often irregular. Very few cases recover when the disease has ad- 
vanced so far ; and, in fact, the greatest danger always exists whenever these 
serious symptoms come on after an accident or injury to the head ; neverthe- 
less death may not take place for weeks in some cases, the patient lying mean- 
while in an unconscious state. The treatment will consist in perfect rest 
after the injury, however slight it may seem to be at first ; he should lie in 
bed or on a sofa in a cool and rather darkened room, and avoid all kinds of 



483 




Eig. lxxx. 




Fia lxxxt. 



~ 




Fig. lxxxii 




jfio, Lxxxni. 



MEN 485 MEN 

excitement. No stimulants should be given, nor are any required, as they only 
tend to flush and excite the patient; the bowels should be kept open, and the 
forehead may be cooled by means of vinegar and water, or an evaporating lo- 
tion, in which small pieces of ice are melting, or an ice bag may be applied to 
the head. Medical advice should always be sought for early, as very little 
hope can exist when the disease has made much progress. 

(2.) Tubercular meningitis is another variety which is very fatal to children, 
and equally so in adults, but not so commonly met with. The same tissues or 
covering are affected as in the preceding variety, but the nature of the inflam- 
matory process differs somewhat in this kind. Acute hydrocephalus is another 
name for this disease, but it should be avoided, as persons are apt to confound 
this disease with chronic hydrocephalus, whereas there is no connection be- 
tween the two. Some have also styled this brain fever. Children are usually 
attacked between two and five years of age. The symptoms begin by their 
feeling listless and disinclined to play about ; they are fretful, and wish to lie 
in their nurse's or mother's lap ; generally they complain of pain in the head. 
In a day or two these symptoms are more marked, and the pain increases, ac- 
companied by very constant vomiting and generally convulsions, although in 
some cases this latter symptom is wanting. The tongue is white and moist, 
the abdomen generally concave instead of convex, and the thumb of each hand 
is turned inwards. The child dislikes the light, aDd the pupils are smaller 
than usual. At times squinting is met with ; the face may be pale or occa- 
sionally flushed, and if the finger be lightly drawn across the forehead a red 
blush or wheal will at once appear. The bowels are usually confined, the 
pulse quick, and the heat of the body greater than usual. Gradually and in 
the course of a few days the child becomes semi-unconscious, lies in its bed, 
taking little, if any, notice of what is going on around, and the symptoms be- 
come still more marked. The stupor generally goes on increasing, the pupils 
dilate, the pulse becomes irregular, often the child utters a low moaning cry, 
and by degrees it passes into a state of complete insensibility, until death puts 
an end to its sufferings. No case recovers after the disease has once clearly 
developed itself, but many cases may be mistaken for it ; thus, a child when 
teething may present at first many symptoms similar to those met with in the 
early stages of this disease, and much alarm may at first be created in conse- 
quence. To distinguish these cases accurately requires a good deal of expe- 
rience and knowledge. The children most liable to be affected with tuber- 
cular meningitis are those of a nervous and excitable temperament, and such 
as are precocious for their age ; those also who are suffering from diseases of 
joints and enlarged glands are subject to it. Death usually takes place in the 
course of three or four weeks from the onset of the malady. The treatment 
will consist in following the same plan as has been mentioned above for trau- 
matic meningitis. A pleasaut way of applying cold to the head is to pound 
ice in small pieces, and place them in a bladder ; this can then be suspended 
from the head of the bed, and placed on the child's head for a couple of hours 
at a time ; in this way the pillow and bed-clothes are prevented from getting 
wet. Very little nourishment can be taken in these cases, and usually a little 
iced milk is most grateful to the patient. 

(3.) Meningitis may come on as a result of exposure to cold or to great 
heat, or in the course of many febrile disorders, as pyaemia, septicemia, etc., 
or from the presence of tumors in the brain, or from disease of the bones of 
the skull as a result of scarlet fever and syphilis. The symptoms are such as 
have been mentioned above, and show a serious disturbance of the functions 



MEN 486 MEN 

of the brain. Nearly all such cases commence with pain in the head, sickness 
fever, intolerance of light, and are followed by convulsions, which lead on to 
stupor, coma, and insensibility. In nearly all these instances, too, a fatal result 
may be expected in consequence of the serious injuries which ensue to such 
important structures. They all depeud, probably, in the first place on some 
altered and poisoned condition of the blood, and the treatment to be adopted, 
in addition to what has been above recommended, will consist in the various 
remedies appropriate to the special cause which gives rise to the disease. 

Another form of meningitis also affects the spinal membranes as well as 
those of the brain; it occurs in an epidemic form, and is very fatal. See 
Cerebrospinal Fever. For inflammation of the membranes of the spinal 
cord, see Spinal Meningitis. 

Menorrhagia. This disorder is known by a profuse discharge of the cat- 
amenia at the menstrual period, attended with more or less debility, pallor, and 
discomfort. It generally occurs in those who are out of health, and who have 
been weakened by having had a large family, by a difficult labor, or in whom 
there is some disease of the womb or ovaries. The flow may lie more profuse 
than usual, but only last the usual number of days, or it may be more or less 
persistent for several days or weeks, but not very great in amount. After de- 
livery the womb does not always return to its usual proportions, and this will 
often be a source of menorrhagia, as the vessels are then congested and read- 
ily bleed. A tumor in the womb, or a polypus growing from it, or cancer of 
that organ, or displacement of it, will all cause this malady. Those who have 
suffered from lactation or who have had miscarriages are also liable to this af- 
fection. The patient will also have pain in the lower part of the back, and 
perhaps down the thighs, pain or difficulty in passing water or in evacuating 
the bowels, and a general inability to walk or undergo any exertion. The 
amount of pallor will be great in proportion to the loss of blood ; the health of 
the patient is but indifferent ; there is very little appetite, no fever or thirst, 
but a general feeling of languor and prostration. It is sometimes difficult to 
distinguish between this affection and an abortion, but in the latter case there 
will be the fact of pregnancy, and the expulsion of undeveloped portions of the 
foetus. Treatment must consist in rest in the horizontal position on a couch, 
and this may have to be enforced for several days or even weeks. Astringent 
medicines, especially those containing iron or tannin, gallic acid or ergot, may 
be given with benefit. Cold applications and the injection of cold water are 
very useful, and must be given when the haemorrhage proceeds from a tumor 
in or cancer of the womb. The latter disease usually comes on in women over 
forty-five years of age, and generally produces a fatal result in a/ year and a 
half or two years. Emaciation, great pain in the back and abdomen, a sal- 
low, cachectic appearance, a fetid discharge, and occasional menorrhagia are the 
main symptoms of this disorder. In all cases of menorrhagia rest must form a 
chief part of the treatment, the diet ba light and nourishing, and constipation 
be avoided ; a gentle drive may be taken in fine weather by those who are able 
to do so, or, if not, a short walk should be taken daily, so as to obtain a little 
fresh air, but if it bring on a 'fresh discharge of hlood this must be discarded 
for a time. The malady is very apt to recur, and the more so after every suc- 
ceeding confinement ; patients so affected should not get up too soon after a 
labor, as an erect posture tends to cause congestion of the womb, and to in- 
duce a fullness of the vessels which predisposes to menorrhagia. 

Menstruation is a function performed by women between the age of 
puberty and middle life ; this forms the child-bearing period, and usually lasts 



MEN 487 MER 

about thirty years. Various names have been given to this function : it is spoken 
of as the menses, the period, the catamenia, etc. When not performed at all 
the patient is said to have amenorrhea ; when the function is performed with 
difficulty or pain it is called dysmenorrhata ; and when the discharge is very 
profuse the individual is suffering from menorrhagia. The appearance of 
menstruation is generally accompanied by more or less pain in the back, head- 
ache, and lassitude ; often, also, the patient loses color, and has a dark ring 
round the eyes. From thirteen to fifteen years of age is the average time 
when menstruation commences, but it may come on a year or two earlier in 
some cases, or it may be much delayed in others. The periods are frequently 
irregular at first, and some months may elapse before the function is carried 
on with regularity. When well established, an interval of about four weeks 
elapses between each period, but sometimes only three weeks intervene. The 
blood that flows differs from ordinary blood in being acid instead of alkaline, 
and in not clotting unless poured out in large quantities. This function is 
always suspended during pregnancy, and is, in fact, the chief symptom from 
which a woman dates the expected time of her confinement. Many causes 
will tend to produce irregularity in the performance of this function during the 
child-bearing period of life : exposure to cold or wet, mental emotion or worry, 
acute diseases, consumption, cancer, and many other diseases may either cause 
menstruation to stop altogether, or to be diminished in quantity, or to occur at 
irregular intervals. The period of life when menstruation ends is known as 
the climacteric jjeriod, and the cessation of the function is often accompanied 
by more or less distress ; the patient becomes nervous and is easily worried, 
suffers from lowness of spirits, pain in the back and between the shoulders, 
pain also frequently in the left side, and headache ; the temper maybe irritable 
and the appetite capricious. These symptoms arise in a great measure from 
a disturbance in the nervous system, giving rise to various neuralgic pains ; 
such symptoms, however, though often troublesome, are not attended by 
danger, and subside when the function of menstruation has quite ceased; the 
flow generally ceases gradually, and becomes more and more scanty ; some- 
times it is for a short time much increased in quantity. Tonic medicines, such 
as iron and quinine, may be given with advantage, and if there is much ner- 
vous derangement, assafoetida or valerian may be given in addition. 

Mentagra, or Tynea Sycosis, is a disease of the beard, moustache, whis- 
kers, and inner part of the nostrils, in which a little fungus or vegetable para- 
site finds its way into the root of the hair. Its presence sets up inflammation of 
the hair follicle, and a little matter forms around the hair; the part around 
becomes hardened, and brownish thick scabs form among the hairs. It may 
be mistaken for acne or impetigo, but the presence of the parasite under the 
microscope will clear up the doubt. The scabs should be removed by moisten- 
ing them with oil and then applying a hot poultice, or the part may be washed 
with hot oatmeal and water. Each hair should be pulled out and some sub- 
stance applied which will destroy the life of the parasite, as acetic acid, per- 
chloride or pernitrate of mercury. The general health must at the same time 
be kept up by a light and nourishing diet, daily exercise, and the administration 
of tonic medicines. 

Mercury, in Latin, Hydrargyrum, is a remedy about which many doubts 
have been raised. Of its power none can doubt, but of the appropriate cases 
in which to allow its power to be exerted there is still much hesitation and 
doubt. 

Metallic mercury is mainly obtained from its red sulphide, cinnabar, which, 



MER 488 MER 

being distilled, yields mercury. This requires re-distillation, however, and 
washing with dilute hydrochloric acid. When pure, metallic mercury is a 
brilliant white, metallic looking liquid, becoming solid at 40° below zero Fahr., 
and volatilizing at a heat below redness. Rolled on paper, pure mercury forms 
globules which leave no stain; if amalgamated with other metals it generally 
does. Liquid mercury is seldom used in medicine ; it has been given in obsti- 
nate constipation, with the idea that its weight would force a passage, but in 
vain. There are, however, several preparations of mercury where the metal 
is only in a finely divided state, and these are very efficacious. Thus, there is 
mercury with chalk or gray powder, consisting of metallic mercury rubbed with 
chalk till the globules disappear. Mercurial pill or blue pill is prepared in the 
same way, by rubbing metallic mercury with confection of roses till globules 
can no longer be seen. Mercurial ointment or blue ointment is prepared in 
like fashion, by rubbing mercury with lard and suet. These are all admirable 
preparations. Mercurial plaster, mercurial liniment, and mercurial suppos- 
itories all have metallic mercury as their basis. The vapor of mercury acts 
powerfully, as used to be seen in its effects on the makers of looking-glasses. 
By rubbing metallic mercury into the skin till the exceedingly small globules 
make their way through its pores, the full effect of the metal may be produced. 
Given in repeated small doses, mercury first of all increases the various secre- 
tions, the saliva, the bile, the intestinal juices, etc. The increase of the saliva 
is well marked, and salivation is one of the best established actions of mercury. 
The saliva increases, the gums become sore and tender, till they can hardly 
close on a morsel of solid food. Round the bases of the teeth they seem 
swollen, red, and spongy, and moreover yield an exceedingly disagreeable 
fetor ; the inside of the lips may suffer also. This is, as a rule, the first indi- 
cation of the full effects of mercury. On the liver mercury seems to have 
the power of increasing the flow of bile for the time being, or, at all events, 
of emptying the gall-bladder. The metal ordinarily acts as a purgative, pro- 
ducing copious, high-colored, soft motions, the increased fluid coming partly 
from the intestinal canal. Frequently, too, the kidneys act better, getting rid 
of a larger quantity of urine than usual. Mercury, in producing its effects, 
always finds its way into the blood, and may also be detected in various secre- 
tions. It influences the nutrition of the blood for the worse, especially if long 
continued or given in weak subjects. Given in over doses or too long, mercury 
produces serious mischief. The body wastes, and a kind of fever may be in- 
duced. This is sometimes marked by skin eruptions. There are also tremors 
or shaking, beginning in the hands and arms, whose movements lack precision ; 
gradually they extend to the whole body. They cannot be controlled, and 
being excited last some time; even the respiration may become spasmodic. 
Salivation may be absent with tremors. Sulphur baths and iodide of potassium 
are the remedies for the condition. In other cases there is terrible salivation, 
the tongue so swollen that nothing can be taken into the mouth ; the teeth 
may fall out and the jaw-bones die. Occasionally pints of saliva flow per day. 
Jn these cases there may be excessive purging. Salivation is most likely to 
follow the swallowing or inunction of mercury. Mercurial tremors more fre- 
quently occur after inhalation. Children are rarely salivated. Mercury used 
to be given in all cases where acute inflammation existed, with a view to arrest 
its effects. Its preparations were constantly given to salivation with this view ; 
now they are seldom so used, except in inflammation of the iris and deep-seated 
parts of the eye, and in inflammation of some serous membranes, as the perito- 
neum, which lines the abdomen. They are also used with a view to the re- 



MBR 489 MBR 

moval of the deposits caused by inflammation, as in effusions into the pleura, 
in pericarditis, etc., but assuredly in some of these its effects are not only 
useless but injurious. In acute rheumatism mercury is still given by some 
practitioners, but they are not numerous. The general opinion is that few rem- 
edies, if any, affect the cause of the disease, which must be watched for com- 
plications. In these, mercury may be of use ; in the ordinary disease, never. 
In certain forms of dropsy mercury may be of great use, especially if from 
antecedent inflammation, but in the majority they are worse than useless. In 
syphilis mercury used to be given invariably; now, not in all, but in a certain 
number of cases. On the whole, a case of syphilis is better for mercury, pro- 
vided the health of the individual will bear the course, but not otherwise. It 
is best, too, perhaps to give it by vapor, as a mercurial vapor-bath, or by ene- 
mata, as that will not interfere so much with digestion. Its use should in no 
case be continued too long, or harm will follow. It is a common practice, and 
on the whole a satisfactory one, to give a blue pill and a slightly purgative 
draught for bilious headache, or when there are the usual symptoms of bilious- 
ness, furred tongue, foul breath, etc. Gray powder is much given in the affec- 
tions of children ; in many it requires caution, especially in rickets. The same 
preparation is extremely valuable in certain forms of diarrhoea, where the 
motions are green and slimy, frequent and offensive, as occurring in children. 
In other cases, corrosive sublimate, especially in adults, does better. The gray 
powder is usually given in doses of from a grain to five grains. The blue 
ointment is rubbed into the skin at the groins and arm-pits to produce the 
effects of a mercurial preparation. 

Calomel, also known as the subchloride of mercury, is one of the best known 
preparations of mercury. It is prepared from the sulphate of mercury, and is 
a heavy white powder, insoluble in water, ether, or spirit, but volatilized by 
heat ; it is quite tasteless. Added to lime-water, calomel yields the well- 
known black-wash (lotto nigra), which consists, however, of the suboxide of 
mercury mainly. The compound calomel or Plummets -pill is another well- 
known preparation ; it contains calomel, sulphurated antimony, guaiacum resin, 
and castor oil. Calomel ointment consists of lead and calomel. Internally 
calomel does not irritate, but generally gives rise to nausea, and purges if given 
in sufficient dose. It acts apparently on the liver and intestines, and is largely 
used in the treatment of certain of these maladies. In children it produces 
green stools. The compound pill is mainly used as an " alterative " in chronic 
skin diseases, especially of a syphilitic origin. Black Wash is used on sores of 
a syphilitic character. As a purgative calomel is given in doses of from two to 
ten grains. Its chief advantage is its tastelessness. If it is to affect the sys- 
tem, only small doses, one fourth or one half a grain, are given every four 
hours. Calomel may also be given as a fumigation. Calomel ointment is 
often used for the relief of the itching of some forms of skin disease, and is 
blown into the eye in certain forms of ophthalmia. 

Corrosive sublimate is the perchloride of mercury. It occurs in crystals of 
a metallic taste ; it is very heavy, and is soluble in water, still more so in alco- 
hol and ether ; when heated it sublimes. Two preparations of it are used, the 
solution of corrosive sublimate {liquor hydrargyri perchloridi) and yellow wash. 
The former consists of an excessively dilute solution of corrosive sublimate ; 
the latter of the peroxide of mercury, the perchloride being thrown down by 
lime-water. This is the most powerfully irritant of all the preparations of 
mercury, and requires to be given with great caution. In large doses it causes 
vomiting and purging, and it may even prove fatal. Applied to the skin it 



MES 490 MES 

corrodes the part, and in this way, too, has proved fatal to children. In very 
small doses it is used in syphilis and skin diseases which have hecome chronic. 
As a lotion it is useful in certain forms of throat and chronic discharges. It 
is helpful in certain parasitic diseases of the skin, when these are due to fungi. 
For other parasites, as lice of all kinds, a very weak solution of corrosive sub- 
limate is the best application, and also often relieves the terrible itching they 
cause. This should not be stronger than a grain or two grains of the salt to 
an ounce of water. Several forms of diarrhoea, especially of the dysenteric 
kind, are relieved by corrosive sublimate ; the dose internally should never 
exceed one-eighth of a grain. 

White precipitate of mercury, orammoniated mercury, is obtained by precipi- 
tating corrosive sublimate by ammonia. It contains ammonia itself, and is 
a white amorphous powder, capable of sublimation. It is never given inter- 
nally, and its only preparation is an ointment which is chiefly used for de- 
stroying vermin ; for this it is well fitted. It is also used for unpleasant smell- 
ing discharges from the nostrils. 

Green iodide of mercury is obtained by causing iodine and mercury to com- 
bine directly. It does not keep very well. It acts similarly to calomel, but 
does not purge nearly so much ; it is therefore chiefly used for the constitu- 
tional effects of mercury, and with many is the favorite preparation for syphilis. 
It is also used as an ointment for skin eruptions. 

The red iodide of mercury is of more importance. Internally it is usually 
combined with some other substance, iodide of potassium and corrosive subli- 
mate being mixed to form it. It is largely given in the advanced stages of 
syphilis, with excess of iodide of potassium. It should not be given in any 
substance containing an alkaloid. Goitre and enlarged spleen have been suc- 
cessfully treated by its ointment, especially in India. 

Red oxide of mercury, also known as red precipitate, is usually seen as red 
shining crystals, entirely volatilizing by heat. Its ointment is only used ex- 
ternally, as an irritant to the eyelids in ophthalmia, to destroy vermin, and the 
like. It is also applied to indolent ulcers of a specific kind. 

The acid nitrate of mercury, or its solution, is made by dissolving mercury 
in nitric acid. This is a colorless and highly acid solution, of which the only 
preparation is an ointment which used to be called citrine ointment. The solu- 
tion itself is a powerful caustic, and has been applied to arrest the disease 
called lupus. It is not given internally. This ointment, too, is irritant or 
stimulant, and is used in some eye diseases, especially inflammation of the lids, 
and in chronic scaly eruptions about the hands, especially from syphilis. 

The sulphuret of mercury (artificial cinnabar), better known as vermilion, is 
not now officinal. It may be employed for local fumigation, and also as an 
inhalation off a hot brick, or from a lamp specially contrived, for syphilitic 
sore throat. It is useless in the earlier forms of sore throat, but may do good 
when there is ulceration ; dilute solution of corrosive sublimate applied as 
spray is, however, better. 

Sulphate of mercury is only used as the basis of these preparations. 

Mesentery. The mesentery is a double fold of peritoneum which retains 
the small intestines in their place in the abdominal cavity ; it is fan-shaped in 
form, and attached to the front of the spine at its narrow end. Around its 
longer margin the bowels are arranged, so that perfect freedom of movement 
upon each other is allowed, while yet each portion keeps in its proper place. 
Between these two folds run some vessels which take blood to and from the 
intestines ; these are called the mesenteric vessels, and consist of arteries and 



MES 491 MBS 

veins ; they are also accompanied by various nerves. There are besides a 
great many glands in the mesentery, called the mesenteric glands, and these 
are often liable to disease ; through these glands passes an alkaline, opalescent 
fluid called the chyle ; this chyle is collected in the intestinal walls by a vast 
number of small vessels called lacteals, which are very analogous to the lym- 
phatic vessels in other parts of the body ; these lacteals join together and form 
larger branches, until, having passed through the mesenteric glands, they con- 
vey the chyle, altered by that process, to the receptaculum chyli, a dilated 
tube lying in front of the spine and serving as a kind of reservoir for that fluid, 
which afterwards passes up the thoracic duct, entering the blood at the left side 
of the root of the neck. The mesenteric glands become much enlarged in 
typhoid fever and in some cases of consumption ; very frequently also they 
become diseased in children, and this may occur very early in infant ' life ; 
when this occurs, the nutrient material of the food which ought to be absorbed 
in the intestine is diminished in quantity, and so the chyle, being altered per- 
haps in quality as well as in amount, and obstructed by the disease in the 
glands, is unable to pass on into the blood as usual, and emaciation and death 
may ensue. Mesenteric disease is most common in scrofulous children ; such 
infants have large stomachs, and a doughy skin ; perhaps the enlarged glands 
may be felt through the abdominal walls, as a hard, firm mass in front of the 
spine ; sickness and emaciation attend the disease, and frequently diarrhoea and 
constipation alternate ; at times dropsy comes on and adds to the suffering. In 
such cases great care must be taken in giving the child a light but nourishing 
diet, consisting chiefly of milk, with an occasional egg., and some beef-tea or 
good mutton-broth ; solid food should be avoided, as it may irritate too much 
the delicate mucous membrane of the stomach and intestines. Preparations 
containing iron, as iron wine or the syrup of the phosphate of that metal, are 
very valuable, and may be given in small doses twice a day. Lime-water 
should be mixed with the milk in the proportion of one part of the former to 
three or four parts of the latter, if there is much sickness or diarrhoea present. 
Great benefit will be derived from rubbing cod-liver oil into the skin night 
and morning ; it often happens that a child dislikes or cannot take cod-liver oil 
by the mouth, and this plan of rubbing it into the skin is very efficacious, and 
prevents any sickness or distress arising from taking it by the mouth ; its 
action is increased in value, if about one-tenth part of strong solution of am- 
monia is added to the oil ; the skin is thereby stimulated and absorption takes 
place with greater ease. Children suffering from this disease often derive 
benefit from going to the sea-side, and although they are seldom in a condition 
to bathe in the sea, yet a daily bath in sea-water in the nursery is of much ser- 
vice. Should dropsy come on in these cases, an operation for removing the 
fluid from the abdomen may be resorted to ; the procedure is simple enough, and 
consists merely in introducing a small hollow tube through the skin, and allow- 
ing the fluid to run through it. The after-treatment will consist in a soft flan- 
nel bandage being passed round the abdomen, rest in bed for a while, and in a 
diet similar to what has been mentioned above. Disease of the mesenteric 
glands attended by wasting is called by the technical name tabes mesenterica 
by some authors. 

Mesmerism, A term usually applied to the phenomena of animal mag- 
netism, after the name of its first propounder, Anton Mesmer, a German phy- 
sician, born at Baden in 1739. Perhaps the time has not yet come when the 
combined physiological, pathological, and psychological phenomena of mesmer- 
ism can be rationally explained. At any rate, it involves a series of facts in 



MES 492 MBS 

relation to the human system which historically have a high interest. Many 
of these are new since the time of Mesmer, but he first gave a systematic 
character to the phenomena and sought to refer them to scientific principles. 
Since the death of Mesmer animal magnetism has had directed towards it a 
great amount of attention, and has been investigated by physiologists of emi- 
nence, and used as a curative agent by some medical men. One of the first 
publications in English on the subject was by Mr. Richard Chenevix, a Fellow 
of the Royal Society, who published a series of papers in The London Medical 
and Physical Journal, in 1829, entitled On Mesmerism, Improperly Denom-' 
inated Animal Magnetism. He performed many experiments, which were 
witnessed by medical men interested in the subject, amongst others by Dr. 
Elliotson, who afterwards became an advocate and believer in the theory. The 
result of Dr. Elliotson's experiments were published in the Lancet and pro- 
duced a great sensation, and phenomena which had hitherto been regarded as 
impossible were constantly produced. Various remarkable cases were recorded 
by medical men, and we find the names of Mr. Herbert Mayo, M. La Fon- 
taine, a Frenchman, and Mr. Braid, of Manchester, associated with the in- 
quiries which, about the years 1841 and 1843, were entered into. A great 
impulse was given to the theory of mesmerism by a series of letters to the 
Athena3iun from Miss Martineau, who attributed her cure from a long-standing 
ailment to the influence of animal magnetism. A correspondence on the sub- 
ject took place at that time in the pages of the Athenaeum, in which Miss 
Martineau's conclusions were shown to be mistaken, to the satisfaction of the 
majority of readers. 

Writers on animal magnetism distinguish many stages. The following 
classification is by Kluge, a German writer on the subject : — 

First Degree. Called waking, when the intellect and senses retain their 
ordinary powers and susceptibility. 

Second Degree. Half sleep, or imperfect crisis. Most of the senses retain 
their activity, that of vision only being impaired, the eye withdrawing itself 
from the power of the will. 

Third Degree. The magnetic, or mesmeric sleep. The organs of the senses 
refuse to perform their respective functions, and the patient is in an uncon- 
scious state. 

Fourth Degree. The perfect crisis, or simple somnambulism. In this stage 
the patient is said to " wake within himself," and his consciousness returns. 
He is in a state which can neither be called sleeping nor waking, but which 
appears to be something between the two. 

Fifth Degree. Lucidity, or lucid vision. This is called in France and mostly 
in this country clairvoyance ; in Germany, hellsehen. In this state the patient 
is said to obtain a clear knowledge of his own internal, mental, and bodily 
state ; is enabled to calculate with accuracy the phenomena of disease which 
will naturally and inevitably occur, and to determine what are their most ap- 
propriate and effectual remedies. He is also said to possess, the same faculty 
of internal inspection with regard to other people who have been placed in 
mesmeric connection (en rapport) with him. 

Sixth Degree. Universal lucidity. In this state the lucid vision becomes 
greatly increased, and extends to objects whether near or at a distance. 

Such is the system as recognized by mesmerists, and many volumes have 
been written on each phase and condition. Many who practice mesmerism 
are themselves skeptical with regard to the real existence of the last two de- 
grees, although such cases are recorded. Many theories have been propounded 



MET 493 MET 

in order to embrace the facts of animal magnetism, and numerous aspects given 
to the question by inquiries, both in confirmation and refutation of the sup- 
posed facts elicited by inquiry. The whole series of phenomena known as 
electro-biology, table-turning, spirit-rapping, and odylic force are based prima- 
rily on this condition of mesmeric sleep or influence. There can be no doubt 
that the condition of mesmeric sleep does exist, and that some persons are 
much more susceptible to this condition than others. When under this in- 
fluence they are readily made to obey the will of another, and become as it 
were the slaves of suggestion and the victims of the operators. They exercise 
their volition unconsciously, and attribute it to the existence of a mysterious 
force. The known fact of the great increase of force that takes place in nor- 
mal conditions of the system when the whole attention is concentrated on one 
idea serves to explain the feats of strength performed by persons in the sleep- 
waking state. The whole of this curious subject has been ably discussed by 
Dr /Carpenter, in an article in the Quarterly Review. Although so many of 
the phenomena of mesmerism admit now of a rational explanation, it is still 
practiced as a mystery, and large numbers of persons give credence to its 
marvels. Exhibitions are constantly made before the public, professing to be 
tests of the power of mesmerism or electro-biology, which are, in fact, but the 
feats of clever conjurers, and present no remarkable phenomena at all. Such 
attempts do but injure the, reputation of those who may be earnestly inquiring 
into natural and curious conditions of the nervous system with a view to dis- 
cover truth. 

Metacarpus is a name given to the bones which lie between the wrist or 
carpus and the fingers or phalanges. 

Metastasis. Change, transposition. This is a medical term used by 
physicians to express that change which sometimes takes place in the seat of 
a disease, as when in gout or rheumatism the heat and pain suddenly leave 
the foot and take up their abode in the hand or fingers, or go from an ex- 
ternal to an internal organ ; such a condition of a disease is called a metas- 
tasis, and is always to be apprehended, as a disease migrating from an ex- 
ternal to an internal part may be more or less dangerous. 

Metatarsus is the name given to the bones which lie between the tarsus 
or ankle and the toes ; it corresponds to the metacarpus of the hand. 

Meteorology. The phenomena which are produced in the atmosphere 
are called meteors ; and meteorology is that part of physics which is concerned 
with the study of these phenomena. A distinction is made between aerial 
meteors, such as winds and hurricanes and whirlwinds ; aqueous meteors, com- 
prising fogs, clouds, rain, dew, snow, and hail ; and luminous meteors, as light- 
ning, the rainbow, and the aurora borealis. 

(a.) Aerial Meteors. Winds are currents moving in the atmosphere with 
variable directions and velocities. There are eight principal directions in 
which they blow : north, northeast, east, southeast, south, southwest, west, and 
northwest. Each of the distances between the directions are further divided 
into four others, making thirty-two directions in all, which are called points of 
the compass. The direction is determined by means of vanes, and its velocity 
by means of the anemometer. There are several forms of this instrument; 
the most usual consists of a small vane with fans, which the wind turns ; the 
velocity is deduced from the number of turns made in a given time, which is 
measured by means of an endless screw and wheel-work. In our climate the 
mean velocity is from 18 to 20 feet in a second. With a velocity of six or 
seven feet in a second, the wind is moderate ; with 80 or 35 feet, it is fresh ; 



MET 494 MET 

with 60 or 70 feet, it is strong; with a velocity of 85 to 90 feet, it is a tem- 
pest ; and from 90 to 120 it is a hurricane. Winds are produced hy a disturb- 
ance of the. equilibrium in some parts of the atmosphere, a disturbance always 
resulting from a difference in temperature between adjacent countries. Thus, 
if the temperature of a certain extent of ground becomes higher, the air in 
contact with it becomes heated ; as it expands it rises toward the higher regions 
of the atmosphere ; whence it flows, producing winds which blow from hot to 
cold countries. But at the same time the equilibrium is destroyed at the sur- 
face of the earth, for the barometric pressure on the colder adjacent parts is 
greater than on that which has been heated, and hence a current will be pro- 
duced with a velocity dependent on the difference between these pressures ; 
thus two distinct winds will be produced, an upper one setting outwards from 
the heated region, and a lower one setting inwards toward it. 

(1.) Regular winds are those which blow all the year through in a virtually 
constant direction. These winds, which are also known as the trade winds, 
are observed far from the land, in equatorial regions, to be constantly blowing 
from the northeast to the southwest in the northern hemisphere, and from the 
southeast to the northwest in the southern hemisphere; thus they blow from 
east to west in the same direction as the apparent motion of the sun. (2.) 
Periodical winds are those which blow regnlarly in the same direction at the 
same seasons, and at the same hours of the day ; the monsoon, simoon, and the 
land and sea breeze are examples of this class. The name monsoon is given 
to winds which blow for six months in one direction, and for six months in 
another. They are chiefly observed in the Red Sea and in the Arabian 
Gulf, in the Bay of Bengal and in the Chinese Sea. These winds blow to- 
wards the continent in summer, and in a contrary direction in winter. The 
simoon is a hot wind which blows over the arid plains of Asia and Africa, 
and is characterized by its high temperature, and by the sands which it raises 
in the atmosphere, and carries with it. During the prevalence of the wind, 
the air is darkened, the skin feels dry, the respiration is accelerated, and a 
burning thirst is experienced. This wind is known under the name of sirocco 
in Italy and Algiers, where it blows from the great Desert of Sahara. In 
Egypt, where it prevails from the end of April to June, it is called kamsin. 
The natives of Africa, in order to protect themselves from the effects of the 
too rapid perspiration occasioned by the wind, cover themselves with fatty sub- 
stances. The land and sea breeze is a wind which blows on the sea-coast, 
during the day from the sea towards the land, and during the night from the 
land to the sea. For during the day the land becomes more heated than the 
sea, in consequence of its lower specific heat and greater conductibility, and 
hence as the superincumbent air becomes more heated than that upon the sea 
it ascends, and is replaced by a current of colder and denser air flowing from 
the sea towards the land. During the night the land cools more rapidly than 
the sea, and hence the same phenomenon is produced in a contrary direction. 
The sea breeze commences after sunrise, increases to three o'clock in the after- 
noon, decreases towards evening, and is changed into a land breeze after sun- 
set. These winds are only perceived at a slight distance from the shores. 
They are regular in the tropics, but less so in our climate ; and traces of them 
are seen as far as the coast of Greenland. (3.) Variable winds are those which 
blow sometimes in one direction, and sometimes in another, alternately, with- 
out being subject to any law. In mean latitudes the direction of the winds is 
very variable ; towards the poles this irregularity increases, and under the 
arctic zone the winds frequently blow from several points of the horizon at 



MET 495 MET 

once. On the other hand, in approaching the torrid zone, they become more 
regular. The southwest wind prevails in the north of France, in England, and 
in Germany ; in the south of France the direction inclines towards the north, 
and in Spain and Italy the north wind predominates. 

Waterspouts are masses of vapor suspended in the lower layers of the at- 
mosphere which they traverse ; they are endowed with a gyratory motion rapid 
enough to uproot trees, upset houses, and break and destroy everything with 
which they come in contact. These meteors may be produced in a calm at- 
mosphere, but are generally accompanied by hail and rain. 

(b.) Aqueous Meteors. Fogs are masses of vapor which condense in the lower 
regions of the atmosphere, and render it more or less opaque. A chief cause 
of fogs consists in the moist soil being at a higher temperature than the air. 
The vapors which then ascend condense and become visible. In all cases, 
however, the air must have reached its point of saturation before the condensa- 
tion takes place. 

Clouds are masses of vapor, condensed into little drops or vesicles of extreme 
minuteness, like fogs, from which they differ only in occupying the higher re- 
gions of the atmosphere ; they always result from th^ condensation of vapors 
which rise from the earth. They are divided into four kinds, the nimbus, the 
stratus, the cumulus, and the cirrus. The cirrus consist of small whitish clouds, 
which have a fibrous or wispy appearance, and occupy the highest regions of 
the atmosphere. The name of mares' tails, by which they are generally known, 
well describes them. Their appearance often precedes a change of weather. 
The cumulus are rounded or even spherical forms which look like mountains 
piled one on the other. They are more frequent in summer than in winter, 
and after being formed in the morning they generally disappear before evening. 
If, on the contrary, they become more numerous, and especially if surmounted 
by cirrus clouds, rain or storms may be expected. Stratus clouds consist of 
very large and continuous horizontal sheets, which chiefly form at sunset and 
disappear at sunrise. They are frequent in autumn and unusual in spring-time, 
and are lower than the preceding. The nimbus or rain clouds are properly a 
combination of the three preceding kinds. They affect no particular form, and 
are solely distinguished by an uniform gray tint and by fringed edges. The 
height of clouds varies greatly : in the mean it is from 1300 to 1500 yards in 
winter, and from 3300 to 4400 yards in summer. But they may exist at 
greater heights ; Gay-Lussac, in his balloon ascent, at a height of 7650 yards, 
observed cirrus clouds above him, which appeared still to be at a considerable 
height. 

Rain. When by the constant condensation of aqueous vapor the individual 
vapor vesicles in the atmosphere become larger and heavier, they form drops, 
which fall as rain. The quantity of rain which falls annually in any given 
place, or as it is termed the annual rainfall, is measured by means of a rain- 
gauge or pluviometer. This generally consists of a cylindrical vessel closed 
at the top by a funnel shaped lid, in which there is a very small hole through 
which the rain falls. At the bottom of the vessel is a glass tube, in which the 
water rises to the same height as inside the rain-gauge, and is measured by a 
scale on the side. The apparatus being placed in an exposed situation, if at 
the end of a month the height of water in the tube is two in hes, for example, 
it shows that the water has attained this height in the vessel : and, consequently, 
that a layer of two inches in depth expresses the quantity of rain which this 
extent of surface has received. If rain-drops traverse moist air, they will, from 
their temperature, condense vapor and increase in volume ; if, on the contrary, 



MET 496 MET 

they traverse dry air, the drops tend to vaporize, and less rain falls than at a 
certain height ; it might even happen that the rain did not reach the earth. 
Many local circumstances affect the rainfall in different countries ; but most 
rain falls in hot climates, for there the vaporization is most abundant. The 
rainfall decreases, in fact, from the equator to the poles. At London it is 
23.5 inches per year ; at Bordeaux it is 25.8 ; at Madeira it is 27.7 ; at Ha- 
vana it is 91.2; and at St. Domingo it is 107.6. The quantity varies with 
the seasons : in Paris, in winter it is 4.2 inches ; in spring, 6.9; in summer, 
6.3 ; and in autumn, 4.8 inches. An inch of rain on a square yard of surface 
expresses a fall of 46.74 pounds, or 4.67 gallons. On an acre it corresponds to 
.22,622 gallons, or 100.99355 tons. One hundred tons per inch per acre is a 
ready way of remembering this fact. 

Dew is merely aqueous vapor which has condensed on bodies .during the 
night in the form of minute globules. It is occasioned by the chilling which 
bodies near the surface of the earth experience in consequence of nocturnal ra- 
diation. Their temperature, then, having sunk several degrees below that of 
the air, it frequently happens, especially in hot seasons, that this temperature 
is below that at which the air is saturated. The layer of air which is immedi- 
ately in contact with the chilled bodies, and which virtually has the same temper- 
ature, then depo.>its a portion of the vapor which it contains ; just as when a 
glass of cold water is brought into a warm room it becomes covered with moist- 
ure, owing to the condensation of aqueous vapor upon it. The state of the sky 
exercises a great influence on the formation of dew. If the sky is cloudless, the 
planetary spaces send to the earth an inappreciable quantity of heat, while the 
earth radiates very considerably, and therefore, becoming very much chilled, 
there is an abundant deposit of dew. But if there are clouds, they radiate in 
turn towards the earth, and as bodies on the surface of the earth only experi- 
ence a feeble chilling, no deposit of dew takes place. A feeble wind increases 
the deposit of dew, inasmuch as it renews the air ; a strong wind diminishes its 
formation, as it heats the bodies by contact, and thus does not allow the air time 
to become cooled. Lastly, the deposit of dew is more abundant in proportion 
to the moisture of the air, and it is greatest when it is near its point of satura- 
tion. The night-dew is a deposit of very minute rain from a very clear sky. 
It takes place during very great heat in moist countries at sunset, when the 
lower layers of the air are cooled below their point of saturation. 

Hoar-frost and rime are nothing more than dew which has been deposited on 
bodies cooled below zero, and has therefore become frozen. 

Snoiv is water solidified in stellate crystals, variously modified and floating 
in the atmosphere. These crystals arise from the congelation of the minute 
vesicles which constitute the clouds, when the temperature of the latter is below 
zero. 

Sleet is also solidified water, and consists of small icy needles pressed together 
in a confused manner. Its formation is ascribed to the sudden congelation of 
the minute globules of the clouds in an agitated atmosphere. 

Hail is a mass of compact globules of ice, of different sizes, which fall in the 
atmosphere. In our climates hail falls principally during spring and summer, 
and at the hottest times of the day ; it rarely occurs at night. 

(c.) Luminous Meteors. This subject includes the lightning, rainbow, and au- 
rora borealis. The first need only be considered here. 

Lightning is the dazzling light emitted by the electric spark when it shoots 
from clouds charged with electricity : sometimes the flash is zigzag, and moves 
with great velocity and sharp outline ; sometimes the flashes, instead of being 



MET 497 MET 

linear, fill the whole horizon without having any distinct shape. There is also 
the so-called .heat lightning, which illumines the summer nights, without the 
presence of any clouds above the horizon, and without producing any noise. 
The lightning discharge is the electric discharge which strikes between a 
thunder-cloud and the ground. The latter, by the induction from the electricity 
of the cloud, becomes charged with contrary electricity, and when the tendency 
of the two electricities to combine exceeds the resistance of the air the spark 
passes, which is often spoken of as a thunderbolt having fallen. The discharge 
generally falls on the nearest and best conducting objects, and, in fact, trees, 
elevated buildings, and metals are more particularly struck by the discharge. 
Hence it is imprudent to stand under trees in stormy weather, especially if they 
are good conductors, such as oaks and elms. The lightning discharge kills men 
and animals, inflames combustible matters, melts metals, and breaks bad con- 
ductors in pieces. After the passage of lightning, a very singular odor is often 
produced. This odor is attributed to the formation of ozone, a peculiar modi- 
fication of oxygen, first discovered by Schonbein in 1840. The return shock is 
a violent and sometimes fatal shock, which men and animals experience even 
at a distance from the place where the lightning discharge has passed. It is 
caused by the inductive action which the thunder-cloud exerts on bodies placed 
within the sphere of its activity. These bodies are then, like the ground, 
charged with the opposite electricity to that of the cloud; but when the latter 
is discharged by the recombination of its electricity with that of the ground, 
the induction ceases, and the bodies reverting rapidly from the electrical to the 
neutral state, the concussion in question is produced. A lightning conductor 
consists of a rod and a conductor; the rod is a pointed bar of iron, fixed verti- 
cally to the roof of the building to be protected ; it is from six to ten feet high, 
and its basal section is about two or three inches in diameter : the conductor is 
a bar of iron or copper, which descends from the bottom of the rod to the ground, 
which it penetrates to some distance. Strands of iron or copper wire may be used 
instead of a rod. A conductor, to be efficient, must satisfy the following condi- 
tions : (1) the rod ought to be so large as not to be melted if the discharge passes ; 
(2) it ought to end in a point, to give readier issue to the electricity disengaged 
from the ground ; (3) the conductor must be continued from the point to. the 
ground, and the connection between the rod and the ground must be as intimate 
as possible; (4) if the building which is provided with a lightning conductor 
contains metallic surfaces of any extent, these ought to be connected with the 
conductor, or else lateral discharges m^j take place between the conductor and 
the edifice, and the danger may be increased. 

The following account of the meteorology of 1869 is taken from the English 
Registrar-General's report of that year, and is drawn up by Mr. Glaisher : — 

Jn the year 1868 the meteorology was remarkable for long continuance of 
high temperature, for unusual distribution of rain, and for a generally early 
season of vegetation. In 1869, however, the several meteorological conditions 
differed but little from the average of twenty-one years ; the mean weekly 
movement of the air was 2043 miles, exceeding the average by 299 miles. 

Atmospheric Pressure. The readings of the barometer showed considerable 
fluctuations early in January ; but were nearly constantly above the average 
from the 6th to the 25th. From this date to the 3d of February the readings 
were low, and on the 1st 28.13 was recorded, a steady increase commenced on 
February 21st,. and reached its maximum, 30.12, on March 23d, after which a 
decrease set in. During April the readings were generally above the average. 
In May a fall took place to 29.01 on the 6th, after which an increase culmi- 
32 



MEZ 498 MIL 

nated in a maximum of 30.06 on the 13th. Frequent fluctuations occurred 
from that time to the end of Jane. The mean readings for July and August 
were unusually high, 29.93 and 29.97 respectively ; in September the average 
reading was 29.64 ; in October the readings were high and very steady ; in 
the month of November the readings were low except from the 10th to the 
21st, when they were above the average; in December there were great fluc- 
tuations, the range being as great as 1.62 inches. (See Barometkr.) For 
an account of the temperature, the reader is referred to the article on the 
subject. 

Rainfall. In both January and February the rainfall was somewhat above 
the average, while there was a slight deficiency in March. In April only one 
inch of rain was measured, which was about two-thirds of the average quan- 
tity ; in May 3.4 inches of rain fell, and this was much in excess of the aver- 
age; while June was unusually dry, as were both July and August. In Sep- 
tember there was an excess, and in October there was a deficiency, of rain, 
while in November an average amount fell. In December again there was 
excess. The rainfall for the year at the Observatory, Greenwich, amounted 
to twenty-four inches, which was two-tenths of an inch below the average of 
twenty-one years, and 1.2 inches below the fall of 1868. The rainfall, how- 
ever, varied considerably at the different stations for observation : it ranged 
from 21.4 inches at Cardington, and 21.6 inches at Eastbourne, to 47.9, 54.3, 
and 54.6 inches, respectively, at Lampeter, Stonyhurst, and Allenheads. Rain 
fell only on 123 days in the year at Stratfield Turgiss, and on 267 days at 
Allenheads, these being the extreme ; at the Observatory, Greenwich, rain 
was measured on 147 days. 

Mezereon Bark is the bark of the Daphne mezereon, a shrub well known. 
Two plants, however, yield the bark of commerce. This bark is thin, flat or 
curled, tough, brown outside and white within. It is not easily broken. 
When boiled, an acrid vapor is given off. There is an ethereal extract of the 
bark, which, however, is seldom given internally in this country. It is a pow- 
erful local irritant, and even blisters. Internally it causes vomiting and purg- 
ing. It has been used in chronic rheumatism, syphilitic pains, and skin dis- 
eases. It is contained in the compound decoction of sarsaparilla. 

Midriff. This word is another term for the diaphragm, or muscle which 
is attached to the sternum or breast-bone just above the stomach, entirely 
dividing that portion of the trunk into two cavities: the upper, the thorax 
or chest, and the lower, the abdomen or belly. It is this muscle which is lia- 
ble to a spasmodic affection known as hiccup, or hiccough, occasioned by some 
slight derangement of the stomach, and usually very transient. 

Migraine, or Brow Ague, is a painful disorder generally seated on one 
side of the forehead, and causing, while it lasts, great distress to the patient. 
It is met with in both sexes, and chiefly in those of a nervous temperament. 
See Intermittent Fever. 

Miliaria are minute vesicles or little blisters, which at first are transparent, 
but soon become opaque and purulent in appearance. They are often seen on 
the trunks and extremities in cases of rheumatic fever. They differ from 
sudamina in being pointed, in their opacity soon after they appear, and in the 
narrow red halo around ; however, some look on the two as identical. They 
usually come on in summer-time, and are connected with profuse perspiration. 

Milk is the liquid formed in the breasts of all the mammalian tribe of ani- 
mals, the object of which is the support of their young till the time comes that 
they can take other food. From the earliest time man has used the milk of 



MIL 



499 



MIL 



the domesticated mammalia for the purpose of supplying himself with food. 
The milk of all forms of mammalia is more or less alike, and contains sub- 
stances necessary for the nutrition for the whole body. Milk is in fact the 
type of all food. (See Food.) Although man in various countries has re- 
course to the milk of the horse, the ass, and the goat, the milk which is most 
frequently used as man's food is that of the cow. For this purpose the cow 
is extensively fed and pastured in the various countries. The following is an 
analysis of the milk of the cow in 100 parts : — 

Water 86.01 

Caseine 5.0 

Batter 3.5 | 

. Sugar of milk .... 4.5 \ 

- Mineral matter .... 1.0 I 



Water 86.0 

Flesh and force producers 5.0 
Heat and force producers . 8.0 



Mineral matter 



1.0 



100.0 J [ 100.0 

Not only does milk contain food in an easily digestible form capable of becom- 
ing the food of infants, but its easy digestibility does not interfere with its 
being used as the food of strong men. The value of milk as an article of 
diet may be stated in an abstract manner, in the ascertained fact that one 
pound of cow's milk when digested and oxidized is capable of producing a 
force which would raise 390 tons one foot high. This force, if it could be ex- 
actly realized, would enable a man to raise 70 tons one foot, or to perform an 
amount of work with his brain and muscles equal to the act of raising 70 tons 
a foot high. This is done through the agency of the oxygen of the air acting 
upon the carbon and hydrogen contained in the heat and force producing con- 
stituents of the milk. The flesh-forming constituents in a pound of milk, the 
caseine, if all digested and appropriated, is capable of making t 8 q of an ounce of 
dry muscle or flesh. Although cow's milk contains the same general constitu- 
ents as human and other milks, there is a considerable difference in the quan- 
tity of these constituents. The following table presents the different quantities 
of the substances contained in 100 parts of woman's, cow's, and ass's milk : — 





Cow's Milk. 


Human Milk. 


Ass's Milk. 




86 
5 
Si 

i 


891 
3 
3 
4 
* 


90 


Caseine, or flesh and force-producers . . . 
o u e f [ Heat and force-producers j " ' " 


2 

H 
6 

h 






100 


100 


100 





It will be seen from this table that cow's milk contains less water and more 
caseine, butter, sugar, and mineral matter than mother's or ass's milk. Hence 
when cow's milk is used for the feeeding of young children, it is usual to add 
a certain quantity of water ; one tablespoonful of water to two tablespoonfuls 
of milk is usually recommended. This, however, is not needed when the milk 
presents less than eight per cent, of cream by the lactometer. But when a 
third of water is added to the milk, the sugar of the cow's milk is reduced 
below the quantity in human milk ; hence it is desirable to add a little sugar, 
say half a drachm or half a teaspoonful to three tablespoonfuls, or a wine- 
glassful of the watered milk. A better substitute for mother's milk than 



MIL 500 MIL 

cow's milk is undoubtedly ass's milk. It should be remembered that ass's 
milk is altogether a feebler milk than mother's milk. It contains more water, 
less caseine, and less butter. It has, however, more sugar, and this may- 
make up for the deficiency in butter. Although ass's milk can be supplied in 
cities at the door if wished, it is too expensive to be used generally, and must 
be regarded as the luxury of aristocratic babies rather than a general substi- 
tute for mother's milk. The milk of the goat is very like that of the cow, and 
is extensively employed in the mountainous districts of Switzerland, where 
the goat is more easily grazed than the cow. In Sweden and Denmark the 
milk of the sheep is used as an article of diet ; in Lapland the people use the 
milk of the reindeer, and in Tartary mare's milk is emplo3 r ed. Cow's milk 
varies in its quantity and composition, according to various circumstances, so 
that no standard can be given by which genuine milk may be ascertained. 
Thus milk is known to vary according to the age of the cow, the age of the 
calf, and other circumstances in the life of the cow. The time of the day at 
which the cow is milked makes some difference. It is found to be richer in 
solids in the morning. The kind of feeding also produces a difference ; beet- 
root and carrots, for instance, are known to increase the sugar. There are 
different varieties of cows which are known to give milk of different quality. 
Thus, Alderney cows give more butter, and long-horns give more caseine. 
Milk as sold in the* large towns of this country is frequently adulterated. The 
most common and frequent, because the easiest, form of adulteration is that of 
the addition of water. Although when large in quantity water may be easily 
detected, yet within the limitations of the natural varieties of milk it is diffi- 
cult to detect the addition. The easiest way of detecting adulteration by water 
is to take the specific gravity of the suspected milk. The specific gravity of 
good milk varies, however, from 1026° to 1035°. The average specific grav- 
ity, therefore, of unskimmed milk is 1030°; at the same time a milk with a 
specific gravity of 1026°, is not to be condemned as necessarily containing 
water. The following table, by Dr. Parkes, gives the specific gravities of 
milks, when mixed with varying quantities of water : — 

Original specific gravity 1030.5 1026 

9 milk and 1 of water 1027 1023 

8£ " 1£ " 1025 

8 " 2 " 1024 1019 

7 " 3 " 1021 1017 

6 " 4 " 1018 1016 

Instruments are sold in the shops by which the specific gravity of the milk 
may be easily ascertained. The quantity of cream afforded by milk after 
standing is a good rough test of the presence or absence of added water. 
The percentage of cream, which may be ascertained by the use of a long glass 
divided into one hundred parts, varies from five per cent, to forty per cent., 
the larger percentages having been known to be given by Alderney cows. 
The average quantity of milk found to be given by cows at Aylesbury (Eng.) 
is thirteen per cent. The milk may be as low as five or six per cent, and yet 
not be adulterated, but if this low percentage of cream is attended with low 
specific gravity, then the milk is undoubtedly adulterated. Starch is some- 
times added to milk to give consistency to the water which has been added. 
This may easily be detected by the microscope or the addition of iodine. Salt 
is added to keep up the specific gravity, and may easily be detected by nitrate 
of silver, throwing down chloride of silver. The brains of animals have been 
added to thicken with, but this fraud is easily detected by the microscope. It 



MIL 501 MIL 

may be said, however, that the adulterations of milk otherwise than with 
water are very infrequent. Mineral adulterations may be detected by evaporat- 
ing the serum of the milk and incinerating the deposit. Milk, after being 
allowed to stand for some time, is very liable to decompose, and become acid. 
In this condition it is quite unfit for the food of young infants. Much of the 
diarrhoea that prevails in the summer among children in large towns seems to 
be due to this condition of the milk. Boilin'g the milk before allowing it to 
stand will to a certain extent prevent this tendency. To prevent this, as well 
as to render adulteration with water impossible, milk has been evaporated, and 
sold under the name of " condensed milk." This article is now manufactured 
on a large scale, both in this country and in Switzerland. One manufactory 
of condensed milk is carried on at Aylesbury, where two hundred persons are 
employed, and the milk of twelve hundred cows, each yielding fourteen quarts, 
is daily evaporated. The milk is brought from farms in the neighborhood, in 
tin cans, and each can is tested by the lactometer. The milk is then passed 
into a vacuum pan, and the vapor thus produced is condensed and thrown 
away. When the milk has acquired a proper consistence, it is mixed with 
sugar. This addition of sugar is the distinguishing feature of the condensed 
milk process. After this the milk is still further condensed, and is run off 
into the little cans which are so well known. The condensed milk thus pre- 
pared is of a semi-liquid consistence, and can be taken out of the can with a 
spoon. An analysis by Liebig shows that it contains, — 

Water 22.44 

Solids ' 77.56 

100.00 
Or, in a more extended form, 

Moisture 25.10 

Butter 11.73 

Caseine 15.17 

Milk sugar 16.24 

Caue sugar 29.46 

Ash „ 2.30 

100.00 

From these analyses it will be seen that the only perceptible difference be- 
tween condensed milk and "ordinary milk is that the former contains more 
sugar and less water than the latter. Condensed milk is thus easily converted 
to the condition of ordinary milk by the addition of cold or hot water. The 
only difference is that the condensed contains proportionately more sugar than 
ordinary cow's milk. The addition of sugar is rendered necessary in order to 
prevent decomposition. This really proves a recommendation of condensed 
milk for infant's food, as the addition of the sugar brings the milk in point of 
sweetness up to the condition of mother's milk. Condensed milk we think 
may be confidently recommended, not only where new milk cannot be had, 
but in all cases where the milk sold is suspected of adulteration. It can also 
be converted into milk for use at any moment, and consequently is free from 
the suspicion of any injurious decomposition. New milk has also been the 
means recently of conveying typhoid fever by means of the water used in 
adulteration, or for cleansing the cans. This evil is entirely prevented by the 
exposure to heat in the preparation of condensed milk. 

Milk Fever, known also as Ephemera, often comes on two or three days 
after a confinement, but generally passes off hi a few days, leaving no evil 



MIN 502 MIN 

effects. The symptoms are languor, heat of skin, furred tongue, restlessness, 
pain in the stomach and breasts, and loss of appetite. The secretion of milk 
does not take place regularly, and the breasts may have to be drawn. Any 
febrile symptoms coming on soon after a labor are apt to cause alarm, as in 
many cases danger may be apprehended. Milk fever, or weed, as it is some- 
times called, comes on very soon, while puerperal fever, a very serious dis- 
order, does not generally appear for a week or ten days after delivery. The 
treatment of milk fever consists in giving cooling saline medicines, a diet of 
milk, gruel, and broth, etc., and keeping the bowels open. The child may be 
kept to the breast, and these must be drawn if the milk does not flow freely. 

Mineral Waters are such as contain an unusual amount of mineral sub- 
stances in solution, from which they derive important healing properties not 
possessed by ordinary water. All water, except that which has been distilled, 
or which falls from the clouds in wide open spaces far removed from towns, 
contains a certain amount of mineral matter in the shape of salts of various 
kinds, to which it owes in great measure the pleasant taste which character- 
izes good drinking-water. (See Water.) Such a water becomes a mineral 
water when these saline ingredients are present in excess. Mineral waters 
have been employed in all ages as remedial agents, but their use is not to be 
confounded with that of a totally different kind — we allude to the belief in 
the efficacy of holy wells, even at the present day, in certain parts of the 
world. These holy wells were merely springs, often remarkable for the 
depth, volume, coldness, or purity of their waters, and which acquired their 
sanctity by the residence of some old saint in their vicinity. Through the 
virtue of his sanctity these acquired their supposed healing powers, and were 
frequented on account of these, not because of any specific substance contained 
in the waters themselves. Wells yielding medicinal waters derive, as do most 
other springs, their water originally from rainfall. This water permeates the 
soil, carrying with it a greater or less quantity of the salts which it encounters 
in its passage, until it reaches the surface of the soil at some lower level, or is 
artificially raised to the surface of the soil, there to be made use of. Accord- 
ing, therefore, to the qualities of the strata through which the water percolates 
will be its qualities when the surface is reached. Various salts of sodium, 
especially the chloride, the sulphate and carbonate, salts of lime, iron, and 
magnesia, with various other less widely distributed ingredients, are found. 
Very often these are held in solution by the help, of carbonic acid gas, which 
gives the water a sparkling quality, or they contain sulphur in the shape of 
foul-smelling sulphuretted hydrogen. Different kinds of water have different 
uses ; for the most part they are used either externally or internally, very 
often in both fashions. Those usually applied externally are as a rule above 
the temperature of the surrounding atmosphere, and are commonly called hot 
springs. They increase the circulation through the parts, and favor the re- 
moval of any effete material which it may be needful for the general health to 
remove. Given internally, their action varies with their constitution, some 
acting as tonics, others eliminatives, as the case may be. One very powerful 
agency in effecting cures by means of mineral waters is the regimen laid down 
by the superintendent, and the total change of air and scene, as well as of 
habits of life, necessitated by removal to the spot where they are to be obtained. 
The existence of these subsidiary influences accounts for the failure which 
commonly follows any attempt to secure the benefit of particular waters at 
home, and to procure the full benefit from them they must be taken on the 
spot. Mineral waters are of use only in chronic disorders, and certain forms 



MIN 503 MIN 

of these seem to be much more benefited than others. Skin complaints, scrofu- 
lous disorders of various kinds, stiff joints, gouty and rheumatic affections and 
neuralgic pains of certain descriptions, diseases of the liver and kidneys, dis- 
orders of the bowels, and certain abnormal conditions of the womb, are those 
most likely to receive benefit from a " course," as it is called, of mineral 
waters. It is important for the invalid very clearly to understand that imme- 
diate relief does not follow the change. Very likely he feels worse in the 
first instance, for he has been dislocated as to his old habits, and has not be- 
come accustomed to the new ; but by and by he will reap the benefit of the 
change, and this will follow him even when he has returned to his wonted way 
of life. Broadly speaking, no invalid should go to a watering-place without 
consulting a medical man of skill ; and having selected the spot most suitable, 
it is generally desirable to place one's self under the care of a local practitioner 
who is acquainted with the specific property of the waters, and how they are 
taken with most advantage. Very often the rules laid down by these local 
men seem frivolous, and we are not prepared to say that they never are so, 
but following them in a good many instances means reaping the full benefit of 
the waters, abandoning them no advantage at all. It is a notion, unfortunately, 
but a mistaken one, that the greater the quantity of water drunk the greater 
the advantage reaped ; no notion could be more erroneous. In all cases the 
patient should begin with a moderate quantity of the water, say two or three 
glasses in the morning before breakfast, and one or two in the evening before 
supper. The patient, if strength will' permit, should rise early, walk to the 
springs or pump-room, swallow slowly a tumbler of the water in a lukewarm 
state, — neither too hot nor too cold, that is, — walk for a quarter of an hour, 
return for another glass, renew the walk gently ; a third glass should follow, if 
permitted, and a gentle saunter home to breakfast. If there is bathing, that is 
generally done in the forenoon, about two hours after breakfast. Dinner 
should be early and light ; an excursion may be made in the afternoon ; in the 
evening it is usual to hear the band play, drink as before a tumbler or two of 
water, and to bed before ten, a light supper having been partaken of some 
hour or so before. A little attention to diet is necessary, and, as a rule, dur- 
ing the period that the patient is drinking the waters his stimulants should be 
restricted to some light wine or well-fermented bitter beer. Above all things, 
regularity and persistence are to be cultivated at such water cures : regularity 
in rising, in eating, and sleeping ; persistence in the object of the cure. Tak- 
ing twice as much of the water one day will not make up for total neglect on 
the next, and so indiscretions in the way of diet or stimulants may at particu- 
lar periods of the course undo the work of weeks. The grand rule is festina 
lente, for too great a hurry to get well may undo the whole good acquired or 
acquirable. Mineral waters are commonly divided or grouped according to 
their constituents. Chief among these are the saline, the chalybeate or iron, 
the sulphurous, and gaseous. Some are faintly acidulous, others are alkaline. 
The saline waters are the most numerous. Some contain mainly purgative 
salts, like sulphate of soda or sulphate of magnesia : such are Leamington, 
Cheltenham, Seidlitz, Pullrfa, Carlsbad, etc. Others, again, contain more com- 
mon salt, and so act less on the bowels : such are Wiesbaden, Baden-Baden, 
Homburg, and Kissengen. Sulphate of lime is found largely in the waters of 
Bath and Buxton ; salts of soda in those of Ems and Toplitz. The chalyb- 
eate waters are sometimes also slightly laxative — a valuable combination. 
Most, however, retain the iron in solution by means of carbonic acid. These 
are especially useful in cases of debility, where the patient seems bloodless and 



MIN 504 MIN 

weak. The sulphurous waters are a tolerably numerous class, especially 
abroad. They are largely patronized for a variety of chronic disorders, skin 
eruptions, liver and womb diseases, gouty and rheumatic ailments. In many 
of these the efficacy is increased by the warmth of the waters. Abroad there 
are many warm springs of this kind, as Aix-la-Chapelle, and many spas of the 
Pyrenees. Gaseous springs can hardly be recognized as a distinct group, in- 
asmuch as both saline and chalybeate waters frequently obtain their palatable 
character owing to the carbonic acid gas they contain. The thermal waters of 
Vichy are salines of this class. The waters of Kreuznach are peculiar in con- 
taining both iodine and bromine in considerable quantity. Hence they pos- 
sess considerable efficacy in dealing with scrofulous disorders, but, being weak- 
ening, require to be prescribed with caution. We shall next proceed to give 
a short account of the most important springs abroad, with their most impor- 
tant properties, and we shall begin with the oldest of these, those of Bath. 

The Bath waters are thermal, their temperature being always over 100° 
Fahr., sometimes as high as 120°. They contain sulphates of lime and soda, 
chloride of sodium and magnesia, some carbonate of lime, silica and iron, all 
held in solution by carbonic acid ; other gases are contained in the waters, 
chiefly oxygen and nitrogen. The waters are sparkling in appearance, owing 
to the presence of these gases, and they are generally drunk in quantities of 
half a pint morning and afternoon. They usually raise the temperature and 
quicken the circulation, increasing certain of the secretions, especially that of 
the kidneys. Should these effects not be produced, especially should head- 
ache, thirst, and nausea supervene, they must be discontinued. The waters 
are also largely used for bathing purposes, all kinds of baths being provided ; 
one, a kind of chair, is so arranged that a helpless invalid may be lowered into 
the water, this having considerable reputation in cases of paralysis. For 
bathing purposes the temperature of the waters is lowered by water of the same 
spring previously cooled ; the proper temperature is from 96° to 98°, and in 
the water at this temperature the patient is allowed to remain a period varying 
from ten minutes to half an hour. Bath is chiefly frequented in late autumn, 
winter, and early spring, for, situated as it is, in a hollow, it is warm, though, 
as a rule, damp, owing to the steam of the hot waters permeating the soil. 
The main diseases for which the Bath waters are adapted are rheumatic and 
gouty affections of a chronic character, neuralgic affections, especially lum- 
bago, rigid joints, and some forms of paralysis. Certain skin diseases, too, are 
benefited by them. For those who are unable to pay there is a hospital open 
to all the kingdom gratuitously ; patients have, however, to deposit a sum 
of money as security for good behavior ; on departure this is returned to 
them. 

Cheltenham is perhaps more of a health resort than a watering-place, and 
as it is situated so as to be sheltered from the east winds by the Cotswold hills 
it is a favorable resort for old East Indians, many of whom are settled there. 
The waters are cold and all saline, except one, which is chalybeate. The 
chief spring is the Montpelier Spa, whose waters contain chlorides and sul- 
phates, with a little iron. These are used both' internally and externally, but 
chiefly internally. They are supposed to be especially valuable in torpidity of 
the liver and bowels, and in gouty disorders. They are sometimes given 
strengthened by a solution of the salts of the spring; but if the patient desires 
the benefit of a full course of the waters, they are best taken natural and 
slightly warmed. If only a dose now and again be taken, then the salts 
may be added. Patients commonly resort for the waters at the time when the 



MIN 505 MIN 

regular inhabitants are absent, that is to say, in the summer months. The 
combination of iron and purging salts is a very valuable one, but the foreign 
springs have attracted many of the former habitues of Cheltenham and other 
English watering-places. 

Leamington in many respects resembles Cheltenham, but is more beauti- 
fully situated. It, too, is mainly frequented by officers and others returned 
from abroad, who have settled there partly for the sake of the society, partly 
for the sheltered situation and waters. The composition of these waters re- 
sembles that of the Cheltenham springs. They contain chlorides of sodium, cal- 
cium, and magnesia, with sulphate of soda. They contain, also, carbonic acid 
and nitrogen and oxygen. The composition of some of the springs differs 
from that of others. On the whole, they are more powerful than are those of 
Cheltenham, and so better adapted for those who suffer from torpid liver and 
bowels, in the first instance at least ; their temperature is about 48° Fahr. 

Tunbridge Wells, situated in one of the most beautiful districts in 
England, is largely visited, not so much for its waters, which are almost neg- 
lected, insomuch that one has considerable difficulty in discovering their where- 
abouts, but because the air is mild yet bracing, the walks are fine, and the 
place one well fitted for a pleasant sojourn. The waters are chalybeate, but 
only feebly so, and require to be taken for a good long time ; nevertheless, 
drunk regularly, and combined with exercise taken in the open air, they may 
be relied upon as being most efficacious in cases of anaemia, such as occur in 
young females of .sedentary habits. Small doses of some opening medicine 
should be given at the same time, Carlsbad water, perhaps, suiting best. The 
iron is held in solution by carbonic acid, and is only in small quantity. Some- 
times steel is prescribed along with the waters, but this is not advisable. 

One of the most important of the English watering-places, certainly the one 
which is most visited for its waters, is Harrogate. Harrogate lies some 
distance north of Leeds and west of York. During the season, which is sum- 
mer and autumn, Harrogate is filled with visitors. The soil is sandy, the air 
pure and bracing. The waters are all cold, but are usually warmed before 
being drunk. Springs of the most various kinds are found here : some strong 
sulphurous, some mild sulphurous, with alkali combined, some saline chalybeate, 
and some purely chalybeate, of a most unusual kind. The strong sulphurous 
waters are the typical waters of Harrogate, for which it has received its repu- 
tation, but very frequently the cure begun by these is completed by one or 
other of the other springs ; but these springs present such a variety that in- 
valids of all classes frequent Harrogate during the season. The strong sul- 
phurous waters are obtained from the old sulphur well or the strong Mont- 
pellier sulphur spring. They contain much sulphuretted hydrogen gas, with 
sulphate of sodium ; besides these there are chlorides of sodium, potassium, 
calcium, and magnesium, with carbonate of lime, and traces of bromides and 
iodides. They are taken internally in doses of about a pint, in divided doses, 
every morning before breakfast, and are also used as baths. These are mainly 
used to stimulate the liver and bowels ; used as baths, the skin ; they also favor 
the secretion of urine, and are especially useful in certain forms of skin dis- 
ease and gouty and rheumatic affections. The mild sulphur springs contain 
less sulphuretted hydrogen and chlorides of sodium and magnesium, but they 
have carbonate of magnesia in addition. These are antacid as well as alter- 
ative. The saline chalybeate contains carbonate of iron, so that these waters 
are tonic as well as alterative. Again, some are purely chalybeate, one 
especially, of a very rare kind, containing a proto-chloride of iron. The alter- 



MIN 506 MIN 

nate use of the mild sulphur waters with those containing iron, or the use of 
the one externally and the other internally, is sometimes attended with the 
happiest results, especially in threatened phthisis and disordered menstruation. 

Buxton is totally different from any of the preceding. The springs, are 
situated among the Derbyshire hills, and are exceedingly bracing. The cli- 
mate is variable, and the rainfall at times heavy. The climate is on\y adapted 
for summer and autumn ; at other times it is often cold and badly adapted for 
invalids. The Waters are tepid, having a temperature of about 80° Fahr., and 
issue from limestone. The salts contained in the waters are small in quantity, 
and are mainly salts of sodium, magnesium, and calcium, with a trace of iron. 
They contain much carbonic acid and nitrogen. The waters are chiefly used 
for bathing, and douche baths are perhaps the favorite form of applying them. 
The waters are useful for stiff joints, especially when these are due to gout or 
rheumatism, to old sprains or muscular contractions. 

There are a few other places in England where waters are drunk, and also 
a few hi Scotland ; most, however, have been abandoned for their more 
fashionable Continental rivals, and indeed some of those here described are not 
in much better case. It would be impossible to give in this slight sketch any 
full account of foreign watering-places, but equally so would it be impossible, 
while pretending to deal with the subject of mineral waters, to conclude this 
sketch without reference to these. 

Spa, in Belgium, whose title has become generic, being applied to almost 
all watering-places, is situated in a valley of the Ardennes. The waters are 
of a temperature of 50° Fahr., and contain much carbonic acid. This holds 
in solution salts of soda, magnesia, lime, and iron, so that these partake of the 
qualities of alkaline and ferruginous waters. The dose given is considerable, 
as much as three pints a day in divided doses, but beginning with a couple of 
glasses. They are valuable as chalybeates. The season is from May to Sep- 
tember. In the Pyrenees are a multitude of springs, which we cannot describe 
individually. Chief among these are the Bagneres de Bigorres, Barege, Bag- 
neres de Luchon, Cauterets, Eaux Bonnes, and Eaux Ghaudes. 

The Bagxeues dk Bihoures are, like the waters of Harrogate, saline, sul- 
phurous, and ferruginous. The Barege waters are sulphurous, and are of 
three kinds : hot, temperate, and tepid. A peculiar pellicle floats on their 
surface, which is supposed to be especially beneficial in chronic rheumatism. 
It is called glairine, zobgene, or baregine. These waters are highly esteemed. 
St. Sauveur, four miles off, has waters similar, but less active. Cauterets is 
more sheltered than Barege, and has many sulphuretted springs, the warmest 
having a temperature of 122° Fahr.; baregine is also present in these waters. 
These are mainly used for skin diseases of an obstinate kind, scaly and pimply, 
in chronic rheumatic and gouty affections, stiff joints, etc. They are said to 
be especially useful where open tracts exist in flesh leading down to dead bone 
or caused by gunshot wound. Some maladies of the womb are also greatly 
benefited by tliem ; so, too, is scrofula and threatened phthisis. Bagneres de 
Luchon and Eaux Chaudes are also sulphurous waters. The latter contain or 
deposit a substance called sulfuraire. Eaux Bonnes are mildly sulphurous 
waters, of which the supply is scanty. They are supposed to be specially 
efficacious in threatened consumption. They are situated 2400 feet above the 
level of the sea, and the air 'is exceedingly fresh and pure. The invalid is en- 
couraged to spend most of his time in the open air. 

Vichy affords perhaps one of the most important mineral waters known to 
us. It is situated in Central France, in a wide, open valley. The air is tem- 



507 




EiG. lxxx viii . Fig. hxxxix. 



■Fir. lxxxvu. 



PLATE XVII. 



MIN 509 MIN 

perate, and the season lasts from May till September. The springs are nine 
in number ; they are all warm, alkaline, and gaseous. They contain mainly 
carbonate of soda and carbonic acid. They also contain, however, some pot- 
ash and ammonia and baregine. The springs mostly employed are the Grande 
Grille, the Celestins, and LTIopital. They are all strongly alkaline, and are 
used both externally and internally. They are used for diseases of the lungs, 
especially catarrh, for irritability of the digestive organs, gravel, catarrh of the, 
bladder, diabetes, chronic gout, and rheumatism, etc. The Grande Grille is 
supposed to be most useful for liver complaints, especially catarrh of the bile 
ducts ; the Celestins is mainly given for urinary disorders ; the Hopital spring 
for gastric catarrh. Their taste is something like soda-water. They are 
largely exported, and are given in doses of half a pint to two pints. 

Aix-la-Chapelle lies to the westward of Cologne, between the Rhine and 
the Maas. It waters are partly warm sulphurous, partly cold chalybeate. 
The sulphurous springs have a. very high temperature, — from 111° to 131° 
Fahr. ; the ferruginous are cold. The latter are of little power. The sul- 
phurous waters contain chloride of sodium and sulphui'et of sodium, along with 
free sulphuretted hydrogen. The waters are extremely disagreeable, though 
less so than some of the Pyrenean sources ; there is abundance of the rotten- 
egg flavor, but the baregine is wanting. They are not much given internally, 
but are chiefly used in baths, douches, shampooing, and kneading, and in these 
cases are of great use in curing old-standing sprains, stiff joints, contracted 
muscles, and the like. Other nvtladies, like skin diseases, may also be bene- 
fited by them. The season is from June to September. Those subject to 
haemorrhages should avoid them. 

Kreuznach is a spa of singular value. The waters are bitter and contain 
chlorides of sodium, calcium, and magnesium, bromides, iodides, and some 
iron. The waters are chiefly used with a view to procure the absorption of 
tumors. It is drunk at first in small quantity, sometimes mixed with hot milk. 
The baths are taken tepid, and quantities of the substance which remains be- 
hind when the salts have been crystallized from the waters are added according 
to circumstances. The waters of Kreuznach have obtained their chief reputa- 
tion in maladies of the womb, especially in chronic inflammation with hyper- 
trophy and induration. Scrofulous ulcers and glands, too, are frequently 
relieved. The use of the waters, like those of Vichy, should not be continued 
too long. There is a risk of weakening the patient. 

Neunahr is situated in the valley of the Ahr, not far from Cologne. It 
contains much carbonic acid, with carbonates of lime and magnesia, some sul- 
phate and chloride of sodium, with a little iron, alumina, and silica. In tem- 
perature the waters are tepid, and not unpleasant to the taste. Two to five 
tumblers of the water are taken in the morning, and half the quantity in the 
evening. In the forenoon a bath may be taken if desirable. The waters are 
useful in rheumatism and a tendency to the formation of gravel, and in mal- 
adies of the throat and lungs connected with these. After a time the bowels 
become quite open, but not greatly relaxed. 

Ems lies in the valley of the Lahn, not far from Wiesbaden. It has long 
been a noted place of resort, and the beauty of its situation is in itself almost 
a sufficient attraction. The waters are warm or hot, — 86° to 133° Fahr., — 
and are saline, alkaline, and gaseous. The waters contain chloride of sodium, 
carbonate of soda, and magnesia, with smaller quantities of lime, iron, man- 
ganese, potass, and lithia. Hence they are alterative, mildly dieuretic, and 
laxative. They are considered specially useful in catarrhal affections. The 



MIN 510 MIN 

waters have a slightly soapy taste, and are often given in milk. The waters 
of one spring are in high repute for the cure of sterility ; if this be due to in- 
flammation and discharge from the womb, local baths are used. They are 
also recommended in catarrhal affections of the lungs and air-passages, and in 
dyspepsia when there is a tendency to consumption ; so also in the form of 
skin disease known as eczema. For gouty subjects they are also valuable, but 
less so than Vichy. 

Wiesbaden lies on the southern slope of the Taunus mountains, and is 
greatty frequented ; its future is, however, somewhat doubtful. The season 
extends from June to September, but the climate is good much later. There 
is only one spring much used, though many are in the town. The temperature 
is very high, — 150° to 160° Fahr., — and it emits volumes of vapor as it rises. 
The water contains chloride of sodium in large quantity, with potass, lime, 
iron, magnesia, some arsenic, and bromine. The carbonic acid is in very 
large bulk. The taste has been compared to weak chicken broth slightly 
salted. The waters have to be cooled before being taken, and then three or 
four glasses produce a slight diuretic and laxative effect. The baths, for which 
also the water is cooled, are usually taken in the forenoon. These waters do 
good in gout or rheumatism, with congestion of the liver, and piles, and also in 
some skin diseases. They are injurious if the individual is weak and prone to 
bleeding from any part. When the waters disagree they give rise to a feeling 
of prostration, loss of appetite, and a feeling of disgust at the waters them- 
selves. Under such circumstances they should be promptly stopped. 

IIomburg, too, has derived its attractions from other sources than its wa- 
ters ; nevertheless these are worthy of mention. This place lies not far from 
Frankfort, and its air is invigorating and bracing, but variable. The waters 
are cold, and contain chlorides along with carbonic acid. The flavor is fairly 
agreeable, though saltish and somewhat bitter. 

Baden-Badex is another of the German watering-places, where a gambling 
table and the French demi-monde offered the chief attractions. It is situated 
in the Black Forest, in a delightful valley, its mineral waters are weak, but 
they are said to contain a good deal of lithia. This place, too, now that the 
gambling table is suppressed, has a doubtful future. 

Kissingex, in Bavaria, stands in a totally different category. It is one of 
the favorite bathing places of Germany, and is situated about thirty miles from 
Wtii'tzburg. Its waters are cold and gaseous. The chief salts are chloride of 
potassium, sodium, lithium, and magnesium, carbonate of lime, and sulphate of 
magnesia, with iodine, bromine, and iron. One spring is generally used in the 
morning, and a milder one in the evening. The waters are useful in habitual 
constipation with congestion of the liver, in dyspepsia with flatulence, and in 
tubercular disease. Gout and gravel are also benefited. Baths are also used, 
but some of them are fortified ; one of the wells ebbs and flows several times 
a day. 

Gastein, in Austrian Tyrol, not far from Sakburg, is another favorite 
place of resort for the sake of its waters. It is situated 3200 feet above the 
level of the sea, and the air is extremely bracing. The season is limited to 
July and August. The springs are thermal, but weak ; sulphate of soda is the 
chief ingredient. The waters are used for baths after cooling, and some derive 
great benefit from them ; chiefly the prematurely old, the hypochondriac, and 
the paralytic. The waters of Toplitz, in Bohemia, resemble those of Gastein, 
but the town lies much lower, in a situatiou of great beauty, the climate being 
exceedingly agreeable. 



MIN 511 MIN 

Friedkichshall and Puxena both supply a water which is highly laxa- 
tive. The waters are blight and clear, with a slight tinge of yellow, and are 
largely exported, previous to which, however, they are somewhat concentrated. 
They contain sulphates of soda, lime, and magnesia, with chlorides, carbonates, 
and bromides. They can hardly be said to be used, except for exportation. 

Carlsbad is situated in Bohemia, some distance from Prague. The season 
extends from May to September. It is 1200 feet above the sea. There are 
several springs ; the principal rises some feet in the air, and gives off clouds of 
vapor; its temperature is 165° . It contains sulphates of soda and potash, 
chloride of sodium, and carbonate of lime, with some iron, alumina, and silica. 
The other springs have a lower temperature. Formerly the water was only 
used for bathing ;■ now baths are seldom used. The number of glasses of the 
water taken daily varies. The waters are mainly given for abdominal com- 
plaints, as in diseases of the liver, engorgement, and the like, dyspepsia, hypo- 
chondriasis, constipation, diabetes, gout, and rheumatism ; also in jaundice 
from gall-stones. 

Still higher up is Martenbad, in the same valley as Carlsbad. The waters 
are mixed, saline and chalybeate, with some carbonic acid ; by standing they 
become turbid. The waters are valuable for chronic diseases of the digestive 
organs, combining laxative and tonic influence. The water, made into a paste 
with peat soil, is used as a mud-bath or poultice, which is useful in healing 
chronic ulcers and dispersing glandular swellings. Gas baths, consisting of 
carbonic acid with a little sulphuretted hydrogen, are also used to remove pains 
from the muscular and nervous systems. 

In the same district is Fuanzensbad, whose waters are cold ; they are 
acidulous, and contain mainly alkaline salts. Here, too, besides being used in 
the ordinary way, the mud and gas baths are high in favor. The black earth 
contains sulphate of soda, iron, lime, and alumina ; it is made into a poultice 
at 100° Fahr., and in it the patient is immersed for a quarter of an hour; 
after this the body is washed in plain water. Various chronic skin diseases, 
indolent ulcers, gouty deposits, etc., may be thus removed. The water taken 
internally improves digestion and the nervous system. 

Aix-les-Bains, in Savoy, is a watering-place well worthy of the attention 
of the invalid. Its greatest fault is its remoteness. The springs are warm, 
one containing sulphuretted hydrogen, the other none. The waters are chiefly 
used externally as douches. The climate is very mild, and admits of a stay 
from April to October. Chronic rheumatism and stiff joints are the forms of 
disease most benefited by the treatment. 

Zoneche stands high in the valley of the Rhone. The waters are hot and 
contain mostly sulphate of lime and other sulphates. The bathers bathe to- 
gether, clothed in woolen gowns, and the bath gradually extends to three 
or four hours, or even more, in the morning, and a shorter period in the even- 
ing. By and by a kind of prickly heat is brought out, the skin so elevated 
falls off, after which the period of the daily immersion is gradually diminished 
till the course is at an end. Scrofulous enlargements, eczema, and gout and 
rheumatism are chiefly benefited. 

Peeffers is also high above the sea, in the Grisons. Its waters are con- 
ducted in wooden tubes down the heights to Rogatz, in the valley of the 
Rhine. Sometimes, however, the waters can only be obtained at Prefifers. 
Baths are chiefly used, but the waters are also drunk. They are useful in 
hysteria and nervous excitability. 

Tar asp, in the Grisons, has springs something like those of Marienbad, 



MIS 512 MOL 

cold and gaseous. The springs are 4300 feet above the sea ; they are said to 
be useful in early phthisis, and when the abdominal organs are out of order. 
Doubtless the elevated region and the pure mountain air have much to do with 
the benefit. This is still more markedly the case with St. Moritz, in the 
Upper Engadine, which lies 5863 feet above the sea-level. The waters, which 
are situated on a still higher level than the village, are chalybeate, with free 
carbonic acid. They are used both internally and externally. The air is 
cold, bracing, and very stimulating. The removal of so much atmospheric 
pressure gives great elasticity to the feelings. The place seems of most value 
in the early stage of consumption, and patients have remained there with ben- 
efit all the year round, though in winter the temperature sinks to 1-4° Fahr. or 
lower. 

Schinznach and its neighborhood contains many springs, those of Schinz- 
nach resembling those of Zoneche ; those of Wildegg, close by, being more 
like those of Kreuznach. 

Miscarriage. See Abortion. 

Mixtures are perhaps the most favorite forms of remedies, — one or two 
substances intended to aid each other's action being combined and given in 
some pleasant vehicle. It is not desirable that too many.objects should be 
aimed at in any mixture, so that its composition should be as simple as pos- 
sible. 

Moles, called also liver stains, mother's marks, pilous and pigmentary 
naivi, are congenital marks of a light or dark brown or black color, situated on 
the surface of the body. They are formed by circumscribed thickening of the 
scarf skin with excessive deposit of organic coloring matter, and are covered 
by numerous thick, stiff hairs. They vary much in shape, size, and situation. 
Most frequently one or two small marks of a rounded form are met with, 
either on the face or on the back of the neck, but in some cases a mole covers 
several inches of surface, and is very irregular in form. Instances have been 
recorded in which almost the whole surface of the body was studded over 
with dark-colored and hairy moles. Peter Messias, on the authority of Dam- 
ascenus, relates, " that upon the confines of Pisa, at a place called the Holy 
Rock, a girl was born all over hair, from, the mother's unhappy ruminating, 
and often beholding the picture of St. John the Baptist, hanging by her bed- 
side, drawn in his hairy vesture." (Daniel Turner.) The usual seats of moles 
are the face, the back of the neck, and the back. Moles, in consequence (of 
friction, often become sore, and sometimes ulcerate. It is believed, too, by 
many surgeons that they are often the starting-points of cancerous growths. 
For these, as well as for cosmetic reasons, it is advisable to have a small and 
isolated mole cut out. If the surgeon's knife be carried in the direction of the 
folds of the skin, the scar will cause very little, if any, disfigurement. For 
large moles very little can be done ; removal of the hairs by tweezers is soon 
followed by renewed growth, and the use of depilatories, or hair-destroying 
applications, does much more harm than good, in consequence of their irritant 
and caustic action on the skin. 

Mollities Ossium is a name given to a fatty degeneration which takes 
place in bone, and which renders it more brittle and liable to bend or break, 
because the earthy matters which give strength to bone are replaced by the 
fatty material It is found in women sometimes, and in them it leads to de- 
formity of the pelvis, thus rendering parturition- difficult, or even impossible, 
by the ordinary method. It also occurs in some lunatics, and renders them 
liable to fracture of the arm, ribs, etc., when any attempt is made by the at- 



MOL 513 MOR 

tendants to struggle with them, and in some cases an ordinary fall or stumble 
will be followed by a fracture. 

Molluscum is a disease of the skin, characterized by round elevations of 
the skin, varying in size from a hemp-seed to a hazel-nut, and marked on the 
summit by a dark point and a depression in the centre. The color of the skin 
over them is sQmetimes translucent, or of a pinkish color. Some of the growths 
have no black mark and no depression. These little tumors may increase 
slowly in size without undergoing any change, or they may ulcerate and dis- 
charge their contents. There seem to be two kinds: (1) Molluscum Jibrosum, 
which consists in an increased formation of the fibrous tissues round the hair 
follicles ; and (2) Molluscum contagiosum, which is due to an increase in the 
sebaceous follicles, so that the contents of each tumor have a cheesy appear- 
ance. The usual seats of molluscum are the back or front of the trunk, the 
neck, face, and scrotum. Its presence is not attended with any constitutional 
disturbance ; it may exist at any age, but is most frequent in children. There 
are generally several of these small tumors present at the same time. The 
treatment is purely local ; the tumor should be laid open, the contents squeezed 
out, and the inside touched with caustic ; if attached by a thin stem to the 
skin, the growth may be snipped off with a pair of scissors, and the cut end 
touched with caustic. 

Monkshood. See Aconite. 

Monomania is commonly defined as being madness on one particular sub- 
ject or limited number of subjects, the mind being tolerably clear on all others. 
Such a definition, though useful, is hardly practical, inasmuch as such persons 
when fairly examined will, as a rule, be found wrong on a good many points. 
Another definition of monomania is that it comprehends all lunatics who have 
passed through the acute stage of the malady, and have at last settled down 
to a knowledge of their condition, whilst as yet there is no dementia. Such 
would include all ordinary chronic cases of mania and melancholia, whatever 
the number of their delusions. Most frequently one predominates over the 
rest. 

Morphia. See Opium. 

Mortality. The state of the public health is a subject of importance, not 
merely to medical men, but to the nation at large ; not only is it needful to 
know the rate of mortality in relation to the population at the time, but it is 
essential to inquire into the causes of deaths, so as to find out how many die 
from preventable diseases, and to form a basis for sanitary legislation. The 
enormous waste of infant life, the injuries inflicted by disease on the military 
population, and the evils of overcrowding, bad food, intemperance, and starva- 
tion, among the civil population, are subjects which for a long time past have 
attracted the attention of sanitary reformers in Great Britain. 

Some account of recent changes will be found in the article on Public 
Health; but this article will be devoted to an account of the death-rate in 
Great Britain as shown in the thirty-second report of the Registrar-General. 
There are no data from which to give similar information in relation to the 
United States. For the past thirty-four years ample records have been kept 
of the births, deaths, and marriages in all parts of the United Kingdom, but less 
completely in Ireland than elsewhere ; and in the copious reports which are 
annually issued, every information on the subject may be found. 

In the year 1869 the deaths registered in England were 494,828, showing 
an increase of 14,206 upon the numbers returned in the two preceding years. 
After allowing for increase of population, the rate of mortality was 23 per 1000 



MOR 



514 



MOR 



against 22, both in 1867 and in 1868. In the 32 years, 1838-69, the average 
annual rate was 22.4 per 1000 ; the lowest rate being 20.5 and 20.8 in 1856 and 
1850 and the highest 25.1 in 1849, the year of the severe cholera epidemic. In 
the same period 10G males died to every 100 females who died, showing a 
higher relative death-rate among males. The following table shows the death- 
rate for the 25 years ending 1869 in groups of five years each : — 



Years. 


Deaths of Males to 
1000 Males Living. 


Deaths of Feimles to 
1000 females Living. 


Deaths of Males to 100 
Deaths of Females. 


1845-49 
1850-54 
1855-59 
1860-64 
1864-69 


24.12 
2.3.13 
22.92 
2.3.34 
24.18 


22.56 
21.51 
21 27 
21.20 
21.42 


102.6 
103.0 
103.0 
104.4 
106.0 


Average of 25 Years 


23.54 


21.59 


104.0 



Of the 494,828 deaths registered in 1869, 254,863, or 51.5 per cent., were 
of males, and 239,965, or 48.5 per cent., of females. The deaths of males 
were to the deaths of females as 106 to 100, and this proportion, according to 
the above table, seems to be gradually increasing. From various causes, the 
females considerably exceed the males in the English population ; but of equal 
numbers living, 114 deaths of males in 1869 were registered to every 100 
deaths of females. In the 32 years, 1838-69, this proportion averaged 109, 
and since 1869 has steadily increased from 105 to 114. 

The mortality among males in England always exceeds that of females ; 
for the 30 years ending 1867 the annual death-rate of males averaged 23.3 
per 1000, while it did not exceed 21.5 among females. At each period of life, 
except at the child-bearing ages, the mortality among males exceeds that 
among females, the largest excess occurring in male children under five years 
of age, who in the 30 years above mentioned died at the rate of 72.4 per 1000 
living at those ages, while among female children the rate did not exceed 62.5 
per 1000. Nor is this excess easy of explanation, although in mature and old 
age the higher rate which prevails among males may be explained by the 
unhealthy and dangerous risks of workshops and manufactories, and of excess- 
ive bodily toil, inducing a variety of bodily iflments. 

During this period the population in England and Wales had increased rap- 
idly : at the census taken in 1841, it was 16.035,198 ; in 1851, it was 18,054,- 
170; in 1861, it was 20,228,497; it was estimated in the middle of the year 
1865 at 20,990,946 ; in 1866, at 21,210,020 ; in 1867, at 21,429,508 ; in 1868, 
at 21,649,377 ; while, by the middle of the year 1869, it had risen to 21,869,- 
607. These estimates are a trifle below the actual increase, and in the census 
taken to 1871, the population was found to be 22,704,108. 

Locality has an influence on the death-rate. In the several counties of 
England, during 1869, the lowest rates were 17.8 in Westmoreland, 17.9 in 
Rutland, 18.2 in Surrey (extra-metropolitan), and 18.4 in Dorset; the highest 
rates were 24.0 in Leicester, 24.6 in the London district, 24.7 in the East 
Riding of Yorkshire, 26.3 in Lancashire, and 26.7 in the West Riding of 
Yorkshire ; the average for the whole country in that year being 22.6. 

Thus the mortality in different parts of England is governed in a great 



MOR 515 MOR 

measure by the proportions of large town populations which they contain ; and 
with the increase of those proportions in Lancashire and Yorkshire in recent 
years the death-rates have steadily increased. The dwellers in large towns 
not only suffer from the effects of over-crowding in dwellings and other sani- 
tary short-comings, but are likewise exposed to greater risk from the various 
forms of mechanical and other injuries, which result in what are classified as 
violent deaths, than are those living in the smaller towns and in rural districts. 

Owing to important sanitary improvements, the mortality in some of the 
large towns has materially improved of late years ; in Birmingham, Manches- 
ter, and Leeds, this feature has been most marked. 

Mortality at Different Ages. Of the 494,828 deaths registered in 1869, no 
fewer than 203,562 deaths occurred of children under five years of age, or 
41.1 per cent, of the total number ; but in this year scarlet fever was very 
prevalent, and carried off a great number. In the table on page 514 it will be 
noticed that of this number, 120,274, or rather more than 59 per cent., were 
under one year of age. This enormous amount of infantile mortality has at- 
tracted the attention of the legislature, and in the parliamentary session of 1872 
a bill was passed for the better protection of infant life. The new law came 
into operation on the 1st of November, 1872. Its object is to guard against 
baby-farming, which has been shown to be so productive of evil in recent years. 
The chief clauses of the bill provide that the houses of persons retaining or re- 
ceiving for hire two or more infants, for the purpose of nursing, are to be reg- 
istered. The age of an infant is under one year. The local authority of the 
place is to keep the register, and may refuse to register unless satisfied that 
the place is suitable, or the applicant of good character. A person so regis- 
tered is to keep a register of all infants received, and to produce the same 
when required. A local authority, for serious neglect, or when a person is 
incapable of providing proper food and attention, or if the house is unfit, may 
strike the name and house off the register. An inquest is to be held on an in- 
fant dying in' a registered house unless a medical certificate is produced to the 
coroner. The punishment for an offense under the Act is not to exceed six 
months, with or without hard labor, or a fine of £5. Fines and penalties re- 
covered are to go to the local rates. The statute extends to the whole of the 
United Kingdom, and the local authorities are specified in the Act. In Lon- 
don the Metropolitan Board of Works is the local authority, and in the City of 
London the Common Council. 

The Bastardy Laws Amendment Bill was also passed in the same session, 
and it is to be hoped that it may have a beneficial effect on the waste of life 
which is caused by the folly, the vices, or the carelessness of the parents. 

The proportion of deaths occurring at the different groups of ages varies 
very considerably in the two sexes. Of the 254,863 deaths of males registered 
in 1869, 109,012 or 42.8 per cent, were of children under five years of age ; 
these included 66,691 or 26.2 per cent, of infants under one year of age. The 
deaths of females in 1869 under five years of age were 94,550 out of the 239,- 
965 deaths at all ages ; the proportion of female children under five was there- 
fore 39.4 per cent. ; of these 22.3 per cent, or 53,583 deaths were of infants 
under one year of age. The proportion of deaths of young male children, 
therefore, considerably exceeded that of females, especially under one year of 
age. Of male children between five and fifteen years of age 16,020 deaths 
were registered in 1869, or 6.3 per cent, of the total male deaths ; the deaths 
of female children at those ages were 15,324, or 6.4 per cent. Between fif- 
teen and fifty-five the male deaths also exceeded those of females, although 



MOR 



516 



MOR 





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MOR 517 MOR 

from fifteen to thirty-five, including the principal child-bearing ages, the deaths 
of females somewhat exceeded those of males. The deaths of males from fif- 
teen to fifty-five in 1869 were 63,389 or 24.9 per cent, of the deaths at all 
ages ; those of females were 61,304 or 25.5 per cent. The males, aged fifty- 
five years and upwards, who died in 1869 were 66,442 or 26.1 per cent.; the 
females, 68.787 or 28.7 per cent, of the deaths of females at all ages. 

The greater longevity among females is especially shown at the extreme 
ages : at ninety-five years and upwards only 166 deaths of males were regis- 
tered in 1869, while the females at those ages were 402. Aged 100 years and 
upwards the deaths of 26 males and 53 females, in all 79 persons, were re- 
ported in 1869 against 63 in 1868. The highest ages said to have been at- 
tained in 1869 were 106 by a male and 107 by a female. 

Deaths in Public Institutions. In the year 1869, 41,263 deaths were re- 
corded in 1002 of the largest public institutions of England and Wales. Of 
these institutions 689 were workhouses, 241 were hospitals and infirmaries, 
and 72 were lunatic asylums. Of each hundred deaths registered in England 
and Wales in the year, 8.3 occurred in large public institutions, of which 5.6 
were recorded in workhouses, 2.0 in hospitals, and .7 per cent, in public luna- 
tic asylums. 

During the year 1869, the deaths in the United Kingdom of Great Britain 
and Ireland, out of an estimated population of 30,611,305 were 695,902; in 
Great Britain alone, 570,617 ; in England and Wales, 494,828 ; in Scotland, 
75,789, out of an estimated population of 3,205,481 ; and in Ireland, 125,264 
deaths, among 5,536,217 ; these last figures, however, are only estimates, as, 
owing to the difficulty of registration in Ireland, only 89,573 deaths were re- 
corded. 

The average strength of the British Home Service in 1869 was 4736 offi- 
cers, and 81,542 non-commissioned officers and men ; of these 28 officers or 
.59 per cent, died, and 875 non-commissioned officers and men died, or 1.07 
per cent. 

The strength of the mercantile marine was 195,490 in 1869 ; of these 
4832 or 2.47 per cent, died during the year ; of this number 1770 were drowned 
by wreck, and 1069 were drowned by accidents other than wreck. 

Within a month after the completion of the quarter the Registrar-General 
issues a return for the period of three months ; the three months, January, 
February, March, contain 90, in leap year 91, days ; the three months, April, 
May, June, 91 days ; each of the last two quarters of the year 92 days. The 
whole of England and Wales is divided into eleven great divisions, and these 
again into 44 registration counties ; these are still further divided into 633 
districts, over each of which is a superintendent-registrar, and these in their 
turn are still further subdivided into sub- districts. The chief divisions are as 
follows : — 



I. London. 


III. South-Midland. 


Part of Middlesex. 


6. Middlesex (extra- metropolitan) 


" " Survey. 


7. Hertfordshire. 


" " Kent. 


8. Buckinghamshire. 




9. Oxfordshire. 


II. South-Eastern. 


10. Northamptonshire. 


1. Surrey (extra-metropolitan). 


1 1 . Huntingdonshire. 


2. Kent (extra-metropolitan). 

3. Sussex. 


12. Bedfordshire. 


13. Cambridgeshire. 


4. Berkshire. 




5. Hampshire. 


IV. Eastern. 




14 Essex. 



MOR 



518 



MOR 



15. Suffolk. 

16. Norfolk. 

V. South-Western. 
1". Wiltshire. 

18. Dorsetshire. 

19. Devonshire. 

20. Cornwall. 

21. Somersetshire. 

VI. West-Midland. 

22. Gloucestershire. 

23. Herefordshire. 

24. Shropshire. 

25. Staffordshire. 

26. Worcestershire. 

27. Warwickshire. 

VII. North-Midland. 

28. Leicestershire. 

29. Rutlandshire. 

30. Lincolnshire. 



31. Nottinghamshire- 

32. Derbyshire. 

VIII. North-Western. 

33. Cheshire. 

34. Lancashire. 

IX. York. 

35. West Riding. 

36. East Hiding (with York). 

37. North Riding. 

X. Northern. 

38. Durham. 

39. Northumberland. 

40. Cumberland. 

41. Westmoreland. 

XL Welsh. 

42. Monmouthshire. 

43. South Wales. 

44. North Wales. 



The first division (London) includes the area within the domain of the Met- 
ropolitan Board of Works, and extends over parts of three counties ; the death- 
rate in the counties of Kent, Surrey, and Middlesex therefore does not include 
those parts situated in the above area, but ouly in the extra-metropolitan por- 
tions of them. 

The following is a table of the number and annual rate per 1000 living of 
deaths occurring in England and "Wales for each quarter of the years 1865-69 • 



Deaths iu the Quarter ending the last Day of 



1865 
1866 
1867 
1868 
1869 



140,410 
138,136 
134,008 
119,676 
133.096 



115,892 
128,551 
112,355 
110010 
118,947 



Sept. 



113,362 
116,650 
108,513 

130,482 
114,644 



Annual Death-rate per 1000 Living in the 
Quarters ending the last Day of 



121,?45 
117,352 

116,197 
120,454 
128,141 



March. 


June. 


Sept. 


27.23 


22.17 


21.40 


2652 


24.34 


21.79 


25 46 


21.06 


20.06 


22.26 


20.41 


23.88 


24.78 


21.14 


20.77 



22.83 
21.87 
21.43 
21.99 
23.16 



In the following summary of the quarterly reports issued by the Registrar- 
General for the year 1869, some further details are given with regard to the 
mortality in different parts of the country. 

First Quarter-: January, February, March. The number of deaths registered 
in England in the first quarter of the year 1869 was 133,096, being at the an- 
nual rate of 24.8 per 1000 of population, and somewhat higher than in the 
corresponding quarter of 1868. The winter of 1869 was not favorable to the 
public health, as in addition to an epidemic of scarlet fever, there was a very 
trying season for those who were troubled with chest complaints. The period 
of life when the greatest susceptibility to a fatal attack of bronchitis exists is 
after €>o ; but at the age of 45 and under 55 the increase is remarkable, as also 
is the high rate of mortality in infancy. The average annual death-rate from 
bronchitis in six recent years among males was 4.42 per 1000 of population, at 
the age of under 5 years ; at the ages 5 and under 45, the mortality was com- 



MOR 519 ' MOR 

paratively inconsiderable ; at 45-55, it was 1.51 per 1000; at 55-65, it was 
8.79 ; and continued to increase as age advanced, namely, 8.76 at 65-75 ; 
16.14 at 75-85; 22 76 at 85-95 ; at 23.57 at the age of 95 and upwards. 
In this quarter (January, February, and March), 648 deaths are registered in 
London from scarlet fever alone, against 339 and 368 in the corresponding 
quarters of 1867-68; measles and whooping-cough prevailed in many districts. 
On the whole, the death-rate of the quarter was below the average of the season 
of the previous ten years. The annual death-rate of the quarter experienced 
by the people inhabiting the chief towns, where there were 37.9 persons to 
every 10 acres, was 26.55 per 1000 of population, against an average of 27.24; 
while the death-rate of persons residing in the small towns and country parishes, 
where the population to every 10 acres only averaged 2.7, was. 22.56 per 1000, 
against an average rate of 23.02. It is to be hoped that improved sanitary 
measures may lessen the evils which make densely-populated districts so fatal. 
During this quarter the death-rate of the chief towns in the United Kingdom 
was as follows : Birmingham, with a population of 360,846, showed a death-rate 
of 20.7 in every 1000 persons; London, with 8,170,754, showed 25.4; Hull, 
with 126,682, showed 26.3; Bristol, with 169,423, showed 26.6; Leeds, with 
253,110, showed 27.5; Dublin, with 320,762, showed 29.1; Sheffield, with 
239,752, showed 29.4 ; Liverpool, with 509,052, showed 29.6 ; Newcastle-on- 
Tyne, with 130,503, showed 30.4; Manchester, with 370,892, showed 31.0; 
Edinburgh, with 178,002, showed 33.0; and Glasgow, with 458,937, showed 
40.1. Birmingham, in the west midland division, and London enjoyed the 
greatest amount of health, and Edinburgh and Glasgow the least. A compar- 
ison of the results for the eleven divisions of England shows that the south- 
eastern, where the mortality for the quarter was at the annual rate of 21.4 per 
1000, was the healthiest. The southwestern and* south midland counties fol- 
lowed next in order of salubrity; their respective death-rates were 21.8 and 
21.9. The mortality of the eastern counties was 22.4; that of Monmouthshire 
and Wales, 23.1 ; that of the northern counties, 26.1. Yorkshire showed the 
high death-rate of 28.1 ; but in this county scarlet fever and typhoid fever pre- 
vailed extensively. 

Second Quarter: April, May, June. During the quarter ending 30th June, 
the health of the country was good ; a mild April, followed by a cold May and 
June, did not act very unfavorably on the public health. The deaths were 
below the average of the season, though many deaths from bronchial affections 
caught in the ungenial March of the preceding quarter terminated fatally in 
this quarter. The total deaths numbered 118,947, and were at the annual rate 
of 21.8 per 1000 of population, against an average of 22.0. The deaths were 
8937 in excess of those registered in the same period of the preceding year ; 
but the death-rate then was exceptionally low. In most of the southeastern, 
south midland, eastern, and southwestern counties of England, the epidemic of 
scarlet fever had almost subsided, but only to be followed by measles and 
whooping cough ; so the benefit arising from exemption from one epidemic was 
counterbalanced by the outbreak of others. In the west midland, north midland, 
northwestern, and northern counties, and in Yorkshire and Wales, scarlet" fever 
continued to reign epidemically, and some places suffered from small-pox. In 
London small-pox and measles declined, as compared with the corresponding 
period of 1868, while scarlet fever and whooping-cough increased, as did also 
the deaths by bronchitis and pneumonia. The deaths in London in each of the 
two quarters ending 30th June, 1868 and 1869, respectively, were as follows : 
small-pox, 187 and 55 ; measles, 741 and 315 ; scarlet fever, 352 and 675 ; 



MOR ' 520 MOR 

whooping-cough, 780 and 1177; bronchitis, 1366 and 1655; and pneumonia, 
878 and 1001. The annual rate of mortality in the population of the country 
districts was at the rate of 20.6 per 1000, the average rate being 20.3, while 
in the chief towns, where the inhabitants are in closer proximity to each other, 
the mortality was at the rate of 22.8, against an average of 23.4, the benefit of 
the low death-rate being confined to the denser districts. In London and 
thirteen other large towns, the annual death-rate of the quarter was 24 per 1000. 
The mortality per 1000 of population rose in the following towns in this quarter, 
as compared with the corresponding quarter of 1868. 

In Glasgow the mortality rose from 29.5 per 1000 iu 1868 to 36.4 in 1869. 

Edinburgh " " 23.8 " " 24.7 

Liverpool " " 25.8 " " 27.3 " 

Hull " " 19.4 " " 24.0 

Newcastle-on-Tyne " " 21.9 " ' " 24.0 " 

Leeds " " 21.3 " " 22.4 

London " " 21.9 " " 22.3 

In the following large towns the mortality fell in the same period: — 

In Manchester the mortality fell from 27.7 per 1000 in 1868 to 25.0 in 1869. 
Bradford " " 25.1 " " 24.7 

Sheffield " " 26 3 " " 24.5 

Dublin " " 22.9 " " 22.7 

Bristol " " 23.3 " " 21.6 

Birmingham " " 20.7 " " 18.3 " 

In Glasgow the high death-rate was partly due to the prevalence of epidemic 
diseases, and partly to the want of proper house accommodation for the poorer 
classes, and to the overcrowding which is met with. The mortality of London 
steadily increased from 20.2 and 21.9 to 22.3 per 1000 in the three spring 
quarters of 1867-68-69. In 57 seaside sub-districts, containing the principal 
English watering-places, the annual death-rate was 20 per 1000 during the 
quarter. On the northeast coast, Whitby and Scarborough showed a mortality 
of 23 and 21 respectively ; on the east coast, Yarmouth showed 23, and Lowe- 
stoft 15; on the southeast coast, Margate showed 23, Ramsgate 27, Dover 16; 
on the south coast, Hastings and St. Leonards showed 15, Eastbourne 12, 
Brighton 19, Worthing and Littlehampton 20, Isle of Wight, Weymouth, and 
Torquay, 19; on the southwest coast, Ilfracombe showed 18; in South Wales, 
Tenby showed 20; in North AVales, Bangor and Beaumaris showed 22, Llan- 
dudno 27; on the northwest coast, New Brighton showed 12, Blackpool 26. 
But these results vary much in proportion to the number of invalids visiting 
these towns, and are not a true index of the death-rate of the resident population. 
The following was the rate of mortality in the chief divisions of the kingdom: 

Southeastern counties at the rate of 19 per 1000 of population. 

South Midland " "19 " 

Eastern " "21 

Southwestern " " 21 

West Midland " " 20 " " 

North Midland " " 22 

Northwestern " " 24 " 

Northern " " 23 " " 

Wales " " 22 

Yorkshire again showed the high death-rate of 25 per 1000, as small-pox 
and scarlet fever were there very prevalent. 

Third Quarter: July, August, and September. The number of deaths 
registered in this quarter was 114,644, or 15,838 less than in the same period 
of 1868, when the prevalence of diarrhoea in London and other large towns 



MOR 521 MOR 

raised the number of deaths considerably above the average. The rate of 
mortality in the quarter was 20.8 per 1000, and in the same quarter of 1868 
it was 23.9, the average of the season being 20.6. In London, 19,306 deaths 
were registered, compared with 19,248 in 1868, and 16,567 in 1867 ; the mor- 
tality of the quarter was at the rate of 24.3 per 1000. Scarlet fever was at 
the time very prevalent, and was most fatal in the east and south districts of 
the metropolis. In the southeastern counties, 9538 deaths occurred, being 
1280 fewer than in the summer of 1868; the rate of mortality was 18.4 per 
1000. The south midland counties showed a death-rate of 18.9 per 1000; the 
eastern counties 18.4; the southwestern counties only 17.1. In the west mid- 
land counties the mortality was at the rate of 18.8 per 1000 annually, and this 
showed a decrease on the same period of 1868. The north midland counties 
had a death-rate of 20.0, scarlet fever and diarrhoea being then very prevalent 
in this division. The rate of mortality in the northwestern counties was 23.2, 
and many of the zymotic diseases prevailed in the large towns. The northern 
counties had a death-rate of 21.3, while in Monmouthshire and Wales it was 
only 16.9 per 1000. 

The eleven millions of people living in the chief towns experienced an annual 
rate of mortality during the quarter of 23.3 per 1000 living, as compared with 
an average of 22.9 ; while the inhabitants of small towns and country parishes, 
numbering somewhat more than nine millions in England, only suffered to the 
extent of 17.4, the average rate being 17.8 per 1000. Of eleven of the largest 
English cities and boroughs the following was the death-rate per 1000: — 



Liverpool . . 


. . 30.5 


Sheffield . . 


. . 25.7 


Newcastle on-Tyne 


23.7 


Manchester . 


. 29.3 


Hull . . . 


. . 25.2 


Bristol 


21.7 


Leeds . . . 


. 27 2 


Bradford . . 


. . 24.6 


Birmingham . . . 


21.4 


Salford . . 


. 25 9 


London . . 


. . 24.3 







As an illustration of the waste of life going on in the country, the Registrar- 
General has remarked that in the ten years, 1851-60, thirty large towns, hav- 
ing a mean aggregate population of two and a half millions, lost every year 
32,735 persons more than would have died had they been subject only to the 
rate of mortality prevailing in the healthy districts of England. In this 
quarter scarlet fever was extremely prevalent. 

Fourth Quarter: October, November, and December. In the last ninety two 
days of the year 1869 as many as 128,141 deaths were registered. This num- 
ber is 7687 more than in the same period of 1868, and 11,944 more than in 
the last quarter of 1867. The mortality was at the annual rate of 23.2 per 
1000 living, whereas the rate in the same season for the previous ten years 
was 21.9 per 1000 : the names of nearly 7000 persons were thus added to the 
death registers of England during the last three months of the year who would 
not have found a place there had the ordinary rate of mortality prevailed. 
While the excess in the deaths in the previous three months ending the 31st of 
September was caused by the high mortality in large towns, in the last quarter 
of the year the excess was shared by the small towns and country parishes. The 
chief towns, inhabited by more than eleven millions of people, experienced a 
death-rate during the quarter of 25.8 per 1000 annually, the average of the sea- 
son being 24.3 per 1000 ; the inhabitants of the small towns and rural parishes 
died during the same period at the annual death-rate of 19.7, the average being 
18.9. The fourteen greatest cities and towns among them, peopled by more 
than six and a half millions of inhabitants, suffered a mortality at the annual 
rate of 27.6 per 1000 living. 

The following was the rate in the chief towns of England: — 



MOR 



522 



MOR 



Sheffield .... 30.8 j Liverpool 28.9 j Newcastle-oii-Tvne 26.4 

Manchester . . . 30.6 Leeds 27.9 ! Birmingham . . . 25.7 

Salford . . . . 29.1 | Hull 26.0 I Derby 29.9 

Bradford .... 26.0 I London 26.7 | Nottingham . . . 2.98 

In London 21,186 deaths were registered in the last three months of the 
year, compared with 19,416 in 1868, and the mortality was at the annual rate 
of 26.7 per 1000; from scarlet fever alone no fewer than 2710 deaths occurred. 
The southeastern counties had a death-roll of 10,466, being at the annual rate 
of 20.2 per 1000. In the south midland counties the mortality was at the rate 
of 20.8 per 1000. The eastern counties experienced a mortality of 19.8 per 
1000; the southwestern counties 20.2; the west midland counties 22.1. In 
the north midland counties the death-rate was 22.1 per 1000, and in the north- 
ern counties it was 22.8. 

The causes of death are also specified at great length in the Annual Report of 
the Registrar-General ; all diseases are placed under five great classes, namely : 
(1.) Zymotic diseases. (2.) Constitutional diseases. (3.) Local diseases. 
(4.) Developmental diseases. (5.) Violent deaths. These classes are divided 
into orders, and these, again, are subdivided into the different diseases known 
by their common names. It is interesting to note the number of those who 
die annually from the seven principal zymotic diseases ; this is shown in the 
following table : — 



Males. 


Females. 




Both 




Under 


Under 


Above 




Under 


Under 


Above 


Disease. 


Sexe->. 


All Ages. 


1 


5 


5 


All Ages. 


1 


5 


5 




All Ages. 




Year. 


Years. 


Years. 




Year. 


Years. 


Years. 


Small-pox . . 


1 ,565 


835 


207 


467 


368 


730 


165 


425 


305 


Measles . . . 


10.309 


5,280 


1,071 


4,869 


411 


5,0:29 


891 


4,554 


475 


Scarlet fever . 


27,641 


13,894 


957 


9,165 


4,729 


13,747 


835 


8,913 


4,834 


Whooping-cough 


10,966 


4,878 


2, 1 55 


4,722 


156 


6,088 


2,404 


5,854 


234 


Continued fever : 




















Typhus . . 


4,281 


2,195 


11 


126 


2,069 


2,086 


- 


129 


1,857 


Typhoid . . 


8,660 


4,147 


137 


778 


3,369 


4,513 


143 


875 


3,638 


Simple . . . 


5,449 


2,700 


310 


732 


1,968 


2,749 


109 


756 


1,993 


Diarrhoea . . 


19,903 


10,251 


6,810 


8.780 


1,571 


9,652 


5,950 


7,813 


1,839 


Diphtheria . . 


2,606 


1,221 


152 


749 


472 


1 ,385 


122 


732 


653 



During this year there was a severe epidemic of scarlet fever, and therefore 
the numbers in the above table are in excess of the average ; but since every 
year one or other zymotic disease is prevalent to a great extent, the totals vary 
but little from year to year. In 1871 small-pox carried off a great many, and 
measles and whooping-cough were very prevalent. Out of 110,601 deaths in 
this year of both sexes and of all ages, from zymotic diseases, as many as 
91,380 deaths were from the seven disorders enumerated in the above table, 
and these are in a great measure diseases which, if not preventable, are c.ipable 
of being much diminished if proper sanitary regulations were carried out ; 
about one death occurs from zymotic disorders out of every 4^ persons who 
die from all causes ; the prevalence of each disorder at different periods of 
life will be noticed in the above table. In the same year 3464 persons died 
by accident or negligence, 142 by homicide, and 409 committed suicide. 
Thirteen causes of death were assigned to over 10,000 persons each in 1869 ; 
all the other causes of death were below that number. 



MOR 



523 



MOR 



Phthisis . . . . ' . 52,270 deaths. 

Bronchitis 43,883 " 

Atrophy and debility . 29,954 " 

Old age 27,932 " 

Scarlet fever .... 27,641 " 

Convulsions .... 26,015 " 

Pneumonia .... 25,246 " 



Heart disease . , . 23,628 deaths. 

Diarrhoea 19,903 " 

Apoplexy 11,054 " 

Whooping-cough . . 10,966 " 

Paralysis 10,950 " 

Measles ...... 10,309 " 



Twenty-five hundred and forty-five persons of both sexes died from burns and 
scalds in England and Wales in this year; of this number 716 were male 
children, and 576 were female children, under five years of age, or nearly half 
the total number; most of these deaths were attributed to carelessness and 
neglect. 

Mortality of the year 1871. In the United Kingdom 677,907 deaths were 
registered in the year 1871, being at the rate of 22.6 per 1000 persons living. 
In England and Wales the deaths were 515,096, the death-rate being almost 
identical with that for the ten years 1861-70. In the four quarters of 1871, 
101,358 deaths were referred to the seven principal zymotic diseases, against 
98,081 in 1870 ; of these 22,907 resulted from small-pox, 9233 from measles, 
18,282, from scarlet fever, 2405 from diphtheria, 9616 from whooping-cough, 
15,396 from the three forms of continued fever, and 23,159 from diarrhoea. 
Compared with the numbers in 1870, the fatal cases of small-pox showed an 
increase of 20,327, and those of measles an increase of 1803 ; the deaths from 
scarlet fever, however, were less numerous by 13,628, and the numbers in the 
other four groups were slightly less. Inquests were held in 25,273 cases, or 
in 4.9 per cent, of the total deaths ; while the cause of no less than 16,059 
deaths was referred to violence, that is, resulted from accident or negligence, 
suicide, murder, or manslaughter. 

Health of foreign cities. In Paris 9856 deaths occurred in the last quarter 
of 1871, being at the annual rate of 22 per 1000 of persons living, but this is 
probably incorrect as the population of Paris, since the war has not yet been 
precisely ascertained ; in Brussels the rate was 27 per 1000 for the same 
period. The population of Berlin is 828.013, and the mortality for the quarter 
was at the annual rate of 37 per 1000, but at that time small-pox and typhoid 
fever were very prevalent ; in Vienna the rate was 28 per 1000 ; in Rome, 
43 per 1000 ; the deaths being excessive from the prevalence of small-pox and 
fever. In Bombay, in the three months ending June 30, 1872, the death-rate 
was 31.2 per 1000; in Madras 33.5 per 1000, small-pox being very prevalent. 
In New York for the same period the rate was 37 per 1000, epidemic cerebro- 
spinal meningitis, small-pox, and scarlet fever being very prevalent. In 
Florence and Turin the rate was 30 and 27.2 respectively. 

The following tables show the number and proportion of deaths per 1000 
of the population in some foreign countries as compared with England for the 
five years ending 1869 : — 

ESTIMATED POPULATION. 



Years. 


England 
and Wales. 


France. 


Austria. 


Spain. 


Italy. 


1865 
1866 
1867 
1868 
1869 


20,990,946 
21,210,020 
21,429,508 
21,649,377 
21,869,607 


37,929,918 
38,067,064 
38,204,696 
38,342,818 
38,481,444 


20,876,643 
20,835,008 
20,986,536 
21,185,021 
21,412,564 


16,423,793 
16,579,090 
16,716,151 
No return. 
No return. 


25,097,182 
25,344,192 
25,404.723 
25,527,915 
25,766,217 



MOR 



524 



MOR 



NUMBER OF DEATHS. 



Years. 


England 
and Wales. 


France. 


Austria. 


Spain. 


Italy. 


1865 
1866 
1867 
1868 
1869 


490,909 
500,689 
471,073 
480,622 
494,828 


921,887 
885,559 
866,366 
918,517 


646,980 
846,991 
590,352 
621,588 
633,447 


538,580 
463,684 
487,151 

No return. 

No return. 


746,685 
733,190 
866,865 
777,223 
713,832 



PROPORTION PER 1000 OF DEATHS TO POPULATION. 



Years. 


England 
and Wales. 


France. 


Austria. 


Spain. 


Italy. 


1865 


23.39 


24.31 


30.99 


37.29 


29.75 


1866 


23.61 


33.26 


33.32 


27.96 


28.93 


1867 


21.98 


22 68 


28.13 


29.14 


34.12 


1868 


22.20 


23.96 


29.34 


No return. 


30.45 


1869 


22.63 


— 


29.58 


No return. 


27.70 



The population does not include that of Hungary and its annexed terri- 
tories, which is estimated at 14,326,364. In 1806 occurred the Austro- Prussian 
war, and cholera was very prevalent; in 186") and 18(16 cholera was very 
prevalent in France ; the Franco-Prussian war interfered with the return for 
1869, and the annexation of Alsace and Lorraine by the Germans in 1871 has 
lessened the population by 2,720,450. The returns for England contrast very 
favorably with those from the above European states. 

Mortification. By this term is meant the death of a part of the living 
body. There are several varieties of this process, styled by surgeons gangrene, 
sphacelus, sloughing, mummification. Gangrene is that stage in which the part 
is hot, swollen, and livid, but not yet quite dead. The term sphacelus expresses 
that condition in which the part is cold and black and utterly deprived of life. 
Mil nullification is dry gangrene, a condition in which a portion of an extremity 
is dry and shrunken. By sloughing is meant a limited death of skin and soft 
structures at the surface of the body. Death of bone is called necrosis, and 
destruction and breaking down of brain tissue is called " ramollissement " or 
softening. The following are the most common exciting causes of mortifica- 
tion : — 

(1.) Mechanical or chemical action. Severe injuries of the extremities, and 
especially compound fractures associated with much crushing and contusion, 
occasionally result in death of the injured parts, the blood supply of which has 
been cut off. The application of actual flame or of hot fluids to the surface of 
the body may also cause destruction of the skin and subjacent soft parts. The 
contact of sulphuric, nitric, and other strong acids, and of the caustic alkalies, 
as ammonia and potash, will also produce mortification. Under this head may 
be included the action of living and putrid animal fluids, as the poison of snakes, 
and the fluid causing the bad result of certain dissection wounds. 

(2.) Stagnation of the blood in a limb due to an obstruction to the circulation 
through the veins, if a limb be tightly constricted at any part by a bandage or 
handkerchief, and this constriction be kept up for eight or ten hours, the ex- 
tremity of the limb will swell, become cold, senseless, and livid, and at last 
mortify. These changes sometimes take place after a limb has been tightly 



MOR 525 MOR 

bandaged for fracture of one or more bones. A common instance of mortifi- 
cation produced by compression of some part of the surface of the body and 
obstruction to the circulation of the blood through the veins is the bed-sore, the 
formation of which, however, is much favored by other conditions, as the ex- 
hausted state of the patient, and the prolonged contact of the skin with urine, 
sweat, and other irritating fluids. 

(3.) Arrest of the supply of arterial blood. When a large artery is torn 
through by a fractured bone or ruptured by external violence, mortification of 
the parts supplied by this vessel will often result, though not always, as a 
sufficient amount of blood may still be supplied by smaller collateral vessels. 
When, in addition to division of a large artery, there is much effusion of blood 
and contusion of soft structures, mortification will certainly take place. Mor- 
tification occasionally results from the blocking of an artery with a clot of 
fibrine detached from the lining membrane of the heart, and carried along 
with the current of blood. In feeble old persons spontaneous mortification 
sometimes attacks the toes or fingers ; this affection, which is called senile gan- 
grene, is generally due to a combination of two or more of the following 
causes : weakness of the heart's action, ossification and contraction of the 
arteries, sluggish circulation, diminished nerve force, exposure to cold and wet. 

(4.) Injury or destructive disease of nerves sometimes causes mortification. In 
a case under the care of Sir Benjamin Brodie, mortification of the skin of one 
foot was observed within a few hours after injury to the spinal cord. Opacity 
and ulceration of the cornea, or transparent membrane of the eye, occasion- 
ally follows division or compression of the fifth cerebral nerve. 

(5.) In France and other countries where rye is an article of food, mortifica- 
tion has been observed to follow the use of this grain when diseased, in conse- 
quence of the growth of a fungus in the ovary. The grain when in this state 
is called ergot, spurred rye, cock spur rye, and, by botanists, Secale cornutum. 
It then contains a poisonous active principle called ergotine, which gives rise, 
when black bread made of the diseased rye has been eaten, to severe cramps, 
itching of the skin at some parts of the body, numbness and loss of sensibility 
at other parts, deafness, and dry mortification of the extremities of the limbs. 
Dr. C. Wollaston, in. the Philosophical Transactions of 1762, reported some 
instances in which gangrene also followed the consumption of diseased wheat. 

(6.) For mortification resulting from the effects of cold and moisture, see 
Frost-bite. 

The predisposing causes of mortification are general debility, due to senile 
decay, to insufficiency or bad quality of food, and to exhausting and severe 
diseases ; to disease of the heart and diabetes. To these may be added the 
local predisposing causes, such as inflammation and congestion of a part of 
the body. 

Moist mortification generally occurs when the circulation of blood in a part 
ceases suddenly ; the dead tissues are then mixed with the stagnant blood and 
serum. Dry mortification, or mummification, results from slow death of a part, 
due to deficient or obstructed arterial supply. When moist mortification at- 
tacks a limb, or a superficial part of the body, the skin becomes distended and 
livid. Blisters containing a dark fluid then form on the surface, and the epi- 
dermis becomes moist and can be readily detached. Large black and purple 
patches then appear, and these increase in size and run into each other. The 
affected part is cold and insensible ; it is much swollen, and crinkles under the 
finger in consequence of the presence of gases. The soft parts under the skin 
are black, putrid, and rotten, and soaked in a thin, ill-smelling fluid. After a 



MOR 526 MOR 

bad compound fracture or gunshot wound of a limb, the mortification often 
spreads very rapidly towards the trunk, and its course is not arrested before it 
carries off the patient. In less severe cases, and when but a small portion of 
an extremity mortifies, in consequence of a deficient supply of blood, the 
edges of the gangrenous patch become sharply defined, and are separated from 
the surrounding and living integument by a bright red groove, moistened with 
purulent discharge. This groove is the 'so-called line of demarkation, and 
when present always indicates an arrest of the mortification. It increases in 
width and depth, and ruddy granulations are formed, from which there is 
a healthy discharge. The deeper portions of the mortified part then become 
detached from the tissues beneath, which are also covered by granulations ; 
before the dead portions are detached, the blood vessels are closed by coagu- 
lation of the blood at their extremities. After the whole of the mortified 
tissue has been thrown off, the resulting wound closes rapidly by granulation 
and scarring. The tissues which are less readily detached, and which gener- 
ally remain when dead for a long time after the removal of other soft parts of 
the gangrenous patch, are tendon and bone. By the formation and subse- 
quent extension of this line of demarkation, a foot or hand, or even the greater 
part of a limb, may undergo spontaneous amputation. This process of sepa- 
ration is generally attended by a profuse and exhausting discharge of pus. 
The intensity of the constitutional disturbance varies according to the extent 
and the cause of the mortification. In cases of rapidly spreading death of a 
limb, in consequence of injury, the patient falls into a very serious condition, 
and presents all the symptoms of low typhoid fever. If the mortification be 
limited to a small part only of a limb, there will generally be heat of skin, 
thirst, headache, nausea, a rapid pulse, and other symptoms of high inflamma- 
tory fever. 

The general treatment of mortification should consist in husbanding the 
patient's strength by giving very nutritious and easily digestible food, with 
port wine and brandy and water as drinks ; opium is administered in most 
cases for the purpose of relieving pain and allaying nervous irritability. 
When the symptoms are those of a low typhoid condition of the system, bark, 
ammonia, and chloric ether are indicated. The local treatment in cases where 
the mortification is limited to one or more fingers or toes, or to a small part of 
the surface of the body or of a limb, ought to be such as would favor the 
speedy separation and throwing off of the dead tissues, and prevent as much 
as possible putrefaction. Loose shreds of skin should be at once removed, but 
care must be taken not to pull away with force any dead tissue that may still 
adhere at its deeper parts. By rough proceedings of this kind troublesome 
bleeding may be caused. The mortified part may be covered or surrounded 
by strips of lint dipped in a weak solution of carbolic acid or of permanganate 
of potash (Condy's fluid), and then encased in a thick layer of prepared oakum 
or of cotton wool dusted with carbolic acid powder. This dressing ought to 
be frequently renewed during the day, and the gangrenous tissues and sur- 
rounding line of demarkation be well syringed with a solution of carbolic acid, 
permanganate of potash, or chloralum. In some cases, where the pain is 
very great and the discharge from the seat of disease very profuse and fetid, 
cold charcoal poultices may do good. In cases of mortification following 
injury and of extensive destruction of the surface of a limb, the surgeon has 
generally to take into consideration the advisability of performing amputation. 

For further information concerning the varieties and special modifications 
of gangrene, the reader is referred to the articles on Bed-sores, Cancul'M 
Oris, Frost-bite, Hospital Gangrene, Phagedena. 



527 




FlO. XCII, 



iPl.G. XCIII 



PLATE XVIII. 



MOU 529 MOX 

Mouth, Diseases of. Under this title it is proposed to deal with some 
of the chief affections of the structures contained within that cavity which is 
bounded in front by the lips ; behind by the soft palate and fauces ; above by 
the hard palate ; below by the tongue ; and on the sides by the cheeks and 
parts of the upper and lower jaw-bones. 

Contraction of the opening of the mouth. This is met with very rarely as 
a congenital deformity, but often results from the effects of injury or disease. 
In the latter case the opening may be much reduced in size, the lips distended, 
and the interior surfaces of these structures and of the cheeks closely united 
to the mucous membrane covering the jaws. This condition not only produces 
a most unpleasant deformity, but often, in consequence of the contraction of 
the opening of the mouth and of the restriction of the movements of the 
jaw, leads to serious disturbances of digestion and nutrition. The most fre- 
quent causes of this unfortunate condition are cancrum oris, lupus or epithe- 
lioma, ulceration of the cheeks and gums from mercury, deep burns of the 
face, and sloughing wounds. 

For affections of this kind there is no treatment short of a well-planned 
and carefully performed plastic operation. 

Spasmodic contraction of the masseter, or large muscle, which closes the jaws, 
is occasionally met with in connection with painful cutting of a wisdom-tooth. 
In consequence of the ulceration of the gum and the irritation about the crown 
of the appearing tooth, the masseter muscle falls into a state of painful and 
persistent spasm. . The jaws are kept closed, and cannot be separated except 
by using a wedge. A similar spasmodic condition is sometimes associated 
with caries of a molar tooth. The only treatment for this affection, and one 
which is always effectual, is removal of the offending tooth. 

Tumors. Cysts are frequently met with on the floor of the mouth. They 
may be congenital or the result of obstructed and distended ducts. These 
growths are described under the head of Ranula. Solid tumors are not 
often observed on the floor of the mouth. A fatty growth occasionally makes 
its appearance under or within the tongue. Large calcareous masses, which 
are supposed to be salivary calculi, seated within the ducts, sometimes form 
under the mucous membrane at the floor of the mouth. The most formidable 
morbid growths to be met with in this cavity are those which spring from the 
upper or lower jaw, in most cases from the former. These generally grow 
rapidly, involve important organs, and necessitate sooner or later some capital 
surgical proceeding. 

For other affections of the mouth see articles on Gums, Hare-lip, 
Quinsy, Ranula, Salivation, Aphthae. 

Moxa. This is a method of applying actual lire to the surface of the 
body for the purpose of producing counter-irritation, blistering, or cauteriza- 
tion, or to form an issue. It is an old and common plan of treatment in the 
East, but is seldom applied in this country. The affections for the treat- 
ment of which it is generally employed are diseases of the spine and joints 
and muscular rheumatic pains. A moxa is composed of some material which 
will burn re'adily, as cotton wool, lint, German tinder, dry rotten wood, made 
into a paste with spirits of wine, blotting-paper, etc. The most convenient 
plan is to take a cylinder of cotton-wool, previously dipped in a solution of 
nitrate of potash, and then well dried, and to place this inside of a small 
pill-box of which the lid and the bottom have been removed. This box should 
then be held over the selected part of the surface of the body by means of a 
loop of thick wire, and the wool ignited. If it be intended to produce only 



MUC 530 MUS 

redness of the skin or slight blistering, the moxa should be held at some dis- 
tance from the skin, and be left to itself to burn out ; but when a slough is to 
be formed and a deep wound to act as an issue, the ignited wool should be ap- 
plied close to the surface, and combustion be kept up by blowing upon the flame 
through a long tube, or by working a small pair of band-bellows. The sur- 
rounding skin must be protected by layers of lint dipped in cold water. When 
the moxa has been consumed, the patch of burnt skin should be covered by a 
fold of moistened lint, which after twenty-four or thirty hours is to be replaced 
by a bread poultice. 

Mucilage. See Acacia. 

Mucous Membrane. The interior lining of the human body, which 
begins at the lips, nostrils, eyelids, and ears, and after lining the several organs 
from which it starts, unites at the back of the mouth or in the pharynx. One 
portion, descending through the windpipe and bronchial tubes, finally termi- 
nates in the air-cells of the lungs ; while another proceeds down the oesophagus, 
or gullet, lines the whole length of the alimentary canal, and finally ends in the 
outlet of the bowels. This membrane is extremely delicate, and when irritated 
or inflamed gives rise to many troublesome ailments. 

Mucus. A thin glairy fluid secreted by the mucous membrane of the 
body, and always present in a certain quantity, which is greatly increased by 
inflammation, and altered in character if it be deposited from unhealthy tissue. 

Mulberry Calculus is a name given to a stone in the bladder, which has 
a rugged surface and is a deep purple color like a mulberry ; such stones give 
great, pain and distress from their rough outline ; they are formed principally, 
if not wholly, of oxalate of lime. See Stone. 

Mumps, also known as Parotitis or Cynanche Parotidea, is an in- 
flammatory affection of the salivary glands, especially of that one lodged be- 
tween the jaw and the ear, called the parotid. It seems to be contagious or 
infectious, and often spreads through a family or district. It begins with some 
degree of fever, and soreness and swelling about the angle of the jaw. This 
swelling gradually extends towards the ear and towards the chin, so that the 
whole side of the face is swollen. The swelling interferes with the movements 
•of the lower jaw, so that the mouth can hardly be opened, and even the slightest 
attempt at opening gives rise to acute pain. From accumulation of the saliva, 
etc., in the mouth itself it decomposes, and, as a consequence, the fetor of the 
breath is very troublesome. The appetite at the same time is usually good, 
and much pain is experienced in endeavoring to satisfy it. The disease does 
not last long ; in about four days it reaches its height and then gradually de- 
clines, rarely going on to suppuration. Occasionally it is said that during the 
abatement of the disease other organs may be affected, especially the testes in 
male subjects ; but this is by no means necessarily so. It is true that these 
organs are so affected sometimes, but the attack is rather simultaneous or follow- 
ing close upon the mumps than any true metastasis, that is passage of inflam- 
mation from one spot to another, leaving one organ and attacking another. 
Such a change of site is rare, and this can hardly be said to be an example of 
it. The remedies to be used for. mumps are simple. The bowels should be 
well opened, best by some saline medicine, say a dose of Rochelle salts, in the 
form of a Seidlitz powder. The patient had better remain in-doors and keep 
warm, with a piece of warm flannel round the throat. The diet should be milk, 
as nearly as possible. Warm opiate fomentations, or dry heat, may be used to 
relieve the pain of the inflamed parts. 

Muscae Volitantes, or Motes, are the small dark bodies and beaded 



MUS 531 MUS 

strings which appear to some individuals floating across the field of vision, and 
give rise to much trouble and often to unnecessary alarm. Sometimes but one 
or two small bodies, like specks of dust, are observed rising and falling, and 
then when the person's attention is directed to some external object these sud- 
denly disappear. At other times, by a sudden movement of the eye, the field 
of vision is crowded both by specks and by beaded strings, which glide about 
for a time and then slowly sink. These bodies are analogous to the highly-re- 
fractive globules which are observed both singly and arranged in strings when 
one looks through a microscope, the field of which is brightly illuminated. 
Muscat are generally observed for the first time at about the age of twenty- 
five, or between this and the age of thirty or thirty-five. At first they are 
few in number, but soon increase. They are usually observed by myopic or 
short-sighted persons, but do not indicate, as is too often supposed, any deep- 
seated and progressive disease of the eye. While these floating bodies increase 
in number as the patient gets older, and give much trouble, they are generally 
associated with a normal continuance of good and in many cases even acute 
sight. Muscas, however, must not be confounded with the mistiness of vision 
and the floating and fixed opacities which are among the symptoms of advanced 
disease of the membranes and humors of the eye, or of haemorrhage into the 
interior of the eyeball. The floating nauseas, or motes, are loose portions of 
the delicate filamentous tissue of the transparent and apparently structureless 
viscid material which fills up the interior of the eye, and which is called the 
vitreous humor. Muscas volitantes cannot be completely removed by treat- 
ment. If at any time they should become unusually numerous and give rise 
to much irritability, the application of a solution of atropine dropped into the 
eye will give temporary relief. 

Muscle forms a very important tissue of the body. There are two kinds 
of muscle : (1.) That which is found in the muscles of the trunk and arms and 
legs, and by which we have the power of moving about ; this kind is made up 
of bundles of fibres, and by the contraction of these fibres, under the influence 
of the will, movement is performed. The biceps, for instance, is a muscle of 
this class ; it forms the well-known prominence in front of the upper arm ; it is 
attached above to the shoulder-joint, and below to the humerus or bone of the 
upper arm ; now, when it contracts, the two ends tend to approach each other, 
and so the arm becomes flexed or bent. In the body, therefore, there is an 
immense number of muscles, by means of which, when they act either singly 
or in combination, every movement can be performed. All these muscles are 
supplied by nerves, which are in direct communication with the brain or spinal 
cord, and by which the will can act upon any part of the system. Since these 
muscles are under the influence of volition, or the will, they are called volun- 
tary muscles. These muscles may become hypertrophied, or increase in bulk 
from active use, as is well seen in the limbs of an athlete, and in the arms of a 
blacksmith ; or they may waste from disease, or become atrophied, as in cases 
of paralysis, or in cases of long-standing disease, as cancer or consumption. 
Local wasting of the muscles of the fore-arm may come on in some cases of 
lead poisoning, and a general and gradual wasting of these muscles is an im- 
portant part of the disease known as progressive muscular atrophy. Spasms, 
or irregular muscular contractions, which occur in the course of tetanus and 
some other nervous disorders, are due to an altered condition in the nerves 
which supply them. (2.) The other class of muscles is known as the group 
of involuntary muscles, because, although they are supplied by nerves and have 
the power of contracting, they are not under the influence of the will ; they 



MUS 532 MUS 

also are formed of bundles of fibres, but of different structure and arranged in 
a different way. The heart, the womb, and the muscular coats of the stomach 
and intestines are made up of this involuntary muscle ; in the heart, the blood 
is propelled through the body by the muscular contraction, and it may increase 
in frequency from disturbed nervous influences, as is seen by the palpitation 
which comes on from fright, etc. This tissue may become hypertrophied in 
some cases of heart disease, and cause that organ to increase vastly in size. In 
the womb, hypertrophy of the muscular coat takes place in pregnancy, and it 
is by the contraction of this tissue that the infant is finally expelled from the 
womb ; the muscular fibres afterwards become fatty and waste away. In the 
intestines it is by means of the gradual wave-like contraction of the muscu- 
lar coat that the food is propelled along the intestinal canal ; if the coat is 
torpid and will not contract, constipation ensues ; while if its action is irregular 
and excited, diarrhoea and griping pains may come on. 

Mushrooms. There are many species of Agaricus known under the 
common name of mushroom, but few which are usually eaten ; and although 
much has been written and said to prove that many more may he safely used 
as food, we are inclined to think that such experiments are better left to those 
who are botanieally acquainted with the peculiar structure of each species, for 
of late many serious accidents have occurred to unskillful judges who have 
eaten poisonous mushrooms instead of those which are really edihle. The 
common mushroom of Great Britain, Ayaricus campestris, is readily known by 
its fragrant odor, which is its chief characteristic, and the ahsence of which is 
very suspicious. When in a very young state it resembles little snow-white 
balls which are called buttons ; afterwards it acquires a stalk, separates its cap, 
and becomes shortly conical, with liver-colored gills, and a white, thick, fleshy 
cap, marked with a few particles of gray. At a more advanced age the cap is 
concave, the color gray, and the gills black; in this state it is called a flap. 
This mushroom, which' is almost the only one ordinarily eaten, is included in the 
few species which are daily gathered and thrown away into the Tiber at Rome. 
This prejudice may possibly have arisen from the fact that one of the Roman 
emperors was poisoned when eating this mushroom, not owing to its own 
nature, but from poison introduced into the dish. Ketchup, which is a popular 
ami not unwholesome condiment, is made from mushrooms, and is the basis of 
most of the numerous sauces which are in common use as additions to cookery. 
There are many other species of mushroom besides Agaricus campestris, sev- 
eral of which are said to be eatable. The fairy-ring mushroom, Agaricus pra- 
tmsis, is well known, and is recommended by Dr. Badham in his book on 
Esculent Fungi as good to eat, dried, powdered, and mixed with sauces. As 
a rule the colored varieties of mushroom are unfit for food, and such as have a 
milky juice should be avoided. 

Musk is the peculiar secretion of the musk deer, a native of Thibet and 
Central Asia. It occurs in irregular reddish-black grains, bedded together and 
soft to the touch. The odor is powerful, diffusive, and persistent. This sub- 
stance is described as stimulant and antispasmodic. No physicians care to pre- 
scribe it. Most of the musk commonly encountered is spurious. 

There is a root known as Soibul or Musk Root which has a similar odor. 
This comes from Siberia, — otherwise its origin is unknown. It seems to act 
something like valerian, and has been used in Russia for low fevers. Its use 
has not been attended by much success in this country. 

Mustard. The seeds of two kinds of Sinapis, one of which yields the black, 
the other the white, mustard. These yield an oil, which is also officinal. The 



MYO 533 NJ1V 

black seeds are smaller than the white. The two together, reduced to powder, 
constitute the officinal substance. The composition of these seeds is peculiar, 
The black give off a volatile oil, which it does not contain ready made, but 
which is formed by the union of two substances contained in mustard if water 
be present. This volatile oil is light yellow and very pungent, while mustard 
does not yield the oil, but contains a non-volatile crystallizable compound ex- 
ceedingly irritant. 

There are two preparations of mustard : First, the well-known poultice, 
which should be made with lukewarm water, and no spirit or vinegar should 
be added. In the officinal preparation linseed meal is added. One of the 
best plans is to spread a little mustard paste over a moderately hot linseed- 
meal poultice, with a thin piece of cambric over that. Second, the compound 
mustard liniment, a new preparation. Mustard seeds and flour act as a pow- 
erful stimulant. In good large doses it causes speedy vomiting, useful in nar- 
cotic poisoning ; in smaller doses, as a mild stimulant, its aids digestion. Ex- 
ternally, mustard acts as a powerful stimulant, useful in local pains of various 
kinds, especially slight inflammations. It is frequently used in foot-baths. 
Various plans are employed for applying mustard to the skin ; the best are 
those hinted at above ; but by far the most convenient is in the shape of Rig- 
ollot's mustard leaves. 

Myopia, a condition in which the vision is altered. See Eye and Vision, 
Short-sight. 

Myrrh is a green resin exuding from the Balsamodendron myrrha, a tree 
of the turpentine group, growing in the East. It occurs in irregular reddish 
fragments, the surface often covered with powder. It lias a peculiar odor and 
taste. Myrrh is contained in a variety of pills, for the sake of its warming 
and stimulant properties. It is frequently given along with iron, and aloes 
especially ; occasionally also as an expectorant. The tincture of myrrh may 
be used for that purpose, as well as for an application to spongy gums, aphthous 
mouth, etc. 

N. 

Naevus called also erectile a tumor aneurism by anastomosis, or commonly 
mother's mark, is anatomically a tumor composed of dilated blood-vessels, and 
those small ones ; or generally it is a diseased formation, in which the vascular 
tissue bears the most prominent part. The simplest form, a congenital one, is 
an affection of no danger, rather a deformity than a disease. Jt is very su- 
perficial, and hardly projects above the level of the skin, consisting of a patch of 
dilated capillaries. Although usually congenital, it may develop later on ; fre- 
quently the patches disappear of themselves, but more generally increase in 
size and vary in shape. The most common localities are the true skin of the 
face, head, neck, back, and buttocks. Another form of naevus is found in the 
subjacent tissues, consisting of dilated veins, causing an elastic, livid tumor. 
The true erectile tumor is one composed of capillaries and arterial branches 
largely dilated, with strong, thick, vascular walls. There is free communica- 
tion between these vascular tubes, which are attended with large tortuous 
veins. The mass may be either suhcutaneous or submucous ; it constitutes the 
true aneurism by anastomosis, and its structure is analogous to normal erectile 
tissue, such as exists in various parts of the body, with this difference ; that it is 
always in nearly the same state of distension, and its bulk and tension varies 
with the state of the circulation, and a local determination of blood in the nor- 



NiEV 534 NJ1V 

mal tissues cause its erection. The growth is usually congenital, and its most 
common situations are beneath the integuments of the face, head, neck, back, 
and buttocks, orbit, bones, or viscera. Pathologically considered, there is no 
aneurism in the proper sense of the term in this growth, as there is no degen- 
eration of coats, but dilatation with hypertrophy, and increased function as 
well. A bruit is heard in it, sometimes associated with a vibratory thrill, and 
although it pulsates synchronously with the action of the heart, this pulsation 
is less distinct and has less expansion than true aneurism. (See Anicdrism.) 
It is worthy of note, that in the female adult these tumors may be the seat 
of vicarious menstruation, the tumor becoming dense and full at the return of 
each period, and the blood slowly distils from some fissure or sore on its sur- 
face. The treatment of erectile tumor may be conducted on three principles : 
(1) removal ; (2) diminution of arterial supply ; (3) effecting change of 
structure. 

(1.) By Removal. In cases where the skin is involved, the removal by the 
application of a ligature is the most successful. The tumor is transfixed by a 
stout needle carrying a hemp or silk ligature, which is left in by withdrawing 
the needle, the loop is then cut, and both sides of the mass included in each 
portion of the thread, which is tied up as tight as it will bear ; by this means 
the nasvus is strangulated or killed, and brought away. In complex naevi 
several such loops must be used. In some instances transfixion with hare-lip 
pins, and ligatures twisted round them, suffice to destroy the tumor. In large 
nasvi, where the integument is uninvolved, it may be dissected from off the 
mass and reflected, so that the naevus may be strangulated subcutaneously, and 
the flaps being replaced, there will be an avoidance of the puckered scar fre- 
quently left after ligaturing these tumors. A method of ligature devised by 
Professor Wood, whereby skin is saved and scar prevented, is thus performed : 
A slightly curved needle on a handle, with an eye near the point, is armed 
with a fine smooth hempen thread; "it is first passed under the skin round half 
the circumference of the morbid tissue, entering and emerging through the skin 
at the opposite pole of the tumor. The short end of the thread is left in the 
puncture and the needle withdrawn, carrying the long end. Next it is passed 
under the base of the tumor across its diameter, entering and emerging at the 
punctures first made. The loop at the eye of the needle is then caught and 
held while the needle is withdrawn, carrying the free end of the thread. 
Lastly, the needle is passed round the remaining half of the circumference, 
under the skin, through the same two punctures, and the ligature thread de- 
tached. There are now a loop and two free ends emerging from the farther 
puncture, the thread being entirely sunk into the puncture nearest the opera- 
tor. The ends are then made each to pass through the loop, and tied very 
tightly in a loop knot, so as to leave the power of tightening it as the parts 
inclosed shrink under the ulcerative process. As the thread is tightened the 
loop recedes into the puncture, but is held there by the ends passing through 
it, and the pressure exercised throughout is everywhere equalized. By this 
method the suppuration and slough formed by the nasvus escapes by the 
punctures along the thread. The small spots of cicatrix remain as the only 
evidence of the operation." Extirpation by the knife is advisable only when 
the tumor is small, and can be lifted up from the parts beneath it, and its shape 
and size accurately determined. Two elliptical incisions should be made so as 
to include the whole of the diseased growth and a little of the sound tissue 
surrounding it. 

(2.) By diminution of the arterial supply. If the tumor is so situated that 



NAI 535 NAI 

it is inaccessible by the knife or ligature, the main arterial trunk may be liga- 
tured ; as, for example, if within the orbit, by ligature of the common carotid, 
or, in some instances, the feeding vessels can be obliterated with a twisted sut- 
ure. 

(3.) By effecting change of structure, — consolidation of the contents, con- 
verting the texture into a compact mass, or by converting it into abscess. The 
means adapted to this end are : pressure ; potassa fusa applied lightly, so as to 
induce ulceration, thus imitating the process of spontaneous cure ; a red-hot 
needle or galvanic cautery introduced frequently and freely through the mass ; 
the injection of some coagulating fluid through a fine syringe; the seton. If 
the nasvus be very small and superficial, the repeated application of nitric acid 
will destroy it; in applying the acid care should be taken that the parts imme- 
diately surrounding the nasvus are not implicated. In children, vaccination in 
the site of the tumor is sometimes of use. By obstructing both the arterial 
and venous supply, the contents of the tumor maybe caused to suppurate, and 
after the evacuation of the pus the naevus sometimes entirely disappear. Am- 
putation has been necessary in some instances, as, for example, where the 
greater part of the foot or hand, or a finger or toe, has been involved. There 
is likely to be considerable haemorrhage in such a case. 

Nails, Diseases of. Acute inflammation of the soft structure into which 
the root of the nail is implanted frequently occurs in the toes, in most instances 
the great toe, after much walking in tight or short boots. The whole toe be- 
comes red and swollen, and even slight pressure upon the free edge of the nail 
causes acute pain. The crescentic margin of skin at the root of the nail is re- 
tracted, and in the course of three or four days there is from this part and from 
under the nail a scanty discharge of dark-colored and ill-smelling pus. The 
whole nail then becomes thickened, and is finally loosened from its attachment 
to the top of the toe, and is thrown off, leaving a new short and delicate nail, 
which grows slowly and is for several months overhung by the structures form- 
ing the swollen extremity of the toe. The usual treatment for this affection is 
absolute rest, and the frequently repeated application of lint dipped in cold 
water or lead lotion. 

Psoriasis of the nail is not often met with. It attacks the nails both of the 
fingers and toes, and is in most instances observed in patients who have had 
the venereal disease. The affected nail becomes brittle, thickened, and very 
rough on its surface. It is also very convex on its upper surface, and has been 
said to resemble in miniature the outside of the concave shell of an oyster. 
The free edge is rough and broken, and the skin at its root and along its sides 
is swollen and reddened. The nail is finally thrown off, and leaves a raw and 
inflamed surface, upon which a small and malformed nail finally grows. In 
severe cases the inflammation extends and involves the whole of the finger. 
In acute and severe cases, warm fomentations or poultices may be applied with 
advantage. The chronic form is usually treated by the internal administra- 
tion of mercury, arsenic, and bark, and by the local application of glycerine 
or tar ointment. The roughness of the surface of the nail may be removed or 
reduced by friction with a small file or with sand-paper. The affection in most 
cases is very obstinate. 

Onychia maligna. This is an unhealthy ulceration of the bed of the nail 
affecting one of the fingers or toes of a scrofulous child. The end of the digit 
is much swollen, and of a deep red color. The nail is expanded at its free 
edge, and is incurved laterally ; it also loses its color, and is lifted from its 
bed by a layer of dark, thin, and very fetid matter. The fold of skin at the 



NAR 536 NAR 

root of the nail is retracted, and at last the nail itself is thrown off, leaving a 
deep irregular nicer with jagged edges. This ulcer increases in extent, and the 
surrounding skin hecomes redder and more swollen. The progress of the ul- 
ceration is attended with severe pain. This disease is often excited by a slight 
injury to the digit. The simplest local treatment for this very obstinate dis- 
ease is the application every second or third day of a strong solution of lunar 
caustic or blue stone. Arsenic also is a useful agent, but ought not to be 
employed except with great caution. The nail should be removed as soon 
as it is loose. The general treatment should consist in placing the patient in 
good air, giving plenty of nourishing food, and in the internal administration 
of chlorate of potash with small doses of bichloride of mercury or gray pow- 
der. 

In-growing toe-nail, or growth of nail into the flesh, occurs in almost all 
cases on the outer side of the great toe. It is a very troublesome and painful 
affection, due to overparing of the nail, or to compression of the foot and toes 
caused by walking in tight boots. The soft and delicate integument at the 
outer edge of the nail, in consequence either of compression or if irritation, 
swells and becomes inflamed. The swelling does not subside, but is kept up 
and increased by the contact of the sharp edge of the nail, which, as this 
structure grows, is imbedded into the overlapping fold of skin, and at last 
causes ulceration and a discharge of pus. From the raw surface thus formed 
there often springs a prominent mass of proud flesh or exuberant granulations, 
which is so extremely tender that the patient cannot wear a boot. Exercise, 
or even an attempt to walk, will often produce redness and swelling of the 
whole toe. When the end of the toe is much inflamed, and the edge of the 
nail is overhung by a large fungous mass of proud flesh, the foot should be 
kept at rest and uncovered by shoe or stocking, and the inflamed parts be 
bathed with some cooling lotion, as a solution of muriate of ammonia in water 
and spirits of wine or lead lotion. In slight cases, and when there is little or 
no inflammation present, the nail, after having been softened in warm water, 
should be scraped very thin with a sharp pen-knife, and under its outer edge 
be then pressed in a small quantity of scraped lint, so as to form a soft and 
yielding pad between the irritated skin and the in-growing nail. The scraped 
lint should first be oiled and then introduced little by little with the end of a 
small probe. This treatment should be repeated every second or third day, 
until the edge of the nail no longer presses against the side of the toe. In 
severe cases, where the ulcer is large and very tender, and the margin of the 
nail is deeply imbedded, removal of the outer half of the nail is the most ef- 
fectual mode of treatment. This is a very painful operation, and should al- 
ways be preceded by the administration of ether, or by what acts quite as 
effectually, the local application of ether spray. 

Narcotics are remedies which procure sleep. There are usually other 
remedies associated with these which may procure sleep in another way, by 
relieving pain. These are technically known as Anodynes, and include such 
substances as belladonna, stramonium, and aconite, which have directly no in- 
fluence in procuring sleep. The only real narcotics, however, are opium, and 
its chief alkaloid morphia, and chloral. The latter substance has been only 
recently introduced, and had better be given in the form of the syrup of the 
hydrate of chloral. Bromide of potassium and Indian hemp are commonly in- 
cluded in the list, but have no direct influence in giving sleep. Sleeplessness 
may, however, arise from various causes, and so a remedy which is useless at 
one time may be of value at another. In the main, however, if we desire to 



NAS 537 NBC 

procure sleep, we must have recourse either to opium or to chloral. Opium 
seems to have this inconvenience, — it is apt to be followed by headache, and 
it constipates the bowels ; it also disorders the digestive organs generally; and 
so it is better to avoid its use in a good many cases. Chloral was introduced 
with the notion that, being absorbed, it would in the blood become converted 
into chloroform, and so produce a kind of anaesthesia. Experience, however, 
shows that it acts rather as a simple narcotic than as an anaesthetic, and its 
effects seem to be less felt afterwards than those of opium. 

Nasal Haemorrhage. See Epistaxis. 

Nausea is a common symptom of dyspepsia and disorders of the stomach. 
When occurring in women in the early morning during the child-bearing 
period, it is one of the signs of pregnancy. In diseases of the liver and kid- 
ney, as well as in those of the stomach, nausea may be a prominent and dis- 
agreeable symptom. It may be produced also by nervous and emotional in- 
fluences. See Indigestion. 

Necrosis. By necrosis is meant the death of bone, analogous to gangrene 
of the soft parts, by which the shaft of a long bone (generally) dies from in- 
jury or inflammation, and is inclosed in a case of new bone. Exfoliation is a 
form of necrosis, but it is the death of a thin superficial layer not encased in 
it new bone. The dead portions of bone are called sequestra. 

Necrosis may be divided into simple and complicated : the former when it 
is unaccompanied by any disease, the latter when associated with fracture or 
caries. It is further divided into idiopathic, when arising without any assign- 
able cause ; traumatic, when the result of injury. Necrosis is also acute and 
chronic ; the first act, so to speak, the local death, being acute, and the sub- 
sequent process of the throwing off of the old and formation of the new being 
chronic. Necrosis varies very much in extent, its simplest form being, as 
above-mentioned, exfoliation, which is an external form ; the internal form is 
where the inner portions of bone die, and the external retains its vitality. 
General necrosis is where both internal portions of the bone perish simultane- 
ously. Necrosis generally stops at the articulating extremities of bones, and 
thus the cancellous structure is less liable to necrosis than the compact, being 
however, at the same time, more liable to caries. (See Caries.) The bones 
most liable to suffer are those most exposed ; namely, the tibia, femur, hu- 
merus, cranium, lower jaw, clavicle, ulna, etc. Acute necrosis is more prevalent 
in the young than in the old. The peculiar form of necrosis affecting the jaws 
has often, as its specific cause, the phosphoric fumes of lucifer-match making ; 
this disease has been discussed in' the article on Lucifer-match Makers' Dis- 
ease. The process of necrosis can be related as follows : In the first place, 
Inflammation ; in the second, Death in the third, Separation; in the fourth, 
Reparation. 

(1.) Inflammation. This inflammation may be the result of a wound, 
bruise, or fracture ; or it may be apparently of spontaneous origin. The 
periosteum is removed, and inflammation of the bone supervenes, and death of 
the bone is probable, although it does occasionally recover; but if the internal 
periosteum be removed or perish, the death of the bone is certain. Exposed 
bone often retains its vitality, though apparently dead ; in these cases it is of 
a brownish color, is dull on being struck, somewhat slippery to the feel, and if 
pulled about with instruments, bleeds. If all vitality be gone, it is white, dry, 
resonant on being struck with a probe, and is perfectly exsanguine. 

(2.) Death. Death of bone is often very rapid, sometimes occurring in a 
few hours ; whilst at others it takes a considerable time. The appearance of 



NEC 538 NEC 

the necrosed portion varies in accordance with the period during which the 
bone is perishing. If very rapid, it hardly appears different from healthy bone. 

(3.) Separation. The separation of the dead portion from the living is 
slow, and its process is somewhat similar to the detachment of sloughs in the 
soft structures. There is great activity in the structures immediately sur- 
rounding this dead portion. The vascularity is increased. It is painful to the 
touch, and bleeds, the blood being florid and arterial in color. A line of sep- 
aration forms at the junction of the dead with the living, and the periosteum 
at this point is thickened. The living osseous substance along the line of 
junction, by becoming transformed into a soft granulation material, at length 
becomes a continuous trench ; this goes on deepening, and the above-mentioned 
substance is firmly connected with the living bone. The formation of this 
trench is accompanied by suppuration, and the pus formed in the neighborhood 
of the dead parts makes its way to the nearest surface, and in so doing in- 
terrupts the production of the new bone which is going on, and leaves sinuses, 
or, as they are called, cloacce ; these cloacae correspond with sinuses in the soft 
parts, the pus passing out through them. A probe passed down any of these 
cloaca? detects the peculiar feeling of the dead portion or sequestrum at the 
bottom of the openings. The separation of dead bone, and the formation of 
the new bone are processes which advance together ; consequently the seques- 
trum is often entirely surrounded by a shell of newly-formed bone. The 
sequestrum is, after separation, to be regarded as a foreign body, of no use to 
the bone, and unconnected with it, and must consequently be treated as such, 
and its removal assisted. The sequestrum is always smaller than the recess in 
which it lies, not from its absorption, but from the transformation of more or 
less of the living bone into soft texture, whereby separation is effected. 

(4.) Reparation. The process of reparation advances both superficially and 
internally ; superficially it is carried on by the periosteum, a membrane invested 
with special ossific power; internally it consists of osseous production from the 
living bone beneath the loosening sequestrum. If the necrosis be internal, and 
a part of the cancellous structure only having become dead, as soon as the 
sequestrum is extruded reparation rapidly follows. The pus escapes through 
the laminated portion of the bone by cloacre, which have been formed by 
ulcerative action, and the process is a very tedious one if the sequestrum be 
small and the original inflammatory action limited, the resulting suppuration 
being slow and slight. When the necrosis is general, the processes of separa- 
tion and reparation advance in the same way. There are instances where long 
bones have been almost entirely reproduced. Great care must be taken 
throughout the whole period of treatment to keep the periosteum as entire as 
possible, and not to remove the dead shaft too soon. Short bones, if wholly 
necrosed, are never reproduced, and reproduction is rare in the flat ones. 

Symptoms of necrosis. In the first place, there will be either signs of some 
local injury, or the general symptoms of osteitis, with suppuration of the soft 
textures round the affected bone. In old-standing cases there is great thick- 
ening of bone and superficial tissues with sinuses leading to the dead bone. 
The presence of dead bone, however, can be determined only by probing or by 
seeing it. If it can be seen, it is either white and dry, or black or yellowish, 
and bare and hard to the touch. 

Treatment: In the early stages of necrosis active measures are not admis- 
sible. When abscesses point they should be opened; all sequestra should be 
assisted to escape, and the health supported by nourishing diet and stimulants. 
If the new shell of bone is not able at first to support the weight of the limb 



NEP 539 NER 

or muscular tension, splints must be employed. No attempt is to be made to 
detach the sequestrum, unless Nature has done her part of the work by entirely 
freeing it from the living tissue. During this process the surgeon's duty is to 
mitigate the symptoms, to prevent the extension of the evil, and to favor the 
advancement of repair. From time to time the rate of progress of the separa- 
tion is to be gently tried by careful probing, and the sequestrum having been 
determined to be loose, steps for its removal must be taken. An incision is to 
be made over it, and if the natural openings or cloacae, etc., be sufficient with- 
out further interference, the mass may be withdrawn by properly devised 
forceps. If, however, such openings are not large enough for its evulsion, the 
new bone must be cut away, either with gouges, chisels, saws, trephines, etc., 
taking care that as little new bone as possible is removed, so that it may be 
brought to the surface. All unnecessary violence must be avoided, from the 
risk of doing damage to surrounding parts. When the sequestrum has been 
removed, the wound must be moderately stuffed with lint, to arrest bleeding, 
and to insure granulation from the bottom. Antiphlogistic treatment must be 
maintained to keep under any accession of inflammation, and perfect rest in- 
sisted on, as it must be borne in mind that, even in the most favorable cases, a 
considerable time must elapse before the necessary consolidation has been 
accomplished. Amputation- is rarely demanded ; but in young subjects, when 
violent inflammation is followed by hectic, or in very chronic cases, when 
separation has become far advanced, but does not complete itself; and when 
the system has been long battling with the exhaustion of irritation and dis- 
charge, and there is evidently no chance of the continuance of the struggle, 
the cause must be removed. Again, amputation is necessary when, in the case 
of the extensive death of a bone throughout its whole thickness, the expected 
reproduction fails. 

Nephralgia is a technical term for pain in the kidney. 

Nephritis signifies inflammation of the kidney ; the disease may be either 
acute or chronic, but for the various kinds the reader is referred to the article 
on Brigiit's Disease. 

Nerves. That nerves and nervous influence play a most important part 
in the phenomena of disease no one will deny, but the exact nature of the 
influence so exerted is far from being fully understood. The nervous sys- 
tem consists of certain central parts called ganglia, or nerve-centres, and cer- 
tain cords connected with these, which we commonly call nerves. These 
centres are distinguished by being made up of small masses, more or less 
irregular in shape, and called cells. These cells commonly send off one or 
more projecting portions of their substance, like tails. These, which are ex- 
cessively minute, serve to connect one cell with another, so as to bring all into 
accord, or, after being carried over by a kind of sheath, go along with many 
others of a like kind to form one of the strings or cords already, alluded to, 
and called nerves. Nerve-centres, then, are mainly composed of nerve-cells. 
Nerves or nervous cords are made up of bundles of finer cords directly com- 
municating with these central nerve masses. The functions or duties of these 
two are totally different : the nerve-cords can only conduct impressions, whether 
they originate without the body or within it ; the centres, on the other hand, 
take note of these impressions and convey a knowledge of them to our under- 
standings. Moreover, should these impressions conveyed from without be of 
such a nature as to demand active exertion on the part of the body, the ap- 
propriate command, so to speak, comes from the central organ of the nervous 
system, and passes to those muscles which have to execute the order. Now, 



NER 540 NER 

the set of nerve-fibres which fulfill the one function will not fulfill the other, 
and so we have two sets of nerve-fibr.es : those which convey impressions to 
the brain, called sensory, and those which convey impulses to motion from it, 
which are called motor. Sometimes we find nerves entirely made up of one 
kind of fibres, motor or sensory, as the case may be, but most frequently 
nervous cords are made up of both kinds. If we take a simple illustration of 
the two kinds of nerves and their respective functions, we shall better under- 
stand them. Suppose by chance we touch a piece of hot iron, the flame of a 
candle, or anything of the kind : this conveys to the part of the body touching 
an impression; this impression is conveyed by the nerves to the brain, and is 
converted into a sensation of pain, but promptly, as the result of experiencing 
this sensation, a stimulus is conveyed through the motor nerves to the part in 
contact with the hot object, which causes it to be promptly withdrawn. So 
speedily, however, all these various acts follow the one on the other that they 
seem to us simultaneous. This is not the place to enter into proofs of this 
position ; we merely make the assertion, knowing that it can be easily proved. 
There are several nervous cords, however, which have a function quite differ- 
ent from these. They preside over all the various movements of life, espe- 
cially respiration, circulation, and digestion, and have a most important bear- 
ing on the subject of disease, especially those presiding over circulation, which 
are sometimes grouped under one heading and called the vaso-molor nerves. 
One of the most important bearings nerves have on disease, however, is that 
exercised through sensory nerves ; these, when over-stimulated, it matters not 
by what means, give rise to a peculiar sensation called pain, and this pain, 
which is a purely nervous adjunct to most diseases, sometimes rises to the dig- 
nity of disease itself. But the pain thus experienced and referred to some 
particular part is not really felt there ; it is felt in the brain, but the origin of 
the impression is ordinarily, but not always, referred to the diseased or injured 
spot. But this painful impression in its turn affects other parts; the nerves 
which rule the action of the heart are affected, and so their peculiar sickening 
feeling, and palpitation or tremulous action of the heart, are produced, which 
is commonly the result of great bodily pain. The sickness is referred to the 
stomach, the palpitation to the heart, but it is the same nerve which produces 
them both, and the same stimulus which affects the nerve. Of recent times 
this mode of arguing has had wider application. The set of nerves already 
alluded to as vaso-motor run along the blood-vessels, and with them penetrate 
into every part. The blood-vessels possess a distinct muscular coat, which is 
ruled by these nerves, insomuch that when the nerves are stimulated these 
muscular fibres contract and so diminish the calibre of the vessels, and conse- 
quently the supply of blood sent to a part. On the other hand, when the 
power of these nervous cords is relaxed, the muscular coat of the vessels 
dilates, and so their calibre is increased ; thereby, of course, increasing the 
quantity of blood sent to a part. Some seek to account for the phenomena of 
inflammation in this way, but in the mean time our knowledge is too scanty to 
admit of any wide generalization ; nevertheless, such facts show how much 
nervous influence is connected with disease, and that it is a fact never to be 
overlooked. No part or organ of the body can be isolated or considered apart 
from its neighbors ; all are mutually dependent, so that when one is ill the 
others are sure not to be well. This is especially true of the nervous system. 
Sound health requires that it should be in a carefully-balanced condition, and 
any organ out of order is apt to give rise to this imperfectly-balanced state of 
the nervous system. Say, for instance, that an individual suffers habitually 



NET 541 NEU 

from indigestion, so that his body is ill-nourished, his brain of course will be 
so also. In him comparatively slight causes will bring on nervous manifesta- 
tions, owing to this condition of his system ; t he may be impatient of slight 
sounds or garish colors ; in point of fact, slight stimuli give rise to inadequate 
results. This is the condition which in ordinary parlance is called nervous- 
ness, or the individual is said to have " the nerves." Rest, quiet, and good 
nourishment are the appropriate remedies. 

Nettlerash, or Urticaria, is a troublesome, stinging skin eruption, which 
gives rise to a sensation resembling that felt after being stung by a nettle. It 
appears on the skin in red and white wheals, slightly raised above the surface 
and producing tingling and itching. It may come on very suddenly and dis- 
appear in a few hours, and then again temporarily appear ; eating mussels or 
periwinkles, or some kinds of oysters, will sometimes produce this disorder, 
and the whole of the face and the body may in a very short time become swollen 
and marked with the eruption. An emetic is the best remedy in such cases, so 
that the irritant matter in the stomach may be at once expelled ; bathing the 
skin with warm water will allay the tingling. Some people are very suscep- 
tible to this rash, and in some it comes out after taking beer or any stimulant ; 
some, again, have it after eating mutton, or pickles, or any acid substance. 
The eruption is disagreeable, but harmless ; the treatment must consist in re- 
moving the cause and in avoiding any article of diet which will produce it ; 
when it appears, bathing with warm water or lead lotion will give relief, while 
a purgative should be administered, so as to remove any irritating cause in the 
intestinal canal. 

Neuralgia is a term given to pains sometimes following the tracks of nerves, 
sometimes lying apart from them, which cannot be referred to any distinct 
morbid change going on in the part. Nevertheless, though there be nothing 
in the spot to account for the pain, this may be of the severest possible char- 
acter, and we are fain, for want of a better causation, to refer it to the nerves 
of the part. Now, nerves, when cut, are not more painful than other parts. 
There is absolutely no pain experienced in slicing the brain ; inflammation in 
tendons, ligaments, periosteum, and the like, where there are few or no nerves, 
is intensely painful. Sometimes, however, pressure on a nerve will give rise 
to pain in distant parts of a most intolerable character. Such is seen in aneu- 
risms of internal vessels pressing upon nerves, and giving rise to frightful neu- 
ralgias. But in ordinary neuralgia we have nothing of the kind ; we have only 
most intolerable pain, and no apparent cause for it. In point of fact, wherever 
we see pain long continued and aggravated, and at the same time we can make 
out no definite cause for the pain, we term it neuralgia. Neuralgia, strictly 
speaking, however, ought to be restricted to pain in the course of nerves, and 
some nerves are affected much more frequently than others. Thus, neuralgia 
of the nerves which give the face sensation is by no means unfrequent ; it is 
most commonly called tic-douloureux. Sometimes the head on one side may 
be affected, or yet again the sciatic nerve be its subject, giving rise to the con- 
dition called sciatica. But internal organs may be affected in like manner, so 
that we may have neuralgic pains of the heart, stomach, or intestines, still more 
frequently of the womb, the bladder, and the rectum ; that is, pain not due to 
any inflammatory or other local change, but due merely, as far as we can say, 
to irritation of the nervous filaments supplied to the parts. It is hard, however, 
to determine whether such and such a pain is neuralgic where internal organs 
are concerned, so here we shall limit ourselves to an account of the simpler 
and better known varieties of neuralgia. 



NEU 542 NEU 

Facial neuralgia, or tic, is perhaps the most common of all, and as the nerve 
attached is made up of three branches, any one of these may be affected. One 
of these branches goes to the eye, and a part of it passec out from the orbit 
and turns up over the forehead. This is often the seat of pain, and when so 
the neuralgia generally affects one side of the forehead, extending upwards 
towards the hair. The next branch of this nerve comes below the eye and ex- 
tends over the cheek and on to the side of the nose. This, too, may be affected, 
and very often is so, especially when the teeth on the corresponding side are 
decayed. The third branch of the nerve extends along the lower jaw, and is 
not so often the seat of pure neuralgic pain as the others. For instance, the 
branch on the forehead may be affected without any definite cause being ascer- 
tainable, that is to say, purely neuralgic, and very possibly dependent on some 
change in the nerve-centre rather than in the branch itself. But in the other 
branches we are much more likely to find a cause in some decayed teeth or 
some condition of the jaw which gives rise to irritation ; and though we include 
such maladies under the heading neuralgia, they are rather instances of pain 
produced in one spot appreciated by the sensory centres in another. Neural- 
gic attacks commonly affect one side only, and they are often attended by or 
end in attacks of nausea and violent vomiting. The pain varies in severity, 
from a slight twinge now and again to unbearable agony. Not unfrequently 
this pain becomes periodic in its onset, appearing at certain hours of the 
day and departing at others, thus simulating the effects of malaria. Whether 
such periodic neuralgias are really produced by malaria is not plain ; un- 
doubtedly cold and damp do exercise a powerful influence over them. Cer- 
tain forms of neuralgia appear to be associated with anremia, and a goodly 
number with imperfect digestion, so that frequently bad teeth and their con- 
sequent imperfect mastication of the food, setting up dyspepsia, go hand in hand 
in producing faceache. Undoubtedly bad teeth are one of the most prominent 
causes of faceache, neuralgia, and otherwise, insomuch that when a patient 
comes complaining of pain in the face, especially the cheek, the first thing we 
do is to examine the teeth, and if any be decayed we send him or her to the 
dentist before trying any local remedy. Rut even with this precaution we 
sometimes miss our mark, for the source of the malady may be the teeth, and 
yet that source be not apparent, for one of the common causes of this form of 
faceache is an outgrowth from the tooth itself, which is technically called an 
exostosis. This is often difficult to detect, though pressure on the affected por- 
tion of the gum gives rise to pain ; and even when detected the patient, having 
had no toothache, and having nothing the matter with the tooth, may refuse to 
have it removed. To those not familiar with the influence exercised by the 
teeth, particularly the molars or grinders, on the neighboring parts when dis- 
eased, the amount of suffering which may be produced by an apparently slight 
cause would be incredible. In some instances so obstinate is the pain pro- 
duced by irritation of the jaw that all the teeth may have to be removed for 
the relief of the malady, and even this may not suffice, for we have known 
violent faceache produced by a badly fitting set of false teeth. Exposure to a 
draught of cold air falling on the side of the face is not an uncommon cause 
of neuralgia. This, perhaps, most frequently occurs in crowded halls or as- 
semblies when a window or door has been partially opened for ventilation, or in 
driving home in a carriage with the windows open, or the like. These causes 
are all the more likely to set the pain going if any such permanent irritation 
to the gum as bad teeth exist, or if the patient be liable to attacks of neuralgia 
of the face. The pain frequently prevents all attempts to sleep, but once the 



NEU 543 NEU 

patient has fallen asleep he may sleep soundly, for the pain no longer torments 
him. Neuralgia of the head presents nothing special. Fatigue or debility is 
its most frequent cause. See Headaches. 

Sciatica is a form of neuralgia which in a good many respects differs from 
those already noticed. The pain most frequently affects the hip or buttock, 
and extends downwards from the point where the great nerve of the lower ex- 
tremity issues from the trunk to the space behind the knee. It may even ex- 
tend further, so as to affect the nerves of the leg and foot, but in all cases the 
pain at the back of the buttock is more severe than elsewhere. Sometimes 
this pain arises from pressure on the nerve within the abdominal cavity, from 
enlargement or misplacement of the womb, for instance. Or the great gut 
may be distended with fasces and press upon it, for the pain in the buttock is 
very often accompanied by constipation. Again, in a goodly number of in- 
stances, the pain seems due to inflammation or some analogous change in the 
health of the nerve itself. If so, the patient has most probably a rheumatic 
taint, or has been exposed to cold or wet. Pregnant women may also suffer 
severely; one side is usually affected, and the effect of it is to lame the patient 
completely; in some instances, indeed, she can obtain rest neither night nor 
day. 

One thing is to be noticed with regard to all neuralgic attacks : they are 
most frequently produced by fatigue, mental or bodily, or, if not brought on 
by these causes, are most readily produced by any other cause in subjects who 
have been exposed to these, or are suffering from the weakness occasioned by 
them. This is a most important indication in treatment ; indeed, it may be 
said to be its basis. Rest and nourishment, nourishment and rest, are the 
foundations of our means of dealing with neuralgia. Nourishment may be 
taken with tolerable ease, but in certain cases where there is sickness and 
vomiting there may be difficulty in improving the general condition. This 
form of neuralgia is often associated with bad teeth, as already pointed out, and 
these must promptly be removed. Frequently after this is done nothing ex- 
cept tonics are required. Stimulants, too, are as a rule necessary, but must be 
carefully selected to meet the wants of each individual case. Rest is all im- 
portant, but rest is not always attainable without something being done for the 
patient. Where the pain is very severe, the best thing that can be done, after 
having had the bowels well cleaned out (this in all cases is an indispensable 
preliminary), is to give the patient the fifth of a grain of morphia acetate 
under the skin of the arm. This will relieve the pain, and procure the rest 
so much needed. Many, indeed, look upon this as being the treatment in all 
instances, but its true value we have just pointed out — it procures rest, and 
so allows time for self-recuperation. 

For opening the bowels in the first instance, saline purgatives are perhaps 
best, but their action may not be sufficiently powerful, and so calomel or even 
croton oil are required ; best of all are the repeated doses of a laxative mineral 
water, such as may be procured at many spas. Aloes, especially as watery 
extract, is a good preparation, particularly in sciatica, where there is a suspi- 
cion that the cause of the malady is habitually over-distended bowels. 

In most cases iron and cod-liver oil are essential. Iron is best given in 
some mild form, as carbonate, or as reduced iron, or as peroxide. Cod-liver 
oil is best given just after food; iron, along with food. In reality they are 
both forms of food rather than of medicine. If the malady is periodic, as it 
often is, whether this depend on malaria or no, quinine had better be given, at 
first in full doses (five grains or so), after in smaller quantities, say five grains 



NEU 544 NEU 

of the citrate of iron and quinine three times a day If there is indigestion, 
that too, must be seen to, rhubarb and soda or potass being usually the best 
remedies. 

In rheumatic cases, especially in sciatica dependent on this cause, iodide of 
potassium is the remedy. Full doses of ten grains or more must be given. 
Bicarbonate of potass is useless. In neuralgic headaches, sal ammoniac often 
does the greatest good. That, too, must be given in large doses, thirty grains 
or so, and it does not always succeed. If the pain be very intense, chloroform 
may be given, but as we can generally procure rest by the administration of 
opium subcutaneously, that is to be preferred. Chloral is a totally different 
thing ; doubtless it will be of the greatest use, but its exact value remains to 
be determined. See Narcotics. 

In sciatica, local remedies have, as a rule, more power than general ones. 
This is hardly true of real neuralgia, but even in that our local remedies seem 
to surpass all others ; moreover, it seems to be best adapted for those very 
cases which we cannot treat otherwise ; we allude to the continuous current of 
electricity. This form of electricity is to be carefully distinguished from that 
commonly in use, which is termed the interrupted current, and which not 
only is of no use, but may positively do harm. The continuous current is 
that which does most good in true frontal neuralgia. Other local means have 
been tried, blisters, red-hot irons, ointments containing aconite, belladonna, 
veratria, and other powerful drugs, all have been tried, and too often tried in 
vain. As a rule, if the neuralgia depend on a local cause, it will disappear 
with the removal of that cause, and will not disappear until it is removed. 
Thus it is utterly useless to apply soothing remedies, ointments, lotions, or 
what not, for a neuralgia dependent on a bad tooth or diseased jaw ; once 
these are seen to, the neuralgia will go. 

With sciatica, however, it is different: that is often greatly benefited by 
bathing in a hot saline fluid, like some of the Continental mineral waters, es- 
pecially if the douche and shampooing are had recourse to. Many cases of 
sciatica are thus cured, and many more might be if the treatment were em- 
ployed. 

Acupuncture was at one time largely employed for sciatica, and in many 
cases it did well, but in others again it did not. In some cases the injection 
of morphia into the parts about the nerve may be said to cure the sciatica ; 
but even when the pain is removed, a long course of time and of remedies must 
be employed to recover perfect health. Blisters over the course of the nerve 
even have been followed by good results, especially when a little morphia has 
been sprinkled over the denuded parts, but we believe that hypodermic injec- 
tions and the local application of hot medicated waters are the best and most 
reliable remedies for sciatica. See Injections. 

Neuritis, Optic, is a condition of the eye not yet fully understood; our 
knowledge of it is comparatively recent. It affects the back part of the eye, 
and is discoverable only by means of the instrument which allows of the pos- 
terior part of the eye being examined during life. If this instrument is so 
held as to throw a beam of light into the eye whilst the observer's eye is situ- 
ated at the proper point of observation, there will generally be seen a kind of 
reddish glare, indicating the reflection of the retina, or fine nervous net at the 
back of the eye, with its blood-vessels. At one particular point, however, if 
the instrument is in proper focus, a white patch becomes clearly defined, and in 
its centre are to be observed blood-vessels, to and from which branches of other 
vessels are seen to ramify in every direction. This is the optic disc, or papilla, 



NEU 545 NIP 

the point where the optic nerve enters, and inflammation of this spot is what 
is called optic neuritis. The marks of this form of disease are commonly laid 
down as being an irregular, hazy, or wooly appearance of the margin of the 
disc instead of its clear, sharply 'defined edge as seen in health ; the surface, too, 
seems swollen, and the whole seems to merge into the surrounding parts. The 
most peculiar point connected with optic neuritis is that it may exist in the 
most marked degree without any interference with vision ; so much so that 
most frequently this condition is first discovered by ophthalmoscopic examina- 
tion. The great value of optic neuritis seems, indeed, to be as a sign of intra- 
cranial disease, — disease, that is to say, under the skull, which might not 
otherwise be detected. Tumors of the brain are commonly so indicated, but 
many points have to be made clear with regard to it. Indeed, its mode of 
causation is by no means clear: some supposing that the influence is propagated 
along the nerve of vision, that is the optic nerve, and its covering; others 
rather by means of the blood-vessels which pass from the interior of the skull 
to the interior of the eye. 

Neurosis is a word employed by modern physicians to indicate a malady 
which depends on some perverted nervous influence rather than on merely 
local change. There may be local change, but this would probably depend on 
the perverted nerve force rather than the perverted nerve force should depend 
on the local change. A goodly number of cases of palpitation of the heart are 
of this character ; that is to say, dependent rather on perverted nerve influ- 
ence than on disease of the heart itself. Two maladies we may, however, 
select which will better exemplify this point. These two are the diseases 
known as Graves's or Basedow's disease, and Addison's disease. The char- 
acters of the first are a peculiar prominence of the eyes, a swelling in the 
throat like a goitre, extreme irregularity of the heart's action, accompanied by 
violent palpitations ; at the same time the patient is painfully nervous. Now, 
some have looked to the goitre as the most prominent symptom, in their esti- 
mation, for an explanation of the malady; needless to say they found it not. 
There is no heart disease to account for the condition ; for though the heart 
beats violently, and there is usually an abnormal sound to be heard, yet this 
can be accounted for in other ways, and there are none of the regular se- 
quences of disease of the heart itself. In short, we are compelled to recognize 
the nervous elements in the case as the most important, and to call the disease 
a neurosis for want of a better explanation. Addison's disease is defined as 
sharply as is Graves's disease. The patient becomes of a bronze color, which 
deepens as the malady proceeds. At the same time the patient's strength de- 
clines, he becomes abjectly weak ; very often also the breathing is interfered 
with, and the digestive functions are always impaired. After death there is 
found in these cases a peculiar condition of two small bodies lying near the 
kidneys, and called supra-renal capsules, but in health they are not known to 
exercise any influence, and that they should do so to such an extent when 
diseased seems hardly probable. Hence, many men have been fain to rec- 
ognize the nervous influence in this malady also, and to call it too a neurosis. 
See Addison's Disease. 

Nicotiana. See Tobacco. 

Nipples, Affections of. Excoriated or Sore Nipples. This trouble- 
some and painful affection, in almost all instances, is met with during suck- 
ling, usually of the first child, and is due to irritation and ulceration of the 
delicate skin of the nipple. The mother first notices one or more deep cracks, 
which are extremely tender and bleed when touched. The skin around these 
35 



NIP 546 NIP 

cracks, fretted by the suction of the child's mouth and constantly bathed by 
milk and discharge, becomes inflamed and raw. In debilitated and unhealthy 
women the inflammatory mischief extends deeply into the tissues of the af- 
fected nipple, and also to the skin covering the breast. When the nipple has 
become so tender that the mothor is compelled to suckle the child almost en- 
tirely on the opposite and healthy side, the breast corresponding to the exco- 
riated nipple is engorged with milk and finally attacked with acute inflamma- 
tion, which results in the development of a large mammary abscess. The usual 
cause of sore nipples is the disregard of cleanliness and neglect on the part of 
the mother to keep the surfaces of the nipples dry. The tender cuticle cov- 
ering these structures is readily excoriated by the contact of fluids, and by the 
friction of moist and dirty linen. In most cases the affection is produced by the 
suckling of the first child and never occurs again ; but some mothers, in spite 
of their careful preparation of the nipples before lactation, and constant at- 
tention to those parts after the birth of the child, are troubled with painful 
cracks and all the inconveniences to which these give rise during every period 
of lactation. Some mothers suffer from sore nipples in consequence of their 
allowing the child to retain the nipple in its mouth for too long a time. It is 
very probable that a diseased condition of the child's mouth may also be a 
cause of this irritation. In order to prevent sore nipples, the delicate skin 
should be hardened by the frequent application of diluted spirits of wine, weak 
lead lotion, or a lotion containing one drachm of alum to half a pint of water. 
A strong infusion of green tea, with the addition of about one-fourth of brandy 
or gin, will also be found a good astringent wash. The use of the lotion should 
be commenced early in the seventh month, and the nipples should be bathed 
night and morning. A bottle with the mouth and neck just large enough to 
admit the nipple should be half filled with the astringent lotion and then be ap- 
plied over the nipple and inverted, so that the lotion may fall down upon this 
organ, and bathe it at every part of its surface. During suckling the nipples 
should be kept as dry as possible, and when not used be covered by cotton 
wool dusted with lycopodium or starch. When ulcers and cracks heal, and 
there is no inflammation of the surrounding skin, these should be lightly 
touched with a pointed crystal of blue-stone, but when the nipple is hot and 
tender, the application of caustic must be deferred until the irritation has been 
allayed by warm fomentations. When a considerable extent of skin both of 
the nipple and on the breast is red, raw, and moist, the best local application 
will be a solution of five grains of lunar caustic in one ounce of water. This 
should be brushed over the affected parts every morning. After the applica- 
tion of any active or caustic agent to the nipple, the mother must take care to 
keep the child from the breast until all traces of the local remedy have disap- 
peared. 

Retraction of the nipple, when associated with a hard and painful swelling 
of the breast, in a woman above the age of thirty-live years, is diagnostic of 
cancer. This condition is occasionally met with in young women whose breasts 
in all other respects are perfectly sound and healthy. This, when the patient 
becomes a mother, gives rise to much trouble, as the flow of milk is obstructed, 
and the secretion accumulating in the gland sets up acute inflammation, which 
may terminate in the formation of a large abscess. Simple and uncomplicated 
retraction of the nipple in young females is caused in most instances by tight 
lacing and compression of the breast, which flattens the nipple and prevents 
its full development. In cases of this kind an attempt should be made at the 
commencement of the period of lactation to produce protrusion of the nipple 



NIT 547 NIT 

by means of a breast-pump, or by the suction of a strong infant of five or six 
months, if this can be made to take a strange breast. The infant just born 
should be handed over to a wet nurse until the state of the mother's nipples has 
been improved. 

Nitre, or Nitrate op Potass, is a remedy of some considerable value. It 
is procured from abroad, by washing the soil or beds of vegetable matter 
specially prepared for the purpose, and is mainly used for the manufacture of 
gunpowder. In medicine it is chiefly used as a cooling remedy, for, dissolved 
in water, it has a cooling saline taste, which is sometimes very grateful. It is 
also given with a view to acting as a diuretic, but its efficacy here is doubt- 
ful. 

Nitric Acid is one of the mineral acids used in medicine, but not, perhaps, 
so much as the others. It does not, for instance, seem so astringent as sul- 
phuric acid, nor does it aid digestion so well as hydrochloric acid. It is pro- 
cured from nitrate of potass by distillation with sulphuric acid, and should be 
quite colorless. Usually, however, it contains nitrous acid, which gives it a 
green or yellow tint. The mixture of this acid with hydrochloric acid, called 
aqua regia, or nitro-hydrochloric acid, is much used. Nitric acid is used ex- 
ternally as a caustic more than the other mineral acids. It is applied by means 
of a piece of stick to the sore, which it completely destroys. The sores so 
treated are usually of an unhealthy description, and this destructive agent is 
applied for the purpose of procuring a fresh and healthy surface with a pros- 
pect of healing. A similar plan is adopted for getting rid of piles. In these 
cases the surrounding skin must be protected ; if it touches it the skirt is stained 
yellow, which is characteristic of the acid. It has been injected into the blad- 
der in a very dilute state for the purpose of neutralizing the evil effects of al- 
kaline urine. Internally the acid is mainly given as a refrigerant, and to rem- 
edy phosphatic urine. Sometimes it seems to do much good in cases where 
mercury cannot be given, in syphilis, and also in some liver diseases, especially 
those of tropical climates. Dilute nitro-hydrochloric acid is perhaps prefera- 
ble as an internal remedy. Jt acts better as a tonic, and as a remedy in dys- 
pepsia arising from chronic gastric catarrh. When the urine is free of phos- 
phates this acid may be given with advantage, certainly with more good than 
can be obtained from either acid singly. It is largely used in liver mischief, 
especially in chronic inflammation, as well as in the cachexia of syphilis. 
Foot-baths of the acid are strongly recommended by some West Indian sur- 
geons. The ordinary dose of either acid in its dilute state, as sold by the chem- 
ists, is ten or fifteen drops in water, if freely diluted. 

Nitrous Ether is only used in the form of spirit, commonly called sweet 
spirit of nitre. It is made by a somewhat complicated process, and the prod- 
uct is not uniform in quality. The basis of the product is alcohol ; this is 
heated and decomposed by sulphuric acid, so that ether is formed. At the 
same time nitrous acid is set free by decomposing nitric acid by means of cop- 
per ; the two unite and form nitrous ether. This liquid is clear, transpar- 
ent, sometimes with a slightly yellow tint, and a fruity odor ; usually, too, it 
is acid. The therapeutic properties of nitrous ether are not very clear. All 
kinds of things have been said of it, but as the preparation is of most uncer- 
tain strength, and sometimes contains no nitrate of ethyl, its supposed active 
principle, it is somewhat hard to tell what these really are. It has been used 
mainly as a stimulant diaphoretic and a diuretic. It has been the custom to 
order it in slight febrile cases, to open the skin, and it has been given in drop- 
sies. Its well-defined properties are limited to its refrigerant action. Hence, 



NIT 548 NOM 

mixed with water, it is an exceedingly pleasant refrigerant to the lips of one 
parched with fever. Jt is a good deal used for this purpose, and may very 
well he combined with nitre itself. The dose should be about a drachm or 
two drachms freely diluted with water. Most specimens procured for exami- 
nation have been had, containing excess of acid, from change through keeping 
or from faulty preparation. 

Nitrous Oxide — Protoxide of Nitrogen, also called Laughing Gas 
— is a transparent colorless gas, with a faint, sweetish smell and taste. It is 
easily made by submitting crystals of nitrate of ammonia to heat, when the 
protoxide of nitrogen will pass over. Sir Humphry Davy first discovered 
that this gas was respirable, and that it produced intoxicant effects upon the 
human system. One of its peculiarities is, when given in small quantities, to 
produce uncontrollable laughter ; hence the name laughing gas. It was found 
subsequently that not only would this agent produce excitement, but anaesthe- 
sia, in the same way as ether and chloroform. After the discovery of the use 
of the last agents, nitrous oxide was almost discarded, but it is again getting 
into use. as it has been found by experience that it is less likely to produce 
fatal effects than either ether or chloroform. See Anaesthetics, Ether, 
Chloroform. 

Nodes. The term node is used to denote certain tumors in connection with 
bone and periosteum. It may be either scrofulous or syphilitic. In the scrof- 
ulous node there is scrofulous matter confined between the carious bone and 
its periosteum, and is due to an affection of the bone. The true node, how- 
ever, is the syphilitic, and is caused by the effusion of lymph between the bone 
and periosteum, owing to inflammation of its deeper layers. The inflamma- 
tion in nodes is not always limited to the periosteum, and the deeper struct- 
ures are thus implicated. The subperiosteal effusion either ossifies, or softens, 
giving rise to caries. The most common place for these tumors is along the 
shin-bone, or the radius and ulna, and on the clavicle and cranium. They fre- 
quently appear so hard as to seem osseous, but in reality it is the semi-solid 
effusion beneath the dense, thickened periosteum which occasions the feeling. 
Nodes sometimes soften, and pus forms, the indications of which are the fact 
of the skin becoming shining, dense, and thinned. The formation of subperi- 
osteal abscess usually ends in exfoliation of the bone. (See Exfoliation.) 
The first indication of the appearance of nodes in a person affected with syph- 
ilis is tenderness of the affected bone, and severe pain and nightly exacerba- 
tions. Soon roundish or oblong swellings are noticed on the bones, usually 
commencing with the skin ; they are tender, and convey a sense of obscure 
fluctuation. If by treatment the disease be arrested, syphilitic exostosis is the 
result ; if not, a quantity of glairy serum is effused between the periosteum 
and the bone, forming a very painful tumor. Extensive exfoliation may en- 
sue, causing intense suffering to the patient, if situated in the skull frequently 
terminating fatally. The treatment consists in the administration of a regular 
course of mercury, or of the iodide of potassium. The nightly pain is best re- 
lieved by leeching or blisters, and the application of strong iodine paint. If 
very tense, fluctuating, and painful, subcutaneous incision, made by passing a 
narrow knife under the skin, and across the tumor, gives great relief. But it 
generally will be found that such remedies as iodide of potass, sarsaparilla, 
and blisters will be sufficient to produce absorption and allay pain. 

Nomenclature. Unto every disease a name is given, and as our knowl- 
edge increases year by year, fresh names are added to signify either new com- 
plaints or fresh groups of symptoms. It is obvious that some diseases are more 



NOM 



549 



NOM 



closely allied than others ; thus all those disorders which are accompanied by 
a high temperature are called fevers ; these, again, are divided into those 
which are catching and those which are not. Some diseases are caused by the 
presence of parasites, others by accident or design. To arrange diseases ac- 
cording to any precise plan is, however, extremely difficult ; if we knew ac- 
curately the causes of every disease, some scientific arrangement might be 
carried out, but our knowledge on this point is as yet very imperfect. Then, 
again, there are many " causes of death " registered which are not diseases at 
all, but symptoms : convulsions and diarrhoea, debility and wasting are ex- 
amples of this kind; the true cause of death is really the cause of these symp- 
toms, if in all cases it could be ascertained. The Registrar-General of Great 
Britain has adopted a nomenclature which has been long in use, and is very 
well adapted for its purpose ; he divides all diseases into five great classes, and 
these in their turn are divided into orders, while under each order are placed 
the diseases as known by their general name. 

Classes. Orders. 

f 1. Miasmatic diseases Small - pox, measles, scarlet 

fever, diphtheria, quinsy, 
croup, whooping- - cough, 
continued fever (compris- 
ing typhus, typhoid, and 
simple continued fever), 
erysipelas, puerperal fever, 
carbuncle, influenza, dys- 
entery, diarrhoea, cholera, 
ague, remittent fever, rheu- 
matism, and other zymotic 
diseases. 
. . . . Syphilis, stricture of ure- 
thra, hydrophobia, glan- 
ders. 
. . . . Privation, want of breast- 
milk, purpura, scurvy, al- 
coholism. 
. . . . Thrush, worms, parasites, etc. 
. . . . Gont, dropsy, cancer, can- 
crum oris, mortification. 

| 2. Tubercular diseases Scrofula, consumption, hy- 

l 

fl. 



I. Zymotic dis- 



2. Enthetic diseases 



3. Dietic diseases 



II. Constitutional 
diseases. 



4. Parasitic d 
f 1. Diathetic 



Di 



III. Local diseas 



of nervous system 



drocephalus. 

Apoplexy, paralysis, chorea, 
epilepsy, convulsions, brain 
diseases, etc. 

Pericarditis, aneurism, heart 
disease, etc. 

Bronchitis, pleurisy, pneu- 
monia, asthma, etc. 

Gastritis, peritonitis, ascites, 
hernia, intussuception of 
intestines, etc., jaundice, 
diseases of stomach, liver, 
and spleen. 

Nephritis, Bright's disease, 
cystitis, kidney disease, etc. 

Ovarian and uterine diseases, 
etc. 

Synovitis, arthritis, and dis- 
eases of the joints, etc. 
Diseases of integumentary system Phlegmou, ulcer, diseases of 
skin, etc. 



2. Diseases of organs of circulation 

3. Diseases of organs of respiration 

4. Diseases of organs of digestion 

5. Diseases of urinary organs . . 

6. Diseases of organs of generation 

7. Diseases of organs of locomotion 



NOS 550 NOS 

Classes. Orders. 

1. Diseases of children Premature birth, cyanosis, 



malformation, spina bifida. 

IV. Developmental j g Digeases of adu]tg Child-birth. 

diseases. g Diseages of old p eople .... Old age. 

[4. Diseases of nutrition Atrophy and debility. 

f 1. Accident or negligence .... Fractures, contusions, gun- 
* shot wounds, cuts, stabs, 

burns and scalds, poison, 
drowning aird suffocation, 

V. Violent deaths. \ etc " b ^ acci,lcnt or ne S H - 

geuce. 

2. Homicide Murder and manslaughter 

(Homicide). 

3. Suicide . Suicide by any method. 

4. Execution Hanging (Execution). 

Nose, Diseases of. (1.) Of the external nose. Fracture of the nasal 
bones. Fracture of the nasal bones is an accident of considerable rarity, owing 
to the firm manner in which they are wedged into the skull and face. The 
displacement should be rectified by passing some such instrument as a strong 
probe up the nostril, aud manipulating the fragments with the fingers ; or one 
blade of a pair of forceps may be run up the nostril, whilst the other is out- 
side, thus grasping the fragments and putting them into place again. There 
is great ecchymosis aud hemorrhage, usually, with this accident, and leeches 
to the part, purgatives, and cold lotions are requisite. 

Incisions. Accurate adjustment of the cut surfaces must be obtained at once, 
as, owing to the extreme vascularity of the integuments of the nose, union 
takes place very rapidly, and unless the adaptation be careful, deformity may 
be the result. In cases where there has been removal of the nose, either par- 
tially or entirely, the portion, after washing and neatly stitching on, has com- 
pletely united, leaving scarcely any scar. The same remark as to the neat 
approximation of the edges of wounds is of equal importance in any part of 
the face. 

Hypertrophy (Lipoma). The integument of the nose occasionally, as the 
result of acne rosacea of long standing, becomes irregularly enlarged, and 
" fleshy excrescences " appear. They give rise to great disfigurement ; they 
are of a dusky, purple color, cold and greasy to the touch, usually occurring in 
individuals over middle age, and most frequently in males. They consist ana- 
tomically of hypertrophied skin and connective tissue, with dilatation of the 
small veins and enlarged sebaceous follicles. They are not dangerous, nor 
painful, only inconvenient and unsightly, and of slow growth. Removal is the 
only remedy. The mass must be entirely shaved off, an operation requiring 
some dexterity ; and the growth does not recur, except in rare instances. The 
term lipoma, frequently given to this skin disease, is pathologically a wrong 
one, as it contains, as a rule, little or no fatty tissue. 

Lupus. The various forms of lupus are discussed in the article Lupus. 

Deficiency from disease or accident. Cases where the whole or part of the 
external nose has been destroyed by disease, such as scrofulous ulceration, lupus, 
syphilis, etc., can be in great measure remedied by what are termed rhinoplastic 
operations, a department of plastic surgery which consists in the transplantation 
of integument from an adjoining part of the face. Such an operation requires 
considerable ingenuity of plan and skillfulness of performance, but it must be 
borne in mind that if the entire bone or cartilaginous framework of the nose be 
wanting, it is almost useless to attempt anything of the sort, as the points of 



NOS 551 NOS 

support are gone. The most common method of supplying the deficiency is by 
what is termed the Indian method. A piece of integument, the shape of the 
nose, laid out flat, is drawn upon the forehead, and the edges of the mutilated 
nose pared; the flap is dissected off the forehead, and brought down and attached 
to the pared edges just mentioned, by sutures. Flaps may be dissected from 
the cheeks, or from any convenient spot where the integument is healthy. Oc- 
casionally such a flap has been taken from the arm. 

Diseases of the internal nose. In order that the internal nose or nasal fossae 
may be completely inspected, with a view to learning their condition accurately, 
a proceeding termed rhinoscopy is had recourse to. Rhinoscopy is anterior or 
posterior. Anterior rhinoscopy is an inspection through the nostrils. The 
nostrils must be dilated, and a good strong light brought to bear upon them. 
A bivalve nasal speculum, made on purpose, is used. This consists of an in- 
strument having two slightly curved blades ; these blades are introduced into 
the nostril, and when separated by handles they dilate the parts, and, being 
highly polished, they throw light into the cavity. Several forms of specula are 
in use, such as Thudichum's and Metz's. That employed by Czerinak consists 
of a small oval mirror, mounted at an angle upon a long slender stem. When 
this is introduced and properly illuminated, the various anterior parts are re- 
flected and brought into view. 

Posterior rhinoscopy. In rhinoscopy or inspection of the nasal cavities from 
behind, a more complicated mechanism is necessary. The instruments are 
similar to those used in examination of the lar} r nx (see Laryngoscope), 
and consist of a mirror, perforated, and attached to the head, hand-mirrors, 
somewhat longer and a little more bent than those used in laryngoscopy, 
and a blunt flat hook, with which the uvula and soft palate are supported and 
drawn forwards. In using the instruments, the patient is seated with his back 
to the light, the head well thrown back, the mouth opened to its fullest extent. 
The operator, seated opposite to him, by means of the spatula, held in the left 
hand, raises and draws forward the uvula and soft palate, and directs the light 
reflected from the perforated mirror, bound round his head, down the pharynx. 
"When the light is made to shine upon it, some portion of the walls or contents 
of the naso-pharyngeal or nasal cavities may be distinctly imaged on the specu- 
lum. If a good view be obtained, the two superior meatuses can be seen and 
their contents, and the mucous membrane of the three turbinated bones, a con- 
siderable portion of the septum narium, some portions of the posterior surface 
of the velum penclulum-palati, the lateral wall of the naso-pharyngeal cavity, 
and the orifices of the Eustachian tubes. In order to see all these structures, 
however, at all satisfactorily, great patience and self-control on the part of the 
patient are essential. 

Diseases of the nasal cavities. Nasal calculi or rhinolithes. These concre- 
tions are generally found in the inferior meatus. They consist of phosphate 
and carbonate of lime and magnesia, chloride of sodium, and mucus or some 
animal matter. These bodies can be removed with forceps, a proceeding of 
some difficulty very often, and the nasal cavities must be afterwards thoroughly 
cleaned by syringing or douching. 

Epistaxis has been discussed in the separate article on that subject. See 
Epistaxis. 

Coryza is an excessive discharge of mucus depending upon catarrh, struma, 
syphilis, or the presence of a polypus ; it is best treated with mild astringent 
washes, or the insufflation of powders, such as tannic acid, or some astringent, 
warm, dry atmosphere,, good living, and cod-liver oil or iron. A severe form 



NOS 552 NOS 

of coryza, due to syphilis, is occasionally met with: it commences as an ordinary 
cold in the head, with increased secretion of the mucus, which, on exposure to 
cold or to alcoholic excess, becomes thicker, more profuse, and greenish in- 
color. There is great uneasiness and tenderness in the nostrils, with continu- 
ous desire to blow the nose. It is frequently attended with headache, alteration 
of the tone of voice, and impairment of smell. AVith regard to treatment, it is 
necessary to administer mercury, both internally and by the inhalation of its 
vapor, and mild astringent and detergent lotions. 

Ozcena, or rhinorrhoca, is a purulent or sanious discharge, giving rise to most 
offensive fetor, rendering the sufferer unbearable both to himself and to those' 
around him. It maybe either (1) catarrhal ; (2) strumous; (3) syphilitic. 
The catarrhal is met with in patients of delicate constitution, and after a long 
and troublesome cold the discharge will become very fetid, generally worst in 
the morning. The discharge is accompanied with headache, relaxed throat, 
cough, and great depression of spirits and deafness. The treatment consists 
in sending the patients to a dry, bracing atmosphere, the inhalation of steam, 
carrying with it vapor of creasote ; constitutionally, bark and mineral acid 
tonics. 

Scrofulous or strumous ozcena usually begins during childhood, and depends 
upon a strumous taint, causing ulceration of the nasal mucous membrane. The 
discharge is very offensive, and if not treated may implicate the bones and car- 
tilages of the nose, setting up destructive ulceration, whereby a most dreadful 
deformity is occasioned. The treatment consists in the administration of bark, 
iodide of potass, cod-liver oil, phosphate of iron, etc. ; of the washing out of the 
nasal cavities with a large syringe containing a little chloride of zinc in solu- 
tion, or a little dilute citrine ointment to be applied to the ulcers with a camel's- 
hair brush. With regard to the syringing out of the nasal cavities, it may be 
borne in mind that when one side of the cavity is entirely tilled through one 
nostril with fluid by hydrostatic pressure, while the patient is breathing through 
the mouth, the soft palate completely closes the chorda?., and does not permit 
any fluid to pass into the pharynx, while the fluid easily passes into the other 
cavity, mostly round and over the posterior edge of the septum narium, and 
.escapes from the other open nostril, after having touched every part of the first 
half of the cavity of the nose, and a great part, certainly the lower and median 
canals, of the second half. The syringe should have a long slender nozzle, 
with a bulbous extremity, perforated by a rose of small holes. The best appa- 
ratus, however, for the purpose is the nasal douche. 

Syphilitic ozcena lias precisely the same general character as the preceding, 
and must, of course, be attacked on the general jDrinciples indicated for the 
treatment of constitutional syphilis. 

Poh/pi. The most common are the simple mucous or benign. The growth 
is soft, of a rather tough consistence, and yellowish-gray in color, bleeding 
slightly when touched, usually growing from the inferior spongy bone, never 
from the septum. It may occur at any period of life, though most frequently 
in middle age. It obstructs respiration, causes a stifling sensation in the head, 
seriously affects the senses of smell and taste, and often occasions deafness. 
The treatment consists in its removal by forceps. The root of the growth is 
to be seized with them, and, by a movement of twisting and pulling, the mass 
is withdrawn from the nostril. The next variety of polypus is the medul- 
lary, bleeding or malignant, occurring usually at the middle or later periods 
of life ; the growth causes great pain, and it occasionally increases with much 
rapidity. Owing to the malignancy of this growth it is impossible to remove 



NOS 553 NUR 

it thoroughly, although attempts may be made from time to time to clear away 
the mass from the nostril. The third form to be mentioned is the fibrous va- 
riety, distinguishable by its great firmness. It is distinctly fibrous in composi- 
tion, and occurs most frequently in young male adults. It seems to adhere to 
the bone, but not to depend upon any diseased condition of it. The operation 
of removing a mass of this nature is always a very serious and formidable 
proceeding. These growths occasionally grow backwards down the pharynx 
instead of forwards, adding, of course, greatly to the difficulty of any operative 
procedure. 

Nosology, the systematic arrangement of diseases. See Nomenclature. 

Numbness, a peculiar sensation felt at the end of a nerve, and caused by 
some altered condition of the nerve, either at its origin or in its course. It may 
be caused by an injury or by pressure ; it may be also a sign of brain disease ; 
it is also caused when a drug, like aconite, is rubbed into the skin. 

Nurseries, or, as they are called in France, creches, are places where an 
infant can be placed during the day, and taken care of while the mother is away 
at work. Of recent years several have been established in London, and are 
doing a very useful kind of work. It has too often been the custom for women 
to leave the younger brothers and sisters in charge of an elder child, and the 
consequence is that while the elder child can thus get no education it has not 
intelligence enough to attend properly to the younger ones ; it becomes de- 
formed in stature, too, from carrying the baby at too early an age, and many ac- 
cidents, such as burns or scalds, arise in this way. At a nursery, for the sum 
of one penny a day, a mother can leave the baby with the knowledge that it 
will be looked after well and fed properly, while the other children will be at 
liberty to go to school. There is, however, a disadvantage in a nursery, and 
this is owing to having too many infants in a room at one time, and in some 
the mortality is high ; and, again, no artificial food is so good for the baby as 
the mother's milk. Nurseries, to be beneficial, should be numerous in a town ; 
the place should be under the superintendence of kind hearted women, who are 
used to children, and the rooms should be well ventilated in the absence of the 
children ; a little sulphur burned in the air and allowed to pass into the various 
rooms, as well as a thorough ventilation afterwards, will generally sufficiently 
purify the air. 

Nursing. In civil and military hospitals, as well as in private life, it 
seems to be a function well adapted for women to nurse the sick ; all experi- 
ence tends to show that we must look to women for the natural care of the 
sick and wounded, the young and the aged, the cares of domestic life, and the 
rearing and training of children. 

For such purposes there can be no doubt that women are much better 
adapted than men, taking them as a class, yet with all their natural aptitude 
for the purpose they require nevertheless a special and careful training, if they 
wish to become proficient for the work they undertake. Of recent years a 
great improvement in this respect has taken place, and nearly all the metro- 
politan hospitals are nursed by women who have undergone a regular appren- 
ticeship. At first they enter when young as probationers, where they gener- 
ally serve for a year on trial ; then they are placed on night duty, and have 
charge of beds ; while afterwards, when they have acquired a sufficient experi- 
ence, they have the whole charge of a ward, with subordinates beneath them. 
In this way, in the course of a few years, a number of women are trained up 
to be most useful and efficient nurses, and then they can be drafted off to 
nurse cases in private, or to take charge of a village hospital. 



NUR 554 NUR 

The following remarks are taken from Miss Nightingale's work on the sub- 
ject, and are the more valuable as coming from one who has no superior on 
the subject to which she has devoted her life. Before the time of the Cri- 
mean war nursing was at a very low ebb, and was chiefly in the hands of 
ignorant and uneducated women. Miss Nightingale proposed to reform this 
state of things not by founding a religious order, as on the continent of Eu- 
rope, but by training, systematizing, and morally improving, as far as possible, 
that section of the large class of women supporting themselves by labor, who 
take to hospital nursing for a livelihood ; by inducing, in the long run, some 
such women to contemplate usefulness as well as maintenance ; and by incor- 
porating with both those classes a certain proportion of gentlewomen who ma} 7 
think lit to adopt this occupation without pay, but on the same rules and on 
the same strict footing of duty performed under definite superiors. The care 
of the sick is the main object of hospitals. The care of their souls is the 
great province of the clergy of the hospitals ; the care of their bodies is the 
duty of the nurses. Great difficulties attend the incorporation of members 
of any religious orders into the work ; their introduction is certain to effect 
far more harm in some ways than it can ever effect good in others. A mix- 
ture of religious orders introduces confusion, weakness, disunion, and mischief. 
In civil hospitals the following rules are laid down for proper nursing : — 

The isolation of each head nurse and her nurses is important. The head 
nurse should be within reach and view of her ward night and day. Associat- 
ing nurses in large dormitories tends to corrupt the good and make the bad 
worse. The ward should have but one entrance, and the head nurse's room 
should be close to it, so that neither nurse nor patient can leave, nor any one 
enter the ward, without her knowledge. 

The day nurses should have eight hours' sleep, and, if it be possible, four 
hours daily for exercise or private occupation. They may have one room. 
The night nurses should be on duty twelve hours, with instant dismissal if 
found asleep ; the same time should be allowed for sleep, exercise, etc., as iu 
the case of the day nurses. Night nurses may have some occupation at night, 
as mending or making clothes, if, by so doing, they do no harm to the pa- 
tients ; it is better to do something than sit awake doing nothing, and often 
there is not much to do of a night. The night nurse should have a shaded 
lamp, so that she can have a light for herself without disturbing the patients 
by the glare. A double ward, with forty beds, or two single wards, can be 
served by one head nurse and three nurses : the head nurse to superintend all 
things, and to do the dressings not done by the surgeons and dressers, assisted 
mainly by one nurse, whom she thus instructs in nursing ; another nurse to 
do the scrubbing and cleaning ; and when these are over to mind the ward 
during the remaining hours in turn or in conjunction with the first nurse ; 
the third to be the night nurse. In the morning, before dressing begins, and 
before the night nurse goes off duty, all three nurses to clean the ward, make 
the beds, wash the helpless patients, etc. Hours of administration of medi- 
cine to be fixed, and the medicine always, except at night, to be given by the 
head nurse. Hours of morniug and evening poulticing to be fixed ; hours 
of exercise of head nurse and nurses to be fixed and arranged with reference 
to duties. A fixed occasional holiday given in turn \o the nurses is good ; and 
an annual longer holiday for them and the head nurse is good, a fortnight 
being a good limit. The holidays should be distributed in rotation for a fixed 
time of year, and comjn-ehended within two or three mouths, or four at the 
outside. The holidays cause inconvenience, no doubt, but on the whole they 



NUT 555 NUT 

do far more good than harm. No head nurse or nurse should he out of the 
hospital before or after the limit of her daily exercise time — two hours — 
without the permission of the matron. The fewer extraordinary absences the 
better. Hospitals are too often near noisy and crowded thoroughfares, while 
nurses, who want fresh air, also want a quiet place : any open gardens or 
squares in the neighborhood should be allowed to them for exercise, The 
head nurses should wear a regulation dress, and nurses another. The dress 
should be of a neutral tint, and of serviceable material, avoiding anything sen- 
sational. All nurses should be paid, and should rank alike, with progessive 
increase after so many years of service ; or better still, there should be a slow 
annual rise. Nurses should be of unblemished character, of strong, active 
habits ; not under thirty nor over sixty years of age. The salary of the 
head nurse should be about $400 a year, with one or two rooms, fuel, and 
light. The night nurse should have a room to herself, and must not sleep in 
the room which the day nurses have just vacated ; entire board, fuel, light, in 
part clothing, and good wages to be given. The nurses' rooms should be sup- 
plied with plain comfortable furniture; and it is best to furnish the rooms for 
them. All provisions, etc., should as much as possible be brought into the 
wards or to the ward doors by elevators, — nothing by the nurses themselves. 
This would save much time, enabling the nurses to do more work, and yet 
have more leisure ; and, above all, it would obviate the great demoralization 
consequent on the nurses, patients, and men servants congregating in numbers 
several times daily. The patients should be made as useful as possible, con- 
sistently with their capacities, inside the wards ; but they should be permitted 
to fetch nothing into it. Nurses should be allowed to receive visitors on cer- 
tain days and hours of the week, and these hours and days should be strictly 
kept to. No occasional ward or wards for accidental and peculiar patients 
should be allowed. 

These rules may require modification in many places, but they form a basis 
on which others may be made. In military hospitals more rigid discipline is 
enforced, and orderlies are employed. In a village hospital one nurse, with a 
helper to clean, etc., is generally enough. 

Nurses should be allowed a good deal of fresh air and a proper amount of 
sleep ; no one can nurse night and day too, and the sick room or ward has a 
depressing influence. They should be treated with firmness and yet with 
kindness, and made to feel as if they were at home. There is generally a 
matron in every large institution, who, without nursing, superintends gener- 
ally the domestic affairs of the establishment. Upon her depends in a great 
measure the comfort and efficiency of the nurses. All religious differences 
must be avoided, and the best way is for each sect to have institutions of their 
own. 

Nutmeg is the seed of the Myristica moschata, and is better known as a 
spice than as a medicine. It contains a concrete oil, solid at ordinary tempera- 
tures, and a volatile oil, to which it mostly owes its property. Nutmeg itself 
is mainly used as a flavoring ingredient in various important preparations. 
The solid oil is used in some plasters, and the volatile oil, dissolved in spirits, 
acts as a gentle stimulant and carminative. It is also contained in aromatic 
spirit of ammonia and aloes pill. In very large doses it is said to produce 
drowsiness or even stupor. The dose of the spirit is about a drachm given in 
sugar. See Mace. 

Nutmeggy Liver is produced in some cases of heart disease when that 
organ becomes gradually congested and full of blood ; slight jaundice may 



NUX 556 NUX 

come on, arid there is generally a dull pain over the liver. It is also the re- 
sult of drinking alcohol. See Liver. 

Nux Vomica is the seed of the Koochla tree, growing in the East Indies. 
It and the fruit of another plant, called the St. Ignatius bean, owe their prop- 
erties to the strychnine which they contain. The fruit of the tree is a round 
berry like an orange, filled with these peculiar seeds in its pulp. The seeds 
of the nux vomica are hollow on one side and raised on the other, as if pinched 
by the thumb. They are very tough and hard, so that they are not easily 
crushed. They are covered with hairs of a velvety character. Two alka- 
loids are contained in these, namely, brucia and strychnia, combined with 
an acid, igasuric acid ; the properties of the drug, however, depend almost en- 
tirely on the strychnia. The preparations of nux vomica are an extract and 
a tincture, and there is an officinal solution of strychnine. Of these the doses 
are as follows : of the extract, a quarter of a grain to 2 grains ; of the tinct- 
ure, 10 to 20 minims ; of the solution of strychnine, 10 to 20 drops. The 
alkaloid itself may be given, but never in doses which exceed the l-24th of a 
grain ; even these may give rise to troublesome symptoms. Strychnine is 
procured from the mix vomica or St. Ignatius bean by steaming the beans, 
then drying them, which reduces their tenacity, and finally powdering in a 
drug or coffee mill. This powder is exhausted by spirit and water, and after 
several other steps the strychnia is obtained in tolerable purity. Given 
internally strychnine produces spasms, mainly by acting on the spinal cord. 
It does not seem to influence the brain to any extent, for in cases of fatal 
poisoning through its means the mind is usually clear to the last. The mode 
in which it acts would seem to be the induction of an over-sensitive con- 
dition of the spinal marrow, so that impressions which under ordinary cir- 
cumstances would produce little or no effect give rise to violent convulsions. 
The first symptoms of an over-dose are twitching of the muscles, often of the 
lower extremities, and a kind of choking sensation about the throat. These 
gradually .spread and increase in intensity till the whole body seems rigid from 
violent muscular contraction. In many ways they resemble those of tetanus. 
The body is often so contracted by the powerful muscles of the back as to re- 
semble an arch, and to rest only on its head and its heels. The muscles of 
respiration are likewise convulsed, so that no respiratory movement is possible, 
and the face becomes first red, then livid, and almost black. Such attacks are 
not continuous, but last for a minute or more; during the interval the patient 
is quite sensible, but the slightest motion of those round about him, sometimes 
even a breath of air, will suffice to bring the attack on again worse than ever. 
The great thing, therefore, is to avoid disturbing the patient if the attacks be 
slight, but if they be severe, or seem to increase in severity, prompt remedies 
must be employed, or death will speedily ensue. If in point of fact the fatal 
issue can be postponed for three or four hours after the beginning of the at- 
tack, there may be good hopes of ultimate success. The cause of death may 
either be a too prolonged interference with respiration, or exhaustion caused 
by repeated convulsive attacks. Used remedially nux vomica or strychnine 
acts as an incentive to digestive action, gives rise, that is, to the sensation of 
hunger, and probably aids digestion. It is one of the best of its class, espe- 
cially in chronic catarrh of the stomach, when the tongue is loaded and the 
bowels irregular. Two or three up to ten drops of the. tincture of nux vom- 
ica given in a little water will often effect great relief in the way of temporary 
symptoms. Flatulence from the same or allied causes it also relieves more 
than any other drug. The dose is as before, and should be taken just before 



OAK 537 OBS 

meals. Some varieties of headache it also remedies, especially those which are 
connected with gastric disturbance and foul tongue. Extract of nux vomica 
is a favorite remedy in constipation, especially that which is habitual. It is 
seldom given alone, but is combined with other substances, like aloes, rhubarb, 
and steel. All cases, however, do not answer to the stimulus. The action of 
nux vomica or of its alkaloid is still more marked in diseases connected with 
the nervous system, and especially those of a functional character. What is 
commonly called nervous exhaustion, from whatever cause arising, is better 
treated by this than by any other drug. In business men who have been 
exposed to much mental worry, and are partially broken down, its use is at- 
tended with singular benefit. In females affected with low spirits and hysteria 
this is often a most valuable remedy, more so than any other ; but on the 
whole it seems better adapted for the coarser maladies of the male sex. In 
maladies more distinctly dependent on organic diseases, as hemiplegia and 
paraplegia, strychnine often does great good, especially after the acute stage is 
over. In reflex paraplegia, such as occurs in those the subjects of uterine or 
rectal disease, when the original cause of the paralysis has been removed, 
strychnine does much good. In certain forms of paralysis, like the essential 
paralysis of childhood, the drug has been injected below the skin over the 
affected muscles. This plan has been highly commended by some, but it 
wants a little more authorization : we should not commend it, considering it 
too dangerous. It is curious to note that when a set of muscles are paralyzed 
they seem to be sooner affected by strychnine than when they are perfectly 
sound, twitching, etc., being more readily produced in these than in the others. 
In some other nervous maladies, as chorea, strychnine has been given, but 
with no great success. The bark of the nux vomica tree was at one time in- 
troduced into Europe instead of Angostura bark; the consequence was several 
cases of fatal poisoning. In poisoning by either nux vomica or strychnia, the 
remedies must be prompt removal of the poison where possible, either by the 
stomach-pump or vomiting, but when the paroxysms have set in an attempt to 
use either generally brings on convulsions. Then it is best to trust to chloro- 
form inhalation. 

0. 

Oak Bark, the bark of the stems and small branches of our common oak 
tree, is mostly used as an external remedy. The bark should be collected in 
spring, and when dry occurs in long, thin pieces covered by a crinkled epi- 
dermis commonly overgrown with lichens. Its smell when moistened is some- 
what peculiar, but its taste is almost purely astringent, owing to the tannic 
and gallic acids which it contains. The quantity of these in different species 
of bark varies a good deal, especially with age, season, and the part of the tree 
from whence the bark is taken. Its only officinal preparation is a decoction, 
which is only used externally. It may, however, be given whenever tannic 
acid is indicated. It is best suited for astringent lotions and injections, aud 
may be combined with various other remedies, provided these are not incom- 
patible with tannin. 

Obesity. See Bantingism, and Weight and Height. 

Obstructions may occur in many of the organs of the body, and set up a 
train of symptoms of a very serious nature, but in each case much will de- 
pend upon the nature and seat of the obstruction. The most important ob- 
structions are those which take place in the intestinal canal, in the liver or 
in the kidney, or in the course of the circulation. 



OBS 558 OBS 

A. Intestinal obstructions. The causes of this mischief are very various, 
and most of them are very difficult to make out, and also to relieve ; hence the 
treatment is uncertain, and often unsuccessful. The causes of intestinal ob- 
struction maybe divided into two classes: (1.) Those which come on sud- 
denly, pursue an acute course, and which will prove fatal if relief be not 
quickly afforded. (2.)* Those which come on gradually and pursue a chronic 
course, and produce symptoms which may subside more readity under the aid 
of medical or surgical measures. Under the first division may be mentioned : 

(a.) Congenital stricture or malformation. 

(b ) Foreign bodies impacted in the internes. 

(c.) Loops formed as a result of inflammation, which may entangle portions of the 

bowels. 
(d.) Invagination or intussusception of the intestines. 
« 

Under the second division may be classed : — 

(a.) Constipation, habitual or accidental. 

(b.) Inflamed intestine, the result of injury. 

(c.) Chronic inflammation of the peritoneum. 

((/.) Tumors pressing on the bowels. 

('«.) Simple stricture of the bowel, the result of ulceration generally. 

(_/.) Cancer of the bowel. 

Congenital malformation of the intestinal canal is generally confined to the 
rectum or the lowest portion of the large intestines ; this deformity, as its 
name applies, occurs before birth, and the only thing that can be done if the 
bowel is closed up is to make an artificial opening for the passage of the ex- 
creta. (See Artificial Anus.) Sometimes the malformation is higher up 
in very rare cases. Few symptoms are seen within the first twenty-four 
hours, but after that constant vomiting comes on and continues until relief is 
obtained or death ensues ; when the deformity is in the upper part of the in- 
testines nothing can be done. 

Foreign bodies may become impacted in the intestines, either by being acci- 
dentally swallowed or introduced up the rectum, or as a result of external 
injury; but this subject has been dwelt upon in the article on Foreign 
Bodies. 

Twisting of the intestines, so as to form loops, which prevent the passage of 
the faeces, is not a very common occurrence. The symptoms are very urgent 
from the first ; great pain is suddenly experienced in a small circumscribed 
spot of the abdomen, and obstinate constipation begins from this time ; the 
part becomes much distended and painful on pressure ; vomiting is generally 
present, and often constant ; the pulse is small, and the countenance is ex- 
pressive of pain and exhaustion. Medical aid must be at once sent for. 

Invagination, or intussusception of the bowel, is often the result of worms 
or of some other irritant cause acting on the bowels. It is very commonly 
observed after death in children, and in such cases it is probably formed dur- 
ing the process of dying ; more rarely it sets up serious mischief, and is attended 
with fatal results. See Intussusception. 

The second division of obstructions offers a more hopeful chance for treat- 
ment. 

Habitual constipation may go on for so long a time that a hard mass of faecal 
matter forms in the intestines, and cannot be dislodged by the natural efforts ; 
the mass generally forms in the large bowel, and may be sometimes felt as a 
tumor ; it may occur in those who take large doses of opium, or any drug 
which has a constipating effect. Injections of warm water must be given uutil 



OBS 559 OBS 

the mass is softened, or portions may be removed by a scoop from the rectum. 
See Constipation. 

Inflammation of the intestines, as a result of injury, may cause portions of 
the bowel to adhere together and set up obstruction ; if high up, little, if any- 
thino - , can be done ; if low down, an artificial opening may be made in the loin 
so as to give relief : in all these cases, pain in the abdomen, distension, and 
vomiting are the most marked symptoms. 

Obstruction may result from adhesion of two portions of the intestines in 
cases where there is a tubercular deposit on the peritoneum, or where two 
ulcers have set up inflammation around them and caused adhesions ; sometimes 
an abscess may then be formed : in such cases there may be no constipation, 
but often diarrhoea, and especially at first. It is very difficult to find out the 
nature of such cases during life. 

The most common cause of obstruction is stricture of the bowel ; it follows 
generally as a result of ulceration ; rarely met with in the upper part of the 
intestines, its common seat is in the rectum, or within a foot of the end of the 
canal. The lower the stricture is the more distended becomes the abdomen 
with flatulence ; there is great pain, vomiting, anxious countenance and con- 
stipation ; often a copious vomit relieves the pain for a time ; surgical aid must 
be sought early, and if the stricture cannot be overcome an artificial opening 
may be made in the loin so as to give great relief, and perhaps save life. The 
operation is called colotomy, and it is useful only in those cases where the 
mischief is below the seat of the operation. The patient will afterwards pass the 
excreta through the new opening, and must wear an apparatus for the purpose. 

Tumors pressing on the bowel may cause obstruction, as hydatids, ovarian 
tumors, etc., but these cases will vary so much with each individual state that 
no description of them would be useful. Cancer may affect the bowel and 
chiefly the rectum, and cause obstinate constipation and obstruction : the emaci- 
ation, pain, loss of flesh, and gradual onset of the symptoms will help to reveal 
the nature of the case, although it may be mistaken for simple stricture ; usu- 
ally the disease may be made out on examining the rectum. Colotomy will 
often give great relief, although it cannot save life. 

B. Hepatic obstructions. The only obstruction in the liver that need be 
mentioned here is due to the presence of a gall-stone in the duct or tube which 
conveys the bile from the liver to the intestinal canal. The symptoms of a 
gall-stone in the duct are great pain in the right hypochondriac region and 
over the liver, vomiting, anxious .expression, thirst, loss of appetite, and a yel- 
low tinge of the skin; when the stone has passed into the intestinal canal 
relief is at once experienced, and the urgent symptoms pass away. If the 
jaundice is intermittent and persists for some time, it may be due to several 
smaller stones passing at different times. The treatment of such obstructions 
during the attack must consist in putting the patient in a hot hip-bath, apply- 
ing hot poultices or hot fomentations to the seat of pain, and in giving some 
purgative medicine ; should the pain be very severe, chloroform may be admin- 
istered with caution, and opium may be given so as to try and procure sleep. 
After the severe symptoms have passed away the patient should lead a regular 
life, be careful of his diet, take plenty of exercise, avoid intoxicating liquors, 
and see that the bowels are kept regularly open. Tumors pressing on the 
bile duct, as in some cases of cancer, may produce obstruction, and so will any 
inflamed condition of the bile duct itself ; in the first instance, nothing can be 
done, but the last cause will generally be removed by treatment. The admin- 
istration of purgatives, as rhubarb draughts, and an occasional dose of calomel, 



OBS 560 OBS 

the regulation of the diet and active exercise will gene. 'ally bring about a cure, 
although such cases may persist for a long time. The main symptoms are a 
dull, aching pain over the liver, constipated bowels, pale faeces, a jaundiced skin, 
dark-colored urine, loss of appetite, a furred tongue, and dyspepsia; under 
treatment these symptoms gradually subside. See Liver. 

C, Renal obstructions. A stone or calculus in the kidney is one of the 
most troublesome obstructions that can occur in that organ, for if situated in 
the pelvis of that organ it prevents the flow of urine to a greater or less degree 
in the bladder ; great pain in the back in one loin or other, so severe as to 
double the patient up, and pain passing downwards to the groin, nausea, vom- 
iting, and often blood in the urine are the main symptoms. They may occur 
at intervals, and generally come on after exertion, as riding on horseback or 
in a jolting vehicle. Often small pieces of stone become detiched and pass 
away in the urine, but their passage is accompanied with very severe pain at 
the time. A hot hip-bath, or hot poultices and fomentations must be used to 
ease the pain, and, if needful, opium may be given or chloroform may be eau- 
tiuu-lv inhaled. If the stone pass down into the bladder, it may then be recog- 
nized and removed by the operation of lithotomy or lithotrity ; very often it 
remains in the pelvis of the kidney, and then causes dilatation and subsequent 
destruction erf that organ. Tumors growing in the abdomen and hydatid cysts 
may cause an obstruction to the flow of urine; so also will cystitis or inflamma- 
tion of the bladder, a stone or tumor in the bladder, and a stricture of the 
urethra. In all these eases the flow of urine is more or less impeded, and the 
parts behind the obstruction become distended, and finally cause a serious 
disease in those parts. 

D. Obstructions may take place in the course of the circulation ; thus a vein 
may be plugged with fibrine, and if this occur in a large vessel the parts below 
will become swollen and (edematous ; in this way gangrene of an extremity may 
be caused ; in other cases an artery may be blocked up, as occurs in some cases 
of hemiplegia or paralysis, because the supply of blood is then cutoff from the 
part ; if the block exist in the brain, it may cause serious consequences, but if 
a small vessel be blocked in other parts of the body, very little harm is done. 
A plug which is formed at the spot of obstruction is called a thrombus ; a plug 
which is carried from a distant point to the seat of obstruction is called an 
embolon. (See Embolism and Apoplexy.) In very rare cases a plug forms 
in the right side of the heart, and may cause death in a short time : very often, 
in the process of dying slowly, clots form there, but give rise to no symptoms 
to call for remark/ Any foreign body met with in any part of the body may 
be looked upon as an obstruction ; thus a marble or coin in the air-passages, a 
piece of meat or false teeth lodged in the oesophagus, a bean or pea in the 
nostrils, are all instances of obstruction. (See Foreign Bodies.) In addi- 
tion to the above obstructions there are some which are of a much more minute 
character, by which very small vessels get blocked up, and as a consequence 
of which very serious mischief may be set up in the organs thus affected. It 
now and then happens that when the heart has become affected after an attack 
of rheumatic fever, vegetations or growths of fibrine which are then found in 
the valves of the heart become washed off by the stream of blood, and block 
up vessels in different parts of the body ; in such cases there is generally pallor 
of the skin, a fluctuating temperature, as shown by the thermometer, and much 
prostration ; such cases generally prove fatal. In all cases of disease of the 
heart, and in many affections of the lungs, as emphysema, etc., the general 
course of the circulation is impeded, and often dropsy may eusue in conse- 



CEDE 561 CESO 

quence. (See Dropsy and Heart.) A diseased condition of liver, as in 
cirrhosis, will also cause an obstruction to the circulation, and since the blood 
cannot flow freely through the portal vein, ascites or dropsy of the abdominal 
cavity will ensue. 

CEdema. By this term is meant the swelling caused by effusion of serous 
or inflammatory fluid into the loose areolar tissue lying under the skin or mu- 
cous membrane. A well known example of oedema is the diffused and soft 
swelling which occurs over the feet and ankles, either as a result of general 
debility or in connection with dropsy due to disease of the heart and kidneys. 
Pressure upon the veins of a limb, and consequent obstruction to the flow of 
blood towards the heart, constitute a frequent cause of oedema. In the last 
stage of cancer of the breast, the arm often becomes enormously swollen in 
consequence of the pressure of the enlarged and cancerous glands in the arm- 
pit upon the veins which return the blood from the upper extremity to the 
heart. A similar result is sometimes produced at the extremity of a limb, in 
consequence of tight bandaging after fracture. In inflammation a modified 
serous fluid is generally poured out, which causes swelling and cedema of the 
affected part. True cedema, caused by effusion of fluid, always forms an inelas- 
tic swelling, which retains for some time any marks made on its surface by com- 
pressing it with the finger. It may be thus distinguished from the hard, solid 
effusion produced by chronic inflammation. 

The following are some of the chief forms of cedema : — 

Dropsical cedema, such as may be met with in the swollen limbs of patients 
suffering from Bright's disease of the kidneys, from disease of the heart, and 
from exhaustion. The legs sometimes become much swollen, and the distended 
skin smooth, glistening, and sometimes red and inflamed. 

Inflammatory cedema is caused by the effusion of a fluid containing fibrine, 
which coagulates spontaneously on exposure to the air ; fluid of this kind is 
formed whenever the surface of the body is inflamed by the application of a 
blister ; but here the effusion is quite superficial. When a similar fluid is 
poured out into the loose areolar tissue under the skin in connection with irrita- 
tive or inflammatory processes, the swelling is called inflammatory cedema. 
The extent of the swelling depends upon the amount and the character of the 
areolar tissue found in the region inflamed. In the loose and abundant subcu- 
taneous tissues of the eyelids a considerable quantity of fluid may be readily 
effused : hence the rapid and extreme swelling of those structures in cases 
of erysipelas and inflammation of the face. The tissue under the conjunctiva 
is also very loose, and swells up rapidly in some severe cases of ophthalmia, 
constituting the condition known by surgeons as chemosis. The most danger- 
ous form, probably, of local inflammatory cedema is the effusion of fluid into 
the loose tissue at the upper part of the larynx, which is often produced in 
children who have inadvertently swallowed some very hot fluid. The narrow 
orifice leading to the larynx and windpipe is speedily closed by the swollen 
tissues, and the patient, if not relieved by surgical treatment, soon dies from 
suffocation. 

CEsophagus. A muscular tube which connects the pharynx above with 
the stomach below, so as to allow of the passage of food from the mouth into 
the intestinal canal. It is lined by a smooth epithelial membrane, and is ca- 
pable of expansion according to the amount of the food swallowed. It is com- 
monly known as the gullet. It is sometimes the seat of cancer and stricture, 
and it may become seriously injured in cases where children swallow boiling 
water by mistake. 



OIN 562 ONY 

Ointments are forms of remedies in which the active substance is wrought 
up with lard or some similar fatty substance, which, being smeared on the skin 
or raw surface, keeps the part moist and preveuts evaporation. Formerly a 
distinct kind of ointments, called cerates, was employed ; in these a consider- 
able quantity of wax was mixed up with the other substances, so that their 
substance was harder and firmer than those of ordinary ointments. The name 
is now done away with, but the substance remains, for a good many of the or- 
dinary ointments contain wax, and are essentially cerates. Ointments have 
been long in favor as applications to wounded surfaces, and doubtless in many 
cases they do well ; but in certain instances, especially when the discharges 
tend to decompose, they do harm ; the fats break up and the fatty acids are set 
free, and so the application becomes a curse rather than a blessing. The same 
untoward results follow the prolonged use of a single application of ointment. 

Olfactory Nerves are special nerves emerging from the brain, one on 
each side, which, spreading out over the interior of the nose, enable man to 
have the sensation of smell. The nerve filament may be stimulated, as in 
cases of taking smelling-salts, and, if seriously injured, the sense may be lost. 
See Brain. 

Olibanum is a kind of gum resin obtained from a plant called the Boswcllia 
serrata. It is not now officinal. It occurs in small masses called tears, of 
an oblong shape, and having a peculiar odor. The resin in it enables it to 
burn with a peculiar odor, and the gum to form an emulsion with water. It 
is a stimulant like myrrh, but is mainly used as incense in Roman Catholic 
places of worship. 

Olive Oil is perhaps better known as an article of food than of medicine, 
yet it is valuable as both. This oil, which is obtained by pressure, from 
olives grown in Southern Europe, and commonly called salad oil, is of a pale 
straw color with a tinge of green in it. It tends, at a low temperature, to be- 
come solid, apparently by the crystallization of its bases, olein and palmitin. 
When brought into contact with an alkali these bases are decomposed, the 
acids, olein, and palmitin uniting with that to form a" soap, the glycerine, which 
is the normal base, being set free. (See Soap and Glycerine.) The oil 
itself is used in making several liniments, plasters, and ointments, and is some- 
times given internally. Internally, in large doses, whether given by the mouth 
or as an enema, it tends to open the bowels, and to act as a laxative. For 
this reason the plentiful use of salad with olive oil will not unfrequently tend 
to open the bowels regularly. It is also used externally for lubricating the 
surface. When cod-liver oil cannot be taken olive oil often can, and if so, is 
sure to do some good. It is not so easily digested as cod-liver oil ; neverthe- 
less, its pleasant flavor and taste renders it superior to the former in a cer- 
tain number of instances. It may be used with advantage by inunction in 
some wasting diseases of children, the smell produced being not nearly so un- 
pleasant as that of cod-liver oil used the same way. 

Omentum is a membrane formed by a double fold of peritoneum, which 
covers part of the intestines as they lie in the abdominal cavity. In thin peo- 
ple it is a delicate structure, but an immense growth of fat may occur in it in 
very stout people. 

Onychia is a disease of the nail dependent upon inflammation of the bed 
of the nail. It occurs under two forms, the simple and the specific. In simple 
onychia, which may be produced by running thorns or splinters, etc., under 
the nail, there is pain, redness, and swelling, and the nail becomes discolored, 
shriveled, and finally falls off, while a new nail makes its appearance below. 



OPH 563 OPH 

The treatment must consist in poulticing and fomenting the finger, and in 
thus trying to subdue the inflammation. Specific or malignant onychia is a 
more serious affection, and is often dependent upon an injury inflicted on one 
in an unhealthy or cachectic state of constitution. A dusky red inflammation 
takes place at the sides or root of the nail, ulceration is set up, and fetid mat- 
ter exudes. The nail shrivels, becomes black, and peels off, while feeble at- 
tempts are made in producing a new nail. Treatment : The nail must be re- 
moved, as it prevents the healing of the surface from which it springs ; the 
ulcer should then be well rubbed with nitrate of silver, and dressed with black 
. wash. At the same time the general health must be kept up by giving a lib- 
eral diet and bitter infusions. 

Ophthalmia. This term is applied to inflammation of the conjunctiva, or 
thin mucous membrane which covers the front of the eyeball and lines the 
inner surfaces of the lids. In some forms of ophthalmia, however, there is 
inflammation also of the cornea, and of the anterior part of the strong fibrous 
coat of the eye which is called the sclerotic. Ophthalmia is a very frequent 
affection, presents very many forms, and originates from one or more of a 
great number of local and constitutional causes. Its simplest form consists in 
slight and temporary redness and itching of the surface of the eye, clue to the 
presence of a particle of dust, or to the prolonged exposure of the eye to 
strong light. At the other extreme of a long list of ophthalmic affections is 
placed the acute purulent or Egyptian ophthalmia, in which there is intense in- 
flammation of the conjunctiva, attended with profuse suppuration and consti- 
tutional irritation, and, in many cases, terminating in rupture of the eyeball 
and total loss of vision. The following are some of the principal and most 
common causes of ophthalmia : the presence between the lids and the surface 
of the eyeball of foreign bodies, such as particles of dust, and other matters ; 
particles of steel and iron, when impelled with much force, adhere to or are 
imbedded in the issue of the cornea or conjunctiva, and so long as they remain 
keep up iuflammation ; an inverted eyelash, by irritating the conjunctiva on 
the front of the eyeball, often causes ophthalmia. Exposure of the eyes to a 
strong draught and the prolonged action of a heated atmosphere are common 
causes, and also much and long-continued exercise of the eyes on minute ob- 
jects, especially if this be carried on under artificial light, and in close badly- 
ventilated rooms. To these conditions may be attributed the frequent occur- 
rence of ophthalmia among watch-makers, working jewelers, compositors, 
needle-women, reporters, and clerks. The eyes are usually much irritated by 
very bright artificial light, whether direct or reflected, and by the reflection of 
strong sunshine from very extensive light-colored surfaces, as the sea, a long 
stretch of sand, or snow. There are certain constitutional diseases which ren- 
der their subjects liable to attacks of ophthalmia ; of these, the principal are 
gout, rheumatism, scrofula, and inherited syphilis. Individuals who, in con- 
sequence of high living and of indulgence in alcoholic drinks, suffer .from dys- 
pepsia and congestion of the liver and other digestive organs, are much pre- 
disposed to inflammation of one or both eyes. Ophthalmia is quite common 
among the very poor, and in bodies of men who are crowded together in foul 
and close rooms, and who are badly fed. Under these circumstances the 
ophthalmia is caused directly by the presence on the inner surfaces of the eye- 
lids of firm and rounded swellings called granulations. 

Simple or Common Ophthalmia is produced by slight injury or by exposure 
to a draught. The symptoms are redness of the conjunctiva, " watering " of 
the eye, a feeling of smarting and stiffness. These in most cases soon pass away 



OPH 564 OPH 

after the application of a cooling lotion, care having been taken to protect the 
eye both from light and the action of cold. 

Catarrhal Ophthalmia is so named because it is caused by exposure to those 
external and climatic influences which give rise to the symptoms of tbe affec- 
tion known as eatarrh or common cold, but which here attack the mucous mem- 
brane of the eye and lids exclusively, or to a greater extent than that of the 
nose, fauces, and air-passages. This form of ophthalmia is met with in pa- 
tients attacked by measles, and occurs in some cases of scarlet fever and of 
erysipelas. The symptoms resemble those of simple ophthalmia much aggra- 
vated. The eyelids feel stiff, and the patient complains of a feeling as if 
" sand or dust had got into the eye." There is a bright scarlet redness of the 
conjunctiva, disposed not regularly over the whole surface, but in irregularly 
formed patches. There is a discharge from the eye, which at first is clear and 
thin, but afterwards of a yellow color, and thick and viscid. During sleep this 
discharge collects at the edges of the lids and dries there, gluing together the 
eyelashes. The lids become red and swollen. The general health gradually 
becomes disordered, and the patient complains of headache, fever, dryness of the 
mouth and throat, and loss of appetite. In ordinary cases, the affection gen- 
erally lasts for about ten days or two weeks, but when the inflammation has been 
allowed to proceed without treatment, it often passes into an obstinate and 
dangerous purulent ophthalmia. In most cases both eyes are affected. In 
old people this form of ophthalmia often becomes chronic, and is then very 
rebellious to treatment. In ordinary cases of catarrhal ophthalmia, where 
there is not very much local irritation, frequent bathing of the eyes with cold 
water and the application of alum lotion (one grain to one ounce of water), or 
of one or two drops of a solution of lunar caustic (one grain to two ounces of 
distilled water), will generally be found effectual. The application of the 
lotion or drops should be made thrice daily. When, however, the patient com- 
plains of severe pain, and the eyelids are red and inflamed, light poppy fomen- 
tations should be applied, and afterwards, if these give no relief, a leech to 
each temple. The edges of the lids should be anointed every night at bed- 
time with glycerine or olive oil. The patient should be recommended to keep 
to a light diet, and the bowels be kept freely relieved, if necessary, by the ad- 
ministration of calomel and black draughts. The eyes should be protected by 
a dark green shade. 

Purulent Ophthalmia sometimes attacks new-born infants, and under these 
circumstances is regarded as a distinct affection, which has been styled ophthal- 
mia neonatorum. The purulent ophthalmia of adults, or the Egyptian ophthal- 
mia, as it is called, in consequence of its prevalence in the French army after the 
campaign of 1805, sometimes attacks individuals who have been collected to- 
gether in numbers under faulty hygienic conditions, and breaks out occasion- 
ally in large schools of young children. In isolated cases of acute purulent 
ophthalmia affecting adults, the affection is very often associated with gonor- 
rhosa. The symptoms of purulent ophthalmia at first resemble those of the 
catarrhal form, hut they rapidly increase in severity, and in the course of 
twenty-four or thirty hours the eyelids become of a deep red color, and swollen 
to such an extent that they cannot be opened. The patient is much alarmed 
by these symptoms, and, as he cannot obtain a glimpse of any object, or even 
tell whether it be day or night, believes that he is blind. Now, between the 
swollen lids there is a constant discharge of thick purulent fluid, which, if ap- 
plied even in minute quantity to a healthy conjunctiva, soon sets up purulent 
inflammation. The conjunctiva is reddened and much swollen, so that it forms 



OPII 565 OPH 

large rolls, which cover over a greater part of the surface of the cornea. The 
patient complains of acute pain, which shoots from the eye to the correspond- 
ing clieek, forehead, and temple. There is considerable constitutional dis- 
turbance, and the patient is generally very nervous and fearful of permanent 
blindness. The affection, if unchecked by treatment, causes ulceration with 
perforation of the cornea, and, in some cases, sloughing of the whole of this 
transparent membrane ; in the latter case there will of course be complete 
loss of vision. With slight ulceration and even perforation the sight, though 
not destroyed, will in most cases be seriously impaired. Occasionally the 
purulent ophthalmia extends with great rapidity from the conjunctiva to the 
other coats, and even to the interior of the eyeball. 

The purulent ophthalmia of infants generally occurs on the third or fourth 
day after birth. In many instances, and especially among the poor, it is not 
noticed for the first day or two, and until irreparable mischief has been pro- 
duced. In the first stage the lids are slightly swollen, and are stuck together 
by some dried mucus. There is intolerance of light, and the infant's brow is 
generally much contracted. At a more advanced stage the lids become red 
and puffy, and are separated from each other by the protrusion of rolls of in- 
flamed and swollen conjunctiva. From the surface of this membrane there is 
a profuse and continuous discharge of thick yellowish fluid, which is sometimes 
stained with blood. The effects of this disease, when severe and if allowed to 
take its course, are sloughing of the cornea and ulceration of this transparent 
membrane, and subsequent opacity. Purulent ophthalmia is more amenable 
to treatment in new-born children than in adults, and in the former class of 
patients, unless the cornea has been already involved, speedily and completely 
subsides without any bad results, after the application of suitable remedies. 

The adult subjects of purulent ophthalmia are usually pallid and weak, and 
should not be treated on any lowering system ; the strength ought to be kept 
up by good but easily digestible food, beer, wine, and in very bad cases brandy 
may be given in moderate quantities. The most useful medicinal agents are 
quinine and opium. The local treatment carried out by most surgeons in this 
country consists in incising the masses of swollen conjunctiva, aud in applying 
some strong astringent, as lunar caustic in strong solution, or in the solid stick. 
The eyes are then to be frequently syringed with a solution of alum. There 
is probably no other local affection in which early professional assistance is 
more necessary than purulent ophthalmia, whether in the adult or young in- 
fant. But in all ca^es of this kind much responsibility is thrown upon the 
nurse or attendant. The eyes have frequently to be bathed, the face must be 
kept clean, and, above all, great care must be taken to wipe away at once the 
purulent discharge, as the contact of this with the conjunctiva of a healthy eye 
will almost certainly set up fresh inflammation and suppuration. The affected 
eye should be covered by a layer of cotton wool fixed by a bandage. This 
covering should be frequently renewed, and when removed .should at once be 
burnt. 

In the purulent ophthalmia of infants the local treatment need not be so 
severe. The frequent application of a solution of alum (fifteen grains to one 
ounce of water) will in most cases prove an efficacious means of arresting the 
course of the disease. 

Granular Ophthalmia. A patient suffering from this form of ophthalmia 
generally presents the following appearances : the edges of the eyelids are red 
and swollen, the upper lid droops over the front of the eye, and the lower lid 
is slightly everted ; the conjunctiva is reddened, and on exposure to bright 



OPH 566 OPH 

light there is a free discharge of tears, and the lids are closed spasmodically ; 
the cornea is pitted on its surface and more or less hazy, and near its circum- 
ference is invaded by a well-marked zone of dilated blood-vessels. On evert- 
ing the upper lip it will be found that the conjunctiva lining its inner surface 
is very red and vascular, and studded with numerous soft and ruddy projections 
resembling the granulations observed on all healthy ulcers. In consequence 
of this resemblance the soft growths, which are enlarged follicles and papillae 
of the conjunctiva, are called granulations, and the inflammation to which they 
give rise by friction over the surface of the eyeball is called granular oph- 
thalmia. These granulations are different in form, size, and consistence in 
different cases. In some cases the inner surface of the lid is studded by mi- 
nute and pale gray granules, which have been likened to soaked sago grains. 
The precise nature and origin of this affection have not yet been marie out. It 
is of frequent occurrence among sailors and soldiers and in large parochial 
schools. It is very common among the peasantry in some parts of Ireland. 
The subjects of prolonged granular ophthalmia are usually pale, weak, and out 
of health. It is a very chronic and obstinate disease, and often causes dense 
opacity of the cornea and incurable blindness. 

The treatment of this affection consists in supporting the strength of the 
patient, and in attempting to rub down and destroy the granulations by astrin- 
gents and caustics. The applications most frequently used by surgeons for 
this latter purpose are blue stone, lunar caustic, acetate of lead, liquor potassae, 
tannin, and quinine. These are all very powerful agents, and necessitate great 
care in their application. 

Scrofulous or Strumous Ophthalmia. This differs from the preceding forms 
of ophthalmia in being an inflammatory affection of the cornea, and not of the 
conjunctiva. It is met with generally in ill-nourished and unhealthy children 
and young women. It is often associated with pustular affections of the scalp, 
and with eczematous scabs and excoriations about the nose and ears. Although 
called scrofulous ophthalmia, this affection is not met with exclusively in indi- 
viduals in whom there is any morbid disposition of a scrofulous or tuberculous 
character. The most morbid symptom of this kind of ophthalmia is great in- 
tolerance of light (photophobia). The patient generally lies with the face 
downwards and the eyes covered by the hands or arms, and when he is raised 
and brought to the light the eyelids are closed spasmodically, and the whole 
face is much contorted. There is a profuse flow of tears, which irritate and 
redden the lower lid and the cheek. When, with much difficulty, the eyelids 
have been separated, the observer will find at first sight but very little to ac- 
count for the acute pain and intolerance of light. The conjunctiva is gener- 
ally clear and free from swelling and redness. On examining the cornea 
closely, it will be found somewhat clouded and studded by a few small super- 
ficial pits or small ulcers, and at the margin may generally be seen one or 
more whitish specks surrounded by distended blood-vessels. In advanced cases 
there is deeper and more extensive ulceration, with dense clouding of the cornea. 

The essential point in the treatment of this affection is the improvement of 
the general condition. If possible, the patient should be sent to the sea-side, 
and be allowed to take exercise in the open air. The diet should be nutritious 
and easily digestible, and a small quantity of wine may be allowed. Prepara- 
tions of steel and cod-liver oil are especially beneficial in cases of this kind. 
The intolerance of light and the pain in the eyes may be much relieved by 
applying small blisters, one after the other, to the temple and forehead. 

Ophthalmoscope. This is an apparatus used for exploring the interior 



OPH 567 OPH 

of the eyeball and the posterior portions of the retina and choroid. It was in- 
vented by Professor Ilelmholtz in 1851, and has since proved itself an invalua- 
ble agent in the diagnosis of affections of the organ of sight, arising from local 
morbid changes, and also from constitutional disorders. Surgeons skilled in its 
use are now able to detect inflammatory and hemorrhagic changes in the 
membranes and humors of the eye, and occasionally discover intra-ocular indi- 
cations of disease of the brain and of Bright's disease of the kidneys, of the 
existence of which serious disorders there had previously been no suspicions on 
the part either of patient or medical attendant. The simplest form of ophthal- 
moscope is a round concave mirror perforated at its centre by a small orifice, 
through which the surgeon can look directly upon the fundus of the eyeball 
illuminated by the rays of a bright light thrown upon the mirror, and reflected 
to the patient's retina. These rays are reflected back from the bottom of the 
patient's eye, and converge at the surface of the reflecting mirror, to the back 
part of which the eye of the observer is applied. In addition to the mirror a 
small convex lens of short focus is often placed before the eye of the patient, 
in order that the observer may obtain a clearer and magnified view of the retina. 
The examination is made in a darkened room, and a gas-burner or oil-lamp is 
so placed that it is on one side of, slightly behind, and on a level with, the 
head of the patient, who sits facing the surgeon. Before the examination 
atropine is usually applied to the surface of the eye, in order to dilate the pupil. 
The use of the ophthalmoscope seldom causes any pain or uneasiness. The 
temporary disturbance of vision which sometimes follows the examination is 
usually due to the action of atropine. 

The above-described form of ophthalmoscope, consisting of the mirror and 
small concave lens, is the one most frequently used, as it can be packed into a 
small compass, and can be readily arranged. Much practice, however, is neces- 
sary before one can render the interior of the eyeball distinctly visible, and detect 
any morbid change in the delicate membranes at its fundus. For the purpose 
of demonstrating intra-ocular appearances to those who have not acquired 
dexterity in the use of the ordinary apparatus, various complicated forms of 
ophthalmoscope have been devised, most of which, however, are open to some 
objection. 

The following are the ophthalmoscopic appearances presented by a healthy 
eye : At the fundus of the eyeball is an orange-red or orange-yellow mem- 
brane, the choroid, in front of which is the transparent retina, traversed by 
very distinct blood-vessels, which radiate from a circular or oval disc of a 
creamy or pale pink color ; this is called the optic disc or papilla, and is the 
outer extremity of the large nerve which passes from the base of the brain into 
the orbit and to the eye.' This disc is situated to the inner side of that portion 
of the retina which lies in the axis of vision when the patient looks directly 
forwards. In this portion of the retina, which is at the centre of the posterior 
portion of the globe, is the macula lutea, or " yellow spot." This, in the living 
subject, is generally indicated by a pale red and irregular patch, which is quite 
free from blood-vessels. It is this part of the retina, and not the ocular ter- 
mination of the optic nerve, which corresponds to the axis of vision. 

The following are the chief morbid changes revealed by the ophthalmo- 
scope : congestion, swelling, shrinking, excavation, and irregular form of the 
optic disc, opacities, and effusion of blood in the retina, and distension and con- 
traction of the blood-vessels traversing that membrane, congestion and inflam- 
mation of the choroid, deposits of inflammatory lymph and of pigment in this 
membrane, and atrophy, with absorption of pigment or black coloring matter. 



OPI 568 OPI 

Haemorrhages into the vitreous humor and incipient cataract may be discov- 
ered by means of the ophthalmoscope. 

Opisthotonos is a technical term used to designate those convulsions in 
cases of tetanus or hysteria, etc., in which the patient is arched backwards, so 
that the head nearly touches the heels. See Tetanus. 

Opium is perhaps the most important drug in our Pharmacopoeia. Various 
kinds are in use, but all are obtained in the same way. The white opium 
poppy is allowed to mature its capsules only for a very short period, only in- 
deed for a few days after the flower leaves have fallen. Then incisions are 
made in its texture, so deep as to reach the sap, but not so deep as to reach 
the interior of the capsule. The sap exudes as a milky juice which speedily 
hardens and becomes brown, forming little masses. These are carefully 
gathered or scraped off and wrought up into balls or cakes, and usually covered 
over with some leaf. Turkey opium is that which is chiefly used in this 
country. Of it, there are two varieties, the Constantinople and the Smyrna. 
Both are now of about the same value, but formerly Smyrna was best. It was 
known from the other by being covered with the capsules of a plant of the 
dock kind. Both are soft, dark brown in color, and possessed of a heavy pecul- 
iar odor called narcotic. The large masses bear indications of having been 
made up of the smaller, called tears. Other varieties are employed for the prep- 
aration of alkaloid, but should not be used for making the officinal prepara- 
tions; such are Egyptian and East Indian opium. These preparations are 
many and various, comprehending a confection, a plaster, an enema, an ex- 
tract, a liquid extract, a liniment, a pill (commonly called compound soap pill), 
a lead and opium pill; aromatic chalk powdered with opium, compound 
ipecacuanha powder, compound kino powder, compound powder of opium, tinct- 
ure of opium or laudanum, compound tincture of camphor, also known as 
paregoric elixir ; an ammoniated tincture of opium, opium lozenges, oint- 
ment of galls and opium, and wine of opium. Of course the doses of these 
vary according to the effect it is desired to produce, but supposing it is in- 
tended to give rise to an effect comparable to that produced by a grain of opium, 
that is an ordinary full dose, they would be as follows : of confection of opium 
5 to 15 grains, of the extract about a grain, of the liquid extract 25 drops ; of 
laudanum 25 or 30 drops; of compound tincture of camphor about the same, 
and of ammoniated tincture of opium rather less; of opium wine rather more 
than 30 drops may be given, of chalk and opium powder 30 to 40 grains, of 
compound ipecacuanha powder 10 grains, of compound kino powder 15 grains, 
of compound soap pill 4 or 5 grains, of compound powder of opium 3 grains, 
of lead and opium pill 4 grains, of opium lozenges 1 to 4. Opium contains a 
great variety of substances of a crystalline character,- and possessed of distinct 
property. Its chief acid is one called meconic acid, its chief base is morphia. 
But besides morphia it contains codeia, papaverina, thebaia, or paramorphia, 
naicotine, narceia, meconine, or opianyl, opianine and porphyroxine, with per- 
haps a variety of others. Morphia in many respects resembles the action of 
opium which may indeed be said to owe its efficacy to the presence of this base. 
Codeia is said to be the most poisonous of the principles. Narcotine is merely 
tonic and antiperiodic and thebaia resembles strychnine. On the whole, not 
much is known with certainty of the action of any of these bases except mor- 
phia. Two salts of morphia are used, the hydrocldorate and the acetate. Of 
the former we have a solution, suppositories, lozenges, and another form of 
lozenge combined with ipecacuanha. Of the acetate merely the liquor or 
solution is officinal. For opium to exercise its free influence, it is necessary 



OPI 569 OPI 

that it should be absorbed into the blood, but it does not greatly matter by 
what way it is introduced, whether by the stomach, the bowel, by a raw sur- 
face, or, as is now extensively practiced, by subcutaneous injection. If in any 
of these ways an ordinary dose of opium, or its alkaloid, morphia, is intro- 
duced, there is first of all a stage which might, though incorrectly, be called one 
of excitement. The mind becomes quiet under its soothing influence, the 
pulse quickens, the mouth grows somewhat dry, but the moisture of the skin 
increases. By and by the pulse slackens, the breathing is long and full, and 
the patient sleeps. When he awakes there is generally thirst, some nausea, 
and very often headache; the tongue is furred and the bowels confined. Should 
a large dose have been given the effects are more marked, the preliminary 
stage is hardly noticed, sleep of a heavy kind speedily comes on, and the breath- 
ing is often stertorous, whilst the pulse is slow. This condition may be in- 
duced by very different quantities of the poison in different individuals. 
Children are unusually susceptible to its action, insomuch that there is danger 
in giving them the weakest preparation of opium in the smallest quantity. On 
the other hand, certain individuals can hardly be affected by its use except in 
large quantity. Such a condition of system is especially brought about by pro- 
longed use of the drug. After a poisonous dose, the stage of excitement is 
hardly noticeable, and narcotism comes on almost at once. There is a craving 
for sleep which can hardly be overcome, and sleep if permitted soon passes 
into complete insensibility ; the surface, at first pale and covered with sweat, 
becomes cold and livid ; the breathing, exceedingly slow and stertorous, grad- 
ually grows more and more shallow till it ceases. The pulse, from being full 
and firm, becomes smaller and smaller, slower and slower, until it ceases to be 
felt. "The muscles of the whole body are relaxed, there is complete loss of 
sensibility, the patient can no longer be roused. The rattle begins in his throat, 
and gradually death ensues. One of the most marked peculiarities of the 
action of opium is its influence on the pupil, which it contracts powerfully, so 
that when the patient is fully under its influence the pupil may seem no larger 
than a pin's point. This is an important diagnostic as to the cause of insen- 
sibility in poisoning by opium, and the insensibility produced in other ways. 
Though these are the ordinary symptoms produced by opium, yet there are 
others of a very diverse character sometimes manifested. As to the remedies 
to be employed in poisoning by opium, these are chiefly means to prevent 
sleep, as the system after having once fallen under its influence to the full ex- 
tent is not easily roused. Shaking, flicking the soles of the feet, etc., are com- 
monly resorted to. But these are only to be had recourse to after the stomach 
has been emptied of the poison. Perhaps the best thing here is the stomach- 
pump, as it admits of the stomach being washed out, but if that is not at hand 
a stimulant emetic — mustard is the best — should be .given, after which black 
coffee should be freely administered from time to time till the patient gets well. 
As belladonna acts in an opposite fashion on the pupils, others have proposed 
it as an antidote for opium, and it has been administered subcutaneously in a 
certain number of successful cases, but whether the belladonna was the agent 
to produce this or no seems uncertain. There are few diseases in which com- 
plications demanding the use of opium may not arise. In fact, its uses are 
legion. Thus in fevers, though we cannot hope to cut short the malady, we 
may obviate certain of its most distressing symptoms by means of opium ; want 
of sleep, especially in typhus, often gives rise to delirium of a low muttering 
sort, with picking of the bid-clothes and wandering. Here opium judiciously 
given may save the patient, who in such cases is in very great danger. Graves 



OPI 570 OPI 

used to give opium combined with tartar emetic in these cases, apparently with 
the best results. Me gave three or four drops of laudanum, with a little tartar 
emetic, every two hours till the patient was quieted. 

In any malady accompanied by this form of delirium, where the strength 
is at the lowest ebb, the tongue brown and dry, the pulse hardly perceptible 
and too quick to be counted, if opium be given in this way along with a certain 
quantity of brandy, to be administered as carefully as the opium, safety may 
be obtained almost when past hope. But the opium must be given in small 
doses, frequently repeated, and the brandy in teaspoonfuls. In acute mania, 
opium with or without tartar emetic is of great service. Sometimes it is best 
given under the skin. 

But the great use of opium is to relieve pain. For this purpose it is now 
mostly given hypodermically, that is, under the skin. For thereby the digestion 
is less disturbed, and the patient is free to take food ; moreover, a smaller quan- 
tity suffices. However, this must be borne in mind, that the quantity required 
to procure ease rapidly increases, so that what would suffice at one time will 
not at another, some time thereafter; and the same holds good of its internal 
administration. It is best, therefore, to alternate its use with that of other 
sedatives, especially chloral, so that the system has time to recover from the 
use of the one before it is necessary to return to it. In this way opium is of the 
greatest service in gall-stones, the passage of urinary calculi, cancers, painful 
ulcers, etc. A single injection may suffice to cure sciatica and other forms of 
neuralgia, if applied on the spot, but as the same result used to follow acu- 
puncture in certain instances, we cannot be quite certain of the efficacy of the 
morphia. The same means may be employed to cure pleurodynia, that is, pain 
in the side, if the pain be deep seated. The same form of the remedy may be 
of use in the vomiting of pregnancy, or to assist persistent hiccup. When the 
pain is in the stomach itself and the vomiting arises from disease of that organ, 
of course it is better to give the opium by the mouth, provided it be not re- 
jected, as it too often is. If so, either a very small piece of morphia and sugar 
may be given, or it may be administered subcutaneously. In certain forms of 
heart-burn, too, it may be employed with advantage, and may be combined with 
tonics. On the bowels it acts much as it does on the stomach, arresting 
their secretion and motion. Hence constipation is one of the most certain con- 
sequences of giving opium, even in small doses. This property becomes of 
great value in disease when it is desirable to restrain inordinate action of the 
bowels. To effect this, no substance is so useful as opium, especially when it 
is desirable to allay irritation as well as to arrest action. In diarrhoea, there- 
fore, both acute and chronic, opium is of great value, especially after the irri- 
tant substance which has given rise to the diarrhoea has been removed; previous 
to that its use is inadvisable. Hence, too, a prescription of use in many forms 
of diarrhoea with griping, ten drops of laudanum in half an ounce of castor 
oil. This combination insures the ejection of the irritant matter, and the im- 
mediate action of the opium to follow it. In diarrhoea connected with tuber- 
culosis it is also of use. In some forms of colic allied to the diarrhoeas we 
have already spoken of, the castor oil and laudanum is the best remedy. In 
peritonitis, where the motion of the intestines is provocative of harm, opium 
is the best remedy ; so, too, in injury to the intestines, especially rupture, from 
whatever cause. When the bowel is affected, especially in its lower portion, 
it is often the practice to administer opium, that is laudanum, by enemata. 
When so administered the injection ought to be of the smallest possible bulk, 
not exceeding an ounce, and ought to be of the temperature of the body, that 



OPO 571 GRA 

is, about 100° Fahr. This is very effectual in some forms of diarrhoea, es- 
pecially in those dangerous forms which curry off children rapidly. In diar- 
rhoea from tubercle or typhoid a similar law prevails. Opium may be exhib- 
ited in this manner with great success when it is desired to relieve pain in the 
neighborhood of the rectum, especially in the bladder and woinb. Commonly 
suppositories are used in such cases instead of injections. Mixed with gall 
ointment it is one of the best remedies we possess for ulceration of the rectum 
and piles. Fissure of the anus, one of the most excruciating of maladies, too, 
may be relieved, if not cured, by a similar application. Given internally, or 
bj the skin, opium or morphia is of the very greatest service to patients the 
subjects of delirium tremens. Frequently it is advisable to add tartar emetic 
or aconite to it ; but if, on the other hand, the patient has long been without 
food it is necessary to feed him carefully, and even to administer stimulants. 
In these cases ammonia is invaluable. In whooping-cough opium is often 
of signal- service, if swallowed slowly, as by sucking a lozenge ; it relieves the 
irritability of parts, and when introduced into the system seems to relieve the 
condition which gives rise to the whoop. As, however, whooping-cough or- 
dinarily occurs in } r oung people, and these bear opium badly, care must be taken 
in its administration. A small dose of opium, especially in the form of Dovei-'s 
powder, will frequently check a cold if it is as yet in the shivering stage. It 
should be given at bed-time, five or ten grains for a close, and care be taken to 
secure a good perspiration afterwards. When morphia is given hypodermically, 
the acetate is commonly used, as nearly as possible in a neutral state, and 
some prefer giving a little atropine with it. The solution should be so reg- 
idated that one or two drops suffice, not more than five should ever be given, 
and the quantity ought not to exceed the fifth part of a grain. 

Opodeldoc is the name commonly given to the soap liniment of the Phar- 
macopoeia. It consists of hard soap, camphor, oil of rosemary, spirit, and 
water. Its chief use. lies in enabling us to rub a part with ease, obviating un- 
pleasant friction, and at the same time acting as a slight stimulant to the parts. 
Its chief value is in sprains after they have ceased to be acute, and when rub- 
bing is of value, tending to remove stiffness" and swelling, and so rendering the 
joint supple again. It is also a most useful basis for other liniments which it 
is desirable to rub into a part, when these contain no oil 1 or soap, such as is 
necessary when much rubbing is intended. 

Opoponax is not now contained in the Pharmacopoeia ; but was so in that 
of London up to 1836. Its properties are similar to other fetid gum resins, 
perhaps most closely approaching galbanum. 

Optic Nerves. These are two in number, and one is supplied to each 
eye, enabling man to have the sensation of sight. Entering the eyeball, they 
each spread out into most delicate filaments on the retina, and as the light 
from without impinges upon them, it gives to the mind those impressions 
which are called light, and which enable men to recognize objects in the outer 
world. These nerves are liable to disease from mischief in the brain, from 
disease in the kidneys, and from over work, injury, etc. See Eye. 

Oranges are the fruit of several species of Citrus belong to the family Av- 
runtiacece. To the same order belong the lemon, the lime, and the shaddock. 
These fruits are all distinguished by containing citric acid. The orange juice 
contains in addition sugar ; hence their use as fruit for eating. In all cases 
where citric acid is indicated, oranges may be used. As a refreshing article of 
food in the sick-room, there is no fruit superior. The peel of the fruits of the 
Aurantiacece contains in little receptacles a volatile oil, which is a pleasant 



ORT 572 ORT 

stimulant and flavorer. This oil is often separated and sold under the name 
of neroli oil, oil of lemons, etc. See Citric Acid, Lemons. 

Orthopnoea means that condition of respiration which compels the individ- 
ual to sit upright. It is one of great discomfort, and often is of dire significance' 
Like most other symptoms, it may depend on a variety of causes, some of them 
having apparently nothing to do with respiration. In many cases of disease of 
the heart, the patient, for a very long period hefore death, is quite unable to 
lie down. The only sleep that can be procured, is got whilst the patient is 
propped up by pillows. In dropsy, too, though not dependent on heart mis- 
chief, the patient is often compelled to sit up continually, any other position 
interfering so greatly with breathing as to necessitate instant change, and 
altogether precluding sleep, except in that posture. In point of fact, whenever 
there is difficulty in obtaining breath, the patient instinctively starts up, for in 
the upright position he is able to call into play many powerful muscles, not 
ordinarily employed in respiration. Moreover, the weight or pressure of the 
contents of the abdomen against the lower boundary of the chest is removed, 
and the powerful muscle of respiration called the diaphragm, or midriff, may be 
called into play with more advantage. 

In various maladies affecting the respiratory organs this condition is notice- 
able. Thus it may be seen when, from whatever cause, the air is prevented 
from entering the chest freely, as in any malady which affects the air-pas* 
sages. Perhaps spasmodic asthma furnishes as good an example of extreme 
orthopnoea as does any disease, for in it the patient may be compelled to lay 
hold of something over his head, so as to fix his arms, besides assuming the 
upright position. When, too, the pleurae are filled with fluid, so as to interfere 
with the movements of the chest, if the condition be symmetrical, that is to 
say, affecting both sides of the chest, we may have orthopnoea very markedly. 

It is, however, in heart disease that we commonly see the condition called 
orthopnoea in its extreme form, to an extent most distressing to the patient, 
and even to attendants. In these unfortunates, owing to causes we cannot here 
explain, the circulation of the blood is sadly interfered with. The blood cur- 
rent, especially in the veins, is dammed back and obstructed, so that these ves- 
sels become overloaded and overdistended. As a consequence the fluid portion 
of the blood passes through their coats into the tissues beyond, and accumu- 
lates there. This is dropsy. Most frequently these transudations begin in the 
feet and gradually creep upwards ; the ankles are affected, then the legs and 
thighs, and then the abdomen, too, is filled. By this time, also, the circulation 
of the blood through the lungs is greatly impeded from the same cause. 
The lungs are congested, and the blood cannot pass freely from the right side 
of the heart to the left. Now to give a sensation of comfortable, easy breath- 
ing, when the process is a pleasure rather than otherwise, it is as necessary that 
there should be a flow of purified blood from the lung as of pure air into it. 
But in the condition of which we speak the flow of blood from the lung is 
obstructed. Moreover, the accumulation of fluid in the abdomen prevents 
the use of the diaphragm as a muscle of respiration, and so the movements 
of the chest-wall must accomplish all. As matters advance apace, the fluid 
from the distended vessels begins to accumulate in the pleura?, which in its turn 
interferes with the drawing of air into the lungs. Thus there is the condition 
of the circulation already alluded to as a cause of difficult breathing, and a con- 
dition of the respiration arising from the former, and intensifying its evil effects, 
added to it, the consequence being orthopnoea of the worst kind, and in too 
many instances only to be terminated with the patient's life. 



573 




Fig, c. 



PLATE XIX. 



OSS 575 OVB 

It will be seen that the explanation here given is mainly a mechanical one. 
The remedies, too, are mainly mechanical. In most cases the orthopncea de- 
pends on interference with the circulation, as indicated by mechanical conges- 
tion. In the olden time men used to remedy that by the lancet ; now we 
seldom use that instrument. Hot-air baths and hydragogue purgatives take its 
place. 

Ossification is a term applied to any of the parts of the body in which cal- 
careous or other matter is deposited in the tissue, so as to produce hardness or 
a bony-like aspect and character. See Degeneration. 

Otitis is a technical name for inflammation of the ear. See Ear. 

Otolithes, or Otoconia, are minute particles of calcareous sand found in 
the membranous labyrinth of the ear. 

Otorrhcea signifies a discharge from the ear; it is often seen in children, 
and chiefly in those who are scrofulous. The ear should be syringed with 
warm water four or five times a day, and then filled with cotton wool and 
sweet oil. See Ear. 

Ovarian Dropsy is the name given to that disease in which a large cyst' 
or cavity, filled with fluid, grows from the ovary and fills the abdomen ; these 
cysts may grow as large as an adult head, or even larger ; the walls are tough 
and fibrous, and contain generally fluid of a dark color. 

Ovarian Irritation is sometimes produced when the ovaries are congested 
at the time of menstruation ; pain, nausea, and faintness are often the chief 
symptoms. A hot hip-bath, or the application of two or three leeches over 
the seat of pain, and then rest in the horizontal position, will generally give 
relief. 

Ovariotomy is the operation by which a surgeon removes an ovarian cyst 
or tumor from the abdominal cavity ; formerly it was thought a very for- 
midable operation, but of late years it has been frequently performed with con- 
siderable success. Its originator, Dr. Ephraim McDowell, of Kentucky, is 
known as the "father of ovariotomy." 

Ovary. The ovaries are two in number, and are situated one on each side of 
the uterus or womb, with which they are at certain times connected by means 
of the Fallopian tubes. Each ovary is about the size and shape of an almond, 
and contains within itself numerous round, cellular bodies, called ova, which 
are of much importance for the development of the ovary. This substance is 
liable to congestion as each menstrual period comes round, and it is often the 
seat of much pain and suffering in cases of dysmenorrhea. The ovary is 
liable to inflammation, and then adhesions may be set up with surrounding 
structures ; sterility, great pain over one or other side of the lower part of 
the abdomen, a feeling of languor and nausea, and pain in the back are among 
the chief symptoms. The ovaries are liable to cystic disease, and in some 
cases enormous tumors are formed in the abdomen, and the case is commonly 
called one of ovarian dropsy. The tumor is generally of slow growth, com- 
mencing on one side of the abdomen, gradually filling it, and making it tense 
and convex. The cyst may be tapped, so as to allow the fluid to escape, or it 
may be removed altogether by the operation known as ovariotomy. 

Overcrowding is an evil we are every day learning more and more to 
appreciate, and which, nevertheless, seems to be increasing rather than dimin- 
ishing. The increased price of food which is absolutely necessary causes less 
to be spent in procuring shelter. A single man may do very well at one of 
the lodging-houses, where cleanliness and something like proportionate air-space 
are enforced, but where there is a family, or where females are concerned, this 



OVE 576 OVE 

is hardly possible ; and so we find them resorting to places unfit for human 
habitation. Were this matter understood, these would have been suppressed 
long ago; but it never has been brought clearly home to the public mind that 
such dwellings are as dangerous to the state, or even more so, than the preda- 
tory tribes they often shelter. The effects of overcrowding are both imme- 
diate and remote. The former strike us the more forcibly, but are infinitely 
less destructive than the latter. The common instances given of immediate 
fatal results following overcrowding are trite enough. Chief among them is 
the history of the Black Hole of Calcutta, famed in s.tory, where 146 men 
were locked up in a dungeon, 18 feet by 14, and ventilated only by two small 
windows. In the morning only 23 were alive, and of these some afterwards 
died. True, all of them did not perish for lack of air ; some were trampled to 
death in the struggle to reach the windows, but the majority died as much 
from the want of air as if they had been hanged or strangled.' The oxygen 
of the air had been entirely consumed, carbonic acid and other useless gases 
being alone left. The other kind of overcrowding, or the result of it, is quite 
different in its manifestations. In the crowded dens and allej's of our large 
cities typhus fever has its familiar abode. Whether this fever originates in- 
variably and simply from overcrowding perhaps does not greatly matter. 
Starting how it may, it is in such districts and among the squalid habita- 
tions thereof that we find typhus fever to rage with most violence, sometimes 
extending elsewhere, to carry off those who can ill be spared by the commu- 
nity. In the Middle Ages, in England, when wars prevailed and men were 
shut up in walled towns or narrow castles, similar conditions favored the rav- 
ages or small-pox and plague. And even at a much later period, when bad 
food, filth, and overcrowding characterized jails, ships, and camps, the same 
scourge, under different names, carried off judges and jurymen, decimated 
fleets, and inflicted on armies more damage than did the enemy; for jail fever, 
ship fever, and camp fever were but modifications of typhus, the child of filth, 
intemperance, and overcrowding. So, too, recent experience tells us that it is 
the neighborhoods we know well to be overcrowded which suffer most from 
cholera, from relapsing fever, in short, from whatever epidemic prevails. As 
to the space allowed for each individual, that varies with the means of renew- 
ing the air. In a room which is occupied day and night each individual ought 
to possess at least 800 cubic feet of atmospheric space. In most of our hospi- 
tals the space allowed is greater — 1200 feet being about the space considered 
normal. In workhouses the minimum space allowed for each sleeper in a dor- 
mitory not used during the day is oOO feet, and in lodging-houses under police 
control at least 250. This, of course, is too small for a sick individual, and 
implies the necessity for ventilation. In barracks soldiers are allowed a space 
of 600 cubic feet, and no one familiar with the interior of a barrack-room will 
think it a whit too much. Nor does overcrowding and its evil effects manifest 
itself in one way only. It of course impairs the health of those subject to it, 
so that an illness which would be trivial to a strong, hardy man means to them 
death. They are subject to more diseases, also, so that they are more fre- 
quently incapacitated from labor. During that time they become burdens on 
the public ; the wife and family, if there are any such, do the same. 

Over-Lactation. In many cases, and especially among the poor, women 
go on far too long before they wean their babe, and the consequence is that 
they become pale and weakly, suffer from headache and pain in the back and 
side, and sometimes also from leucorrhoea. A child, as a rule, should be 
weaned after nine or ten mouths, but in many cases it is kept at the breast up 



OVU 577 OX-G 

to eighteen months, or even two years of age, to the great injury of the 
mother and in a less degree to the child. The treatment will consist in wean- 
ing the child, giving nourishing food and tonics, and in moderate out-door 
exercise. See Diets. 

Ovum is the small cellular body which exists in the ovary in great num- 
bers, and which when it has passed into the womb, and become impregnated, 
is developed into the future embryo. 

Oxalate of Cerium is a remedy now contained in the Pharmacopoeia, 
but only recently so. It is a white granular powder, insoluble in water, but 
decomposed by strong heat, the oxalic acid being destroyed. The salt seems to 
act locally as a sedative, and has been chiefly employed in irritable states of 
the stomach accompanied by vomiting. Its use in point of fact seems to be 
much as in the cases where bismuth and nitrate of silver are used, but it is 
also said to be very useful in the vomiting of pregnancy, where these are com- 
paratively useless. The salt has also been used in cases of chorea and epilepsy. 
It was introduced mainly because nitrate of silver, whose action it simulates, 
blackens the skin by long use, and this does not. The dose is one or two 
grains, given along with or just after food. It is not very generally used. 

Oxalic Acid is an organic acid found present in many plants. It gives 
the acidity to sorrel and rhubarb, hence these plants are used as articles of 
diet. Oxalic acid, however, is a poison, and is often mistaken for Epsom salts, 
or used by the suicide. The best remedy for poisoning by oxalic acid is car- 
bonate of lime — common chalk. The lime forms an insoluble compound 
with the oxalic acid, and renders it innocuous. See Oxalic Acid Diathesis, 
Poisoning. 

Oxalic Acid Diathesis, as it was called by those who first described the 
tendency to pass oxalates in the urine, is a condition in which we now, rightly 
or wrongly, do not greatly believe. Undoubtedly some people more than 
others have a tendency to pass oxalate of lime in their urine. This most fre- 
quently is accompanied by considerable irritation, of the urinary passages, indi- 
gestion, and a mental irritability, which may be accounted for without elevat- 
ing the whole symptoms into a peculiar variety of constitution which the term 
diathesis implies. Very often the presence of oxalates in the urine seems to 
depend on imperfect respiration. Sometimes, and perhaps more frequently 
than in the other instance, it depends on indigestion or errors of diet. Rhu- 
barb contains much oxalic, and eating it induces in many people a copious 
oxaluria, merely temporary, however, iu its character. Sweet substances in 
some individuals give rise to something of the same kind. When oxaluria 
prevails, and it cannot well be detected except by microscopical examination 
of the urine, such substances should be avoided, and acids, especially the hy- 
drochloric, or dilute nitro-hydrochloric, taken in small doses (ten to fifteen 
drops) just after food. 

Ox-gall, or Bilk, is not very often used in medicine. It is purified after 
being taken from the gall-bladder of the ox by adding to it spirit ; this throws 
down the mucus, which is afterwards separated by decautation. In color it is 
yellowish-green, with a peculiar odor. Its taste is at first sweet, afterwards 
intensely bitter. It is soluble in water and spirit. Bile contains many things, 
but the bile acids seem to be the most important substances. These are reab- 
sorbed under ordinary circumstances, and undergo further changes. Bile pre- 
pared thus is supposed to act as a laxative, and also to aid in preserving the 
contents of the alimentary canal from putrefactive change. Thus it is of use 
where the entrance of the bile of the liver into the alimentary canal is pre- 
37 



OXY 578 OZO 

vented from whatever cause, and in constipation supposed to depend on insuffi- 
cient bile flow. Meanwhile its value is mainly speculative. See Liver. 

Oxygen is one of the elements, is a gas and a supporter of combustion. It 
exists in the atmosphere in the proportion of twenty-one parts to seventy-nine 
of nitrogen. In the atmosphere it becomes the means of all kinds of combus- 
tion, and the principal agent in putrefaction. It is the sole means of supply- 
ing the oxygen that is required for the oxidation of the tissues of animals, and 
the maintaining of animal heat. See Heat, Heat Animal, Ozone, Respi- 
ration. 

Oxymel consists of a mixture of honey and acetic acid. This preparation 
is but little used, even as a vehicle, though it is rather an agreeable one. The 
only oxymel of importance is that of squills, which is largely used, espe- 
cially among children, for the purpose of procuring the effects of squill. See 
Squill. 

Oxyurides is a word used for thread-worms ; Oxyuris vermicular is is the 
technical name for the thread-worm. See Thread-worms. 

Ozcena. This term is applied by surgeons to a profuse, and almost con- 
tinuous discharge, from the nose, of pus or purulent fluid, having a very of- 
fensive odor. The nature of this fluid varies in different cases. In some in- 
stances it is thick, tenacious, and of a yellow color, and dries up into dense 
thick scabs ; in others it is thin and clear ; occasionally it is mixed with blood. 
The term ozcena does not imply a single disease, but merely a symptom com- 
mon to many affections of the nostrils ; it may be met with in simple ulcera- 
tion, and in syphilitic or strumous ulceration of the nasal mucous membrane, 
but is most marked in connection with disease of the bones of the nose. The 
so-called simple or idiopathic ozoena depends upon a granular condition of the 
nasal mucous membrane which occurs in delicate patients, and is much ag- 
gravated by the causes of ordinary cold. Scrofulous ozcena generally occurs 
in unhealthy children, and is associated with external signs of scrofula, as en- 
largement of the glands of the neck, scabs about the nose and ears, etc. The 
prolonged presence of a foreign body, as a pea or bead, in the nose will often 
give rise to ozoena by setting up irritation and ulceration of the surrounding 
mucous membrane. 

In the treatment of pzocna the first object should be to remove scabs, foreign 
bodies, and all possible causes of irritation. The nostrils should be then 
washed out with a warm solution of common salt, one teaspoonful to one pint 
of water. This may be done either with a large syringe or with the nasal 
douche of Dr. Thudichum. The patient should every morning and evening 
sniff up the steam of boiling water, to a pint of which a teaspoonful of tincture 
of iodine, or twenty drops of creasote, have been added. When ozoena seems 
to be due to a scrofulous or syphilitic taint, the proper constitutional treat- 
ment should be carried out. 

Ozone is a peculiar substance discovered by Schonbein in 1858. It may 
be prepared by passing a succession of electric sparks through atmospheric air 
or dry oxygen, when a peculiar odor will be perceived. Ozone is much 
denser than oxygen itself ; it may be destroyed by a heat of 550° Fahr. ; it is 
insoluble in water, and in solutions of acids or alkalies; when present in the 
air it acts as an irritant to the air-passages. This substance possesses con- 
siderable bleaching properties, acts as a powerful oxidizing agent, and corrodes 
organic matters. Its presence may be detected by moistening a slip of paper 
with starch and iodide of potassium ; the ozone, if present, will liberate the 
iodine from the iodide of potassium, and the free iodine will color the starch 
blue. Its influence on man is not yet understood. 



PAC 579 PAI 



Packing, as it is technically termed, is of two kinds, wet and dry, but the 
latter is so uncomfortable that it is seldom had recourse to. Wet packing has 
become almost entirely an instrument in the hands of hydropathic practi- 
tioners, but most certainly it is worthy of a wider appreciation. One reason 
for its want of popularity is really a want of knowledge of how and when to 
apply it. A great number of slighter maladies, such as incipient colds, etc., 
may be cured by it ; it marvelously removes fatigue, and withal may as easily 
be given in a private house as in the best appointed hydropathic establish- 
ment. Perhaps the simplest form of wet pack is the local one for sore throat 
which our great grandmothers were wont to employ. A stocking fresh re- 
moved from the foot, and so somewhat damp from perspiration, was applied 
to the throat, the damp part or sole next the skin, and the whole then wrapped 
round the throat and kept on all night. In the morning this was removed, 
the parts were washed with cold water, and very probably the pain was gone. 
This was modified somewhat by substituting a towel or piece of linen wrung 
out of cold water wrapped round the throat, and covered over with flannel, 
care being taken that the wet cloth did not extend beyond the parts to be re- 
lieved. This, too, is very successful, and worthy of trial. The wet pack is 
the same in principle, but applied to the whole body instead of to a part. As 
a preliminary the patient should take a smart walk or some similar exertion, 
not enough to tire, but sufficient to put the surface in a nice warm glow. 
When he returns his bed should be found prepared, by removal or folding 
down of all the bed-clothes, including the feather bed, if any. On the mat- 
tress should be spread a piece of waterproof sheeting if desired, but this is not 
absolutely necessary. Over this or in its place may be spread a thick blanket, 
and when the patient is ready this, in its turn, is covered with a sheet loosely 
wrung out of cold or nearly cold water, according to the season of the year. 
On this the patient is stretched quite naked, and then the sheet is tucked up 
tight all round about him, so that he lies swathed in the sheet like an Egyptian 
mummy ; over this blankets are tucked in, and the whole may be covered up 
by the feather bed, if there is one ; if not, a due supply of blankets must be 
used. The head is carefully wetted, a wet towel placed over the forehead if 
desired, and the patient left to himself for half an hour. Though cold at first 
the bodily lieat soon begins to exert itself, and the whole mass becomes heated, 
so that the wet sheet acts like a kind of gigantic poultice applied to the whole 
surface of the body. However, should the reaction not take place of its owu 
accord, it will be necessary to insure its appearance by the use of hot-water 
bottles. The result is a copious but imperceptible transpiration from the skin, 
which tends to open the pores better than anything else. At the end of half 
an hour the patient is to be stripped and well bathed with cold or nearly cold 
water, and the process is at an end. During the period he is left he most fre- 
quently sleeps or dozes, so much tranquillity does it give. Dry packing is 
simply sweating induced by a heap of bed-clothes. 

Pain is one of the most common symptoms in disease, but it may arise 
from a great many conditions, and may therefore require different modes of 
treatment. No greater relief can be afforded than to adopt some means by 
which a patient can be made easier and free from this disagreeable symptom, 
and whereas in many cases it may be impossible to cure the disease or avert 



PAI 580 PAI 

the fatal end, yet it is often in our power to modify the severe symptoms and 
give a vast amount of relief. All pain is felt in the nerves, whatever may be 
the cause which gives rise to the sensation. The causes of pain may be 
divided into two great classes : (1.) Those depending upon too much blood 
in the part, and where there is an increased tension in the vessels. (2.) Those 
depending upon an impoverished state of the blood and an altered condition in 
the nutrition of the nervous centres ; such pains are more commonly known as 
neuralgic pains, although, strictly speaking, all pain must be neuralgic. Under 
the first head may be included the pain caused by inflammation of any part, 
and more especially of the serous membranes, as in pleurisy, peritonitis, and 
pericarditis ; also in the joints, as in gout and rheumatic fever ; these cases are 
attended with more or less fever, and the pain is caused by the over-distended 
vessels in the inflamed part interfering with the nerves distributed there ; of 
this kind also is the pain met with in an abscess, and it is well known how 
much more painful is an abscess under the tendon of the finger or in the gum 
than in some more lax tissue; and this is due to the tension of such a part, for 
where the skin is loose the swelling does not hurt much, but where the 
abscess is bound in by firm walls the pain is much greater. This accounts, 
too, for the relief sometimes experienced after the face has become swollen 
from toothache, for the fluid has escaped then from the vessels, and the ten- 
sion is diminished. Pain, when due to this cause, can be relieved in several 
ways, but all the methods adopted have in common the object of relieving the 
distended vessels ; a few leeches over the affected part will give relief by with- 
drawing some of the blood ; hot fomentations, made by wringing out flannels 
in hot water, turpentine stupes, hot linseed-meal poultices, and cotton wool, 
are all most useful means of locally allaying the pain ; sometimes continuous 
cold, applied by placing pounded ice in a bladder, will relieve ; at other times a 
hot bath will do good. Other measures may be adopted, as the hypodermic 
injection of morphia, the local application of belladonna or aconite, and the 
internal administration of opium. The second class includes tic-douloureux, 
sciatica, hysterical pains, and what are commonly known as neuralgic pains. 
They are generally associated with pallor and debility. Nothing is more 
common than to meet with such cases as the following : A woman who has 
borne several children, and suckled them for some time, finds herself losing 
strength and flesh ; her appetite is bad, and she generally has been unable to 
get sufficient nourishment, perhaps having meat only once a week, while all 
the time her strength should have been well supported while nursing her baby. 
In time, besides feeling weaker, she is nervous and low-spirited, has pain across 
the forehead and over the top of the head, dimness of vision, occasionally giddi- 
ness, pain in the left breast and left side, pain in the back and either across 
the loins or between the shoulders. Now and then there is pain in the limbs; 
she is pale, and may suffer from leucorrhoea, is unfit for much exertion, and, 
although still feeling ill, is obliged to attend to her children and household 
work. For such a case relief can only be obtained by supplying her with 
nourishing and wholesome food, by rest in a horizontal posture, by a short 
daily walk on a flue day, so as not to become weary, and by moderating the 
quantity of stimulants taken daily. It is also most needful to give tonics, as 
iron and quinine, so as to improve the general health. Iron is not often borne 
well at first, and then the mineral acids, with some bitter infusion, may be 
given. Change of air and scene is very valuable, but in such cases few can 
afford it. 

Pain of this kind is very common in pregnancy, and then one side of the 






PAI 581 PAL 

face is generally affected ; there is no swelling or redness, and leeching the 
gum or extracting a tooth is a perfectly useless proceeding in such cases ; 
quinine and some chloric ether is the best remedy. The pain in brow ague or 
migraine (see Intermittent Fever) is of a similar nature, and may be also 
caused by malarious influences. Removal from the damp locality and the in- 
ternal administration of large doses of quinine are the most likely measures to 
give relief. In these people, as in the previous case, there is always pallor 
and anaemia, and the mischief is not in the nerves but in the nerve-centres, — 
as the brain and spinal cord, — which are not properly nourished. In many 
fevers and in cases of syphilis, where the blood becomes gravely altered in 
quality, neuralgic pains are very common : in the former, the fever must be 
treated ; in the latter, iodide of potassium will do much good. Lastly, there 
are certain muscular pains which come on because the rnuscle is tired ; of such 
a nature are the pains felt by one after a long day's ride without being used 
to it, the pains caused by a troublesome cough in the intercostal muscles on 
each side from the violent exertion, the aching pains caused by laughing im- 
moderately, and the pains brought on by any unusual exertion, and. generally 
known as stiffness. The treatment must be rest for the affected part ; when 
the cough is distressing means must be taken to relieve this, and a warm and 
wide flannel bandage should be fastened round the waist. 

Painter's Colic is commonly met with in those who work with lead and 
its preparations, and more especially with those who deal in white lead. The 
disease is characterized by a blue line on the gums, great pain in the bowels, 
and constipation. See Lead-poisoning. 

Paints. The diseases arising from working with lead are described in the 
article on Lead-poisoning. It may suffice to state here the danger arising 
from children using toys painted green, or from the habit of putting into the 
mouth paint-brushes and the cakes of ordinary color-boxes. Most green 
colors contain arsenic, and the poison may cause a sore throat, running at the 
eyes, purging, sickness, and pains in the abdomen. Similar results are brought 
about by having a green paper in a room, and serious consequences may ensue. 
See Poisoning. 

Palate. The palate may be considered under the separate portions of the 
hard and the soft palate. 

The hard palate is that portion of the roof of the mouth immediately pos- 
terior to the gums and teeth ; it is supported by the bony arch of the palate 
and upper jawbones, and is covered with a tough, dense mucous membrane, 
inseparably united to the periosteum of the above-mentioned bones. There is 
a median ridge, which marks the position of the congenital division of the 
parts, and there are numerous transverse ridges on either side of it. 

The soft palate, or velum pendulum palati, is a soft movable substance, 
attached above and in front to the hard palate, whilst behind and below it ter- 
minates in a thin, free crescentic edge, from the centre of which the uvula 
hangs, thus dividing the edge into two semilunes. This velum is situated 
somewhat obliquely, its fixed edge being superior and anterior to the bone, 
the surface looking downwards and forwards towards the mouth and tongue, 
the opposite surface looking upwards and backwards. The mucous membrane 
contains a good many glands, and is covered with ciliated epithelium on its 
upper surface, and squamous in its inferior. In the act of deglutition the 
velum and uvula are raised so as to touch the back part of the pharynx, and 
thus prevent the food from ascending into the upper and nasal part of the 
cavity, from which it might regurgitate into the nares. The soft palate is each 



PAL 582 PAL 

side attached to the tongue and pharynx by muscles named palato-glossus and 
palato-pharyngeus, forming the anterior and posterior pillars of the fauces, and 
between these pillars lie the tonsils, vascular glands which secrete a viscid' 
mucus, expressed at the moment of deglutition, and which lubricates the food 
on its downward passage to the oesophagus. 

Affections of the palate. By far the most frequent affection of the palate 
which is met with either in the hard or soft, or both combined, is cleft palate. 
This is a congenital fissure, arising from an arrest of development of the nat- 
ural vault of the palate, the nature of which is alluded to in the article on 
Hare-lip. (See Hare-lip.) If the hard palate be extensively deficient con- 
genially, it is very difficult to remedy it surgically, at least by operative pro- 
ceedings. The dentist, by applying a metal or vulcanite plate (termed an 
obturator), to take the place of a natural palate, may do great good; such a 
deformity, however, usually is co-existent with fissure of the lip, and in such 
cases the lip affection should be first attended to. When the chasm is very 
wide, probably an operation will not do much, but first-rate advice should be 
taken at the earliest stage of the child's existence. A mere fissure or crack 
often closes spontaneously, uniting during adolescence. It is incases of fissure 
of the soft palate that the surgeon has it in his power to render such valuable 
service. It has been already mentioned that the normal soft palate is arched 
and vaulted, and subject to varying degrees of tension during deglutition, etc. 
The muscles which raise the soft palate are the levatores palati; those tending 
to stretch it and make it tense, the tensores or circumfiexi palati ; whilst 
others, the palato-glossi and palato-pharyngei, likewise put great tension upon 
it downwards and laterally. Now it is evident that the actions of these mus- 
cles must tend to keep apart the preexisting fissure, and this fact having been 
determined, the surgeon has a plan of action before him. The operation for 
the relief of this affection is termed staphyloraphy generally, and it consists 
of three stages : the first is the setting free of muscular tension ; the second 
the preparation of the edges of the existing fissure thus set free ; and, thirdly, 
the putting in of such sutures or stitches as are necessary for the purpose of 
securing contact between such prepared edges. The first stage requires a long 
time generally for its preparation, such, for instance, as the accustoming of the 
patient to keep the mouth open for a long time at a stretch, the rendering the 
palate less sensible to the tickling, niggling proceeding to be hereafter prac- 
ticed, the determination not to swallow saliva, if the patient be of a sensible 
age (young children should have chloroform). Tlien the muscles, levator and 
circumfiexus palati, and sometimes the palato-glossus and palato-pharyngeus, 
are divided by a peculiarly formed knife or scissors ; afterwards the edges to 
be approximated are pared of their mucous membrane, so as to admit of their 
union by adhesion ; and. lastly, the sutures to fix them are introduced, and 
this is by far the most difficult part of the procedure, requiring as much steadi- 
ness on the part of the patient as skill on the part of the surgeon. The pa- 
tient should be thoroughly acquainted with the nature of the operation, as far 
as he can be, and must be convinced of its utility and chance of success. The 
operation, however, should be proposed, and, if possible, undertaken at in- 
fancy, with mechanical assistance and ether, in order to obviate any defective 
articulation, which will have been acquired if the operation be put off till 
puberty or after. 

Ulceration and exfoliation. The mucous membrane is liable to ulceration, 
usually as a result of syphilis. This form of ulceration, however, invariably 
affects the bony palate as well, causing perforation, exfoliation of bone, and 



PAL 583 PAL 

adhesion of the soft palate by cicatrix, occluding the buccal and nasal portions 
of the pharynx. Such a state of things is associated, of course, with tertiary 
syphilis, and constitutionally requires iodide of potass, tonics, etc., and locally 
nitrate of silver, nitric acid, and chlorinated lotions. If the hard palate exfo- 
liates (see Exfoliation), the separation must be patiently waited for, and not 
hurried by rough attempts at pulling the piece of dead bone away. As the 
whole thickness of the palate perishes, an aperture will exist between the nasal 
and buccal cavities, and if this cannot be closed by spontaneous cicatrization an 
obturator must be adapted ; a mere fissure or sinus can be closed generally by 
the repeated application of a heated wire or cautery. 

Tumors of the soft palate. These may be: (1) fibro-cellular ; (2) cysts; 
(3) warts. (1.) The fibro-cellular are mostly pendulous in character, and are 
usually attached to the free border or upper surface of the soft palate. They 
are painless, and being inconvenient they must be removed by scissors and for- 
ceps. (2.) The cysts are generally obstructed muciparous ducts ; they are to 
be treated by free incision, and the subsequent application of nitrate of silver or 
nitric acid. Sebaceous cysts occasionally occur, appearing of a yellowish-white 
color through the mucous membrane ; free incision and a drop of nitric acid on 
a probe destroy them. Abscess occurs sometimes, and should be immediately 
opened. 

Palm. The affections to which the palm of the hand may be subject are : 
(1) eruptions ; (2) abscess ; (3) ganglion ; (4) wounds ; (5) contraction of the 
palmar fascia. 

Eruptions. The most frequent eruption, and the most troublesome to deal 
with, is psoriasis. It is most usually dependent on a syphilitic taint, particu- 
larly if associated with a like eruption on the soles of the feet. It commences 
as a red blotch, extending irregularly ; the scarf skin becomes detached and 
white-looking ; this becomes scaly, falls off, and leaves fissures, often very pain- 
ful and gaping, generally following the lines of flexion. It often attacks the 
fingers at their extremities, at the margin of the nail, or in the flexures. Many 
methods are prescribed for its cure, but certainly no eruption is so chronic, the 
patient's general health suffering a marked influence after a while. The exhi- 
bition of mercury both internally and externally is the sheet-anchor, in small 
doses, and extended over a long period. The inunction of glycerine and creasote 
in equal portions, followed up by a mercurial or any preparation of tar, seems 
to be the best, combined with glycerine. 

Abscess. Abscess may be either superficial or deep, either caused by a poi- 
soned wound, or the result of a neglected whitlow, the pus burrowing into the 
palm along the theca of a tendon. The symptoms are tolerably obvious; the 
pain and constitutional disturbance are very great, the tenseness of the fascia? 
holding down the purulent effusion. Poultices and hot fomentations are to be 
applied to promote the formation of pus, which must be freely evacuated as 
early as possible. The knife should be pushed boldly down upon the middle 
of one of the metacarpal bones, as near its head as possible to avoid the palmar 
arch, and the bone itself should be reached, so that the theca may be opened. 
A small pledget of lint should be placed in the wound to favor the evacuation 
of the matter, and hot poultices applied, the arm supported in a sling, tonics 
and change of air prescribed. The importance of early incision in either pal- 
mar abscess or whitlow cannot be too strongly urged, as the results of neglect 
are very serious, being either a permanently stiffened finger, or utter loss of a 
portion or the whole of a finger or metacarpal bone. 

Ganglion. This subject is treated of under the head of Burs^e. 



PAL 584 PAL 

Contraction of palmar fascia. The strong fibrous aponeurosis which covers 
the palm may itself he entirely contracted, or that portion of it belonging to one 
or more fingers. On endeavoring to straighten the fingers there is a general 
resistance offered by the tissues of the palmar surface. The essential cause of 
the deformity is constitutional, and allied to gout or rheumatism, often frequently 
determined by some local irritation, such as using a tool, whip, or walking-stick. 
Unlike gout or rheumatism, however, the disease is painless. Frictions^ ma- 
nipulations, and the employment of mechanical apparatus, and in old-standing, 
unyielding cases tenotomy, are of great service. Care in diet and wine are of 
great help to the treatment. The disease is chiefly met with in males, and 
those who have freely indulged in wines, spirits, or beer, and 'it is frequently 
associated with a corresponding contraction of the fascia in the soles of the feet, 
the plantar fascia. 

Palma Christi. The name by which the castor-oil plant is known in this 
country. It is sometimes cultivated in gardens on account of its beautiful 
leaves. Its botanical name is Ricinus communis. It belongs to the natural 
order Euphorbiacece and is a native of India, but is widely distributed over the 
warmer regions of the globe, and throughout the Mediterranean region. In 
our climate the stems of the" Palma Christi do not attain a height of more than 
from five to eight feet ; in India they grow from eight to ten feet, while in 
Spain, Crete, and Sicily the plant is said to become a small tree. The stem is 
pointed, of a purplish-red color, and covered with a glaucous bloom like that 
of a plum. The leaves are large stalked palmate; deeply divided into seven 
lance-shaped segments, and at the junction of the blade with the stalk of the 
leaf is a small saucer-like gland. The flowers are in spikes. There are several 
varieties of this plant, differing chiefly in the size of their seeds. It is stated 
that the best oil for medicinal purposes is derived from the small seeds ; that 
procured from the large seeds is coarser, and in India is only used for lamps 
and veterinary purposes. A prevalent error is that the acrid purgative principle 
resides in the seed-coats and the embryo only, while the albumen is destitute of 
it. The oil is extracted by boiling the seeds, and by pressure under a hydraulic 
press ; the latter process without boiling the seeds yields the most esteemed oil. 
After expression the oil is purified by being allowed to stand, by decantation, 
and by filtration. In India the oil, after having been obtained by pressure, is 
mixed with a certain proportion of water and boiled till the water has evapo- 
rated. In France the oil is obtained by macerating the bruised seeds in alcohol, 
but the process is expensive, and the product inferior. The larger quantity of 
the oil used in this country is imported from India. Castor oil is very largely 
employed as a gentle and effective aperient; its nauseous taste is, however, a 
great objection to it. This may be partially overcome by mixing it with brandy, 
orange wine, or peppermint- water, and by making it into an emulsion with the 
yolk of an egg or mucilage. The leaves are used for various purposes, for which 
their size and coolness render them serviceable, and especially as an application 
in rheumatism. 

Palpitation is the name given to the beating of the heart when that ceases 
to be insensible and becomes obvious to the feeling of the individual. The two 
things which seem to have most influence in producing this alteration are in- 
creased violence of the heart's action, and perhaps mere irregularity of action. 
Under ordinary circumstances the motion of the heart is so even and regular 
that one can detect its beating only by placing the hand over the spot where 
its apex strikes against the ribs, but in certain cases of heart disease the beating 
may be so violent as to shake the bed in which the patient lies. Palpitation, 



PAL 585 PAN 

though very often a sign of heart disease, is hy no means invariably so ; per- 
haps, out of all the cases of palpitation one sees, the majority are in individuals 
not the subjects of heart disease, for, as already pointed out, anything which 
interferes with the regularity of the heart's action produces the painful or un- 
pleasant feeling of palpitation, and that may readily be done in many ways 
without the substance of the heart being affected. 

Disorder of the motion of the heart, which may be taken as synonymous 
with palpitation, is commonly due to some alteration in the functions of the 
heart, necessitating more violent effort on its part, or to some other cause in- 
terfering with its movements, such as disordered nerve influence. Like other 
muscular structures, the heart is directly under the control of the nervous sys- 
tem, but its nerve-supply is more than ordinarily complicated. The nerve- 
supply is drawn from the brain, as is the case with other organs, but it reaches 
the heart in two ways : one by a nerve called the vagus or pneumogastric, 
which passes downwards from the brain through the neck to the chest, to end 
finally in the abdomen ; the other by way of the spinal cord, which at differ- 
ent places gives off branches which ultimately reach the heart and control its 
motions. The former of these, that is the vagus, is mainly engaged in con- 
trolling or regulating the heart's action ; the latter nerves are rather devoted to 
stimulating its substance to act. Any increase or diminution of the action of 
the vagus is likely to give rise to alteration in the motion of the heart itself, to 
produce quicker or slower motion or irregular motion, in short, the phenomena 
we call palpitation. Now, this nerve has a very wide series of connections, 
supplying many organs besides the heart itself, and any affection implicating 
these is likely to derange the nerve influence, not only as affecting the diseased 
organ, but also as influencing the heart. Hence it is that palpitation is very 
frequently brought about by affections of the stomach, the vagus supplying 
both. Palpitation or some other form of irregularity in the heart's action, say 
irregularity or even intermittence of the pulse, may be brought about by nerve 
action in a totally different way. Thus, as is well known, anxiety, fear, and 
various other mental emotions produce beating of the heart, that is, palpita- 
tion, where the stimulus arises in the brain, and is conducted to the organ 
where it is manifested, that is, the heart, by means of nervous influence. In 
a goodly number of cases, however, the palpitation is due to change in the 
heart itself. This change very likely is in the first instance valvular ; that is 
to say, connected with the flood-gates of the heart. The alteration in the valve 
interferes with the heart's action, chiefly in that the heart never is able to 
empty itself properly, or if it does the cavities are promptly filled again, so 
that the chambers become habitually over-distended. At the same time in 
many cases the substance of the heart increases in thickness, and its beat in 
force, so that the ordinary work of the heart is, so to speak, accomplished with 
greater violence than usual, this violence being manifested as palpitation. It 
is thus quite plain that, as the causation of palpitation varies, so must its 
treatment. If it depends on disease of the substance of the heart, then treat- 
ment must be directed to remedy that, and digitalis is most commonly the best 
remedy ; if from other mischief, as indigestion or the like, that must be seen 
to ; but in the majority of cases the palpitation yields to a stimulant, as aro- 
matic spirit of ammonia. 

Palsy is the common name for paralysis. See Paralysis. 

Pancreas. This organ is a gland lying in the abdominal cavity in front of 
the spine and behind and below the stomach. It consists of a main tube, from 
which branch off multitudes of small tubes, each of which has a blind extremity 



PAN 586 PAR 

or dilatation ; these tubes are lined with epithelium, and around the tubes are to 
be found vessels and nerves, which supply the gland with nourishment and 
regulate the amount of its secretion. The secretion from the pancreas is called 
the pancreatic juice; in conjunction generally with the bile duct, it opens into 
the duodenum or first portion of the small intestines. Except at the time of 
digestion the functions of this gland are not called into action, but when the 
food has passed from the stomach and become chyme the secretiou from the 
pancreas mixes with it and converts it into what is called chyle. The pancre- 
atic juice seems to have the property of subdividing the fatty particles of the 
food into very minute particles, so as to make an emulsion and cause an easier 
absorption of the fatty matter by the vessels which lie in the walls of the in- 
testines. See Digestion. 

Pancreatic Juice is the fluid secreted by the pancreas or "sweetbread" 
after a meal. It enters the duodenum or first portion of the intestinal canal in 
conjunction with the bile duct, and, mixing with the food, aids in digesting the 
fatty matters and rendering them fit to be absorbed into the circulation. 

Pandemic is a term applied when a disease has spread all over a large 
continent at the same time; thus an attack of cholera or influenza may affect 
all Europe in any given year, and then the disease is said to be pandemic. 

Papules, or pimples, occur on the skin in some diseases of that tissue; 
small-pox generally begins with a papule, and then goes on to become pustular. 
Lichen is also a papular disease, and so is the small pimple caused by a flea 
bite ; strophulus or red-gum and prurigo are also papular diseases. 

Paracentesis. By this term is meant an operation for removing fluid 
effusion from the interior of the body. The common and expressive word for 
this operation is tupping. The region in which it is most frequently per- 
formed is the abdomen. Dropsical fluid, or the fluid effused in connection 
with ovarian disease, often accumulates to such an extent as to interfere 
seriously with the respiratory movements, and to threaten death by congestion 
of the lungs and suffocation. Paracentesis abdominis by withdrawing the fluid 
gives great relief, and in some cases strength, but in comparatively few assists 
a radical cure of the dropsy. The spot at which the surgeon generally taps is 
in the middle line of the anterior wall of the abdomen, and about three inches 
below the navel. The instrument used is a thick, sharp-pointed trocar, which 
slips through a tube called a canula. After the abdominal wall has been 
punctured the trocar is withdrawn, and the dropsical fluid is discharged in a 
full stream through the canula. The chest is frequently tapped for the relief 
of the lung mischief caused by accumulation of dropsical or inflammatory 
serous effusions and of pus. The operation is usually performed with a small 
trocar and canula, and the surgeon selects either the space between the fifth 
and sixth ribs, at the side of the chest, or the space between the eighth and 
ninth ribs, in a line with the lower angle of the blade-bone. In cases where 
pus has made its way outwards from the chest, an incision is usually made at 
the place where it points. Tapping has in some few cases been performed for 
the relief of dropsy of the pericardium, which is the loose fibrous bag inclosing 
the heart and the roots of the large blood-vessels. This operation is an ex- 
tremely dangerous one, and is not resorted to save in the presence of critical 
cardiac symptoms. The head is occasionally tapped for the relief or radical 
cure of hydrocephalus. The surgeon uses a very fine trocar, and punctures 
the head either at the anterior fontanelle or at some other open place away 
from the middle line of the body. But a small quantity of fluid is withdrawn at 
each puncture, and the child's skull is then compressed by an elastic bandage. 



PAR 58T PAR 

This operation ought only to be performed in almost hopeless cases of the dis- 
ease, as it is by no means a safe proceeding, and is often followed by convul- 
sions and other serious symptoms of nervous irritation. 

Paracentesis Abdominis is a term used to signify the operation of 
tapping the abdomen in cases of dropsy or ovarian disease ; a sharp-pointed 
instrument (trocar), fitting in a cylindrical tube, is pushed through the wall of 
the abdomen into the fluid ; the trocar being withdrawn, the tube is left in and 
allows the exit of the fluid. There is very little pain in the operation, and 
great relief in most cases follows at once. Paracentesis thoracis is a similar 
operation used in cases of empyema and sometimes in pleurisy ; in such cases 
the chest wall is generally punctured between the seventh and eighth ribs. 
The details of treatment require much skill and knowledge to bring about a 
successful termination. See Empyema. 

Paradise, Grains of, is a name given to the larger cardamom seeds, — a 
beautiful aromatic carminative ; but the lesser seeds and those of a smaller 
variety are supposed to contain more aromatic qualities than the grains of 
paradise ; hence they are generally preferred. 

Paralysis, with which the word palsy is often used synonymously, signifies 
a loss of motion in any part of the body ; but as the nerves supplying most 
parts of the body are of a mixed character — that is, motor and sensory — 
the idea generally conveyed implies also a loss of sensation. Paralysis may, 
however, be motor or sensory, ur both. Moreover, it may be complete, when 
there is a total loss of power and sensation, or partial, when these are partly, 
not wholly, lost. Sometimes the word partial is used to imply that only cer- 
tain parts of the body are affected, but for this purpose the term local is per- 
haps preferable. General paralysis implies that the whole body is affected, but 
the term general paralysis of the insane expresses one particular form of mal- 
ady, which is accompanied by insane delusions. Occasionally the term aci- 
nesia is used to signify paralysis of motion, anaesthesia being employed to in- 
dicate loss of sensation ; but most frequently the idea of paralysis is limited to 
loss of motion, anaesthesia being the corresponding term made use of with 
regard to loss of sensation. 

The two most common forms of paralysis are hemiplegia and 'paraplegia. 
Hemiplegia is that form of paralysis which affects one lateral half of the body 
without the other side being affected ; hence hemiplegia is right or left. 
Paraplegia, on the other hand, means paralysis of the lower half of the body; 
but there is no right or left paraplegia ; it must affect both sides, — if not quite 
equally, at all events to some extent. 

There are certain other peculiar titles given to varieties of paralysis, such 
as amaurosis, which used to be bestowed on any form of blindness supposed 
to depend on disease and paralysis of the optic nerve. Loss of hearing was 
called cophosis, and loss of smell anosmia. Moreover, certain forms of pa- 
ralysis have the distinguishing character of proceeding from bad to worse. 
These forms are described as progressive, but this is a title of little value. 
There are besides these many other forms of paralysis, the chief of which we 
shall briefly record. 

General paralysis, as seen in ordinary practice, means practically double 
hemiplegia. Both sides are affected, especially the extremities ; but of course, 
respiration and circulation go on, otherwise death would ensue. In general 
paralysis the patient is motionless, and very often unconscious ; but the heart 
and the lungs having a nerve-supply not affected by what may render the 
limbs motionless, go on, the diaphragm becoming the sole organ of respiration. 



PAR 588 PAR 

This cannot continue long ; either the patient recovers or dies. If he recov- 
ers gradually, it is seen that one side has been affected more than the other, so 
that the one usually gets well before the other, and the case resolves itself into 
one of hemiplegia. For general paralysis of the insane, see Insanity. 

Hemiplegia is the most common form of paralysis. Ordinarily it is produced 
by an injury to one side of the brain, and then, if the right side of the brain is 
injured, the left side of the body is affected, and vice versa. But all forms of 
hemiplegia do not depend on brain mischief — some may arise from injury to 
the spinal cord, affecting o\\\y one side of it ; and so we may have cerebral, or 
brain hemiplegia, and spinal hemiplegia ; but the latter is not nearly so com- 
mon as the former. There is one peculiar form of hemiplegia sometimes met, 
and called cross-parahjsis. In this affection part of one side is affected, and 
part of the other — as an arm on one side, and a leg on the other. It is rare. 
Riii'ht hemiplegia is not unfrequently accompanied by a more or less complete 
loss of the power of speech — not the loss of articulating power only, but also 
complete loss of the power of giving names to things, so that sometimes only 
a single phrase remains behind to express all or the main ideas. This is called 
aphitsia. For full particulars relating to one-sided paralysis, see Hemiple- 
gia. 

Paraplegia, or paralysis of the lower half of the body, is generally due to 
disease of or injury to the spinal cord. Thus, suppose an individual receives an 
injury whereby his spinal covering of bone is driven in on the spinal marrow, 
paralysis more or less complete promptly follows in all the parts beneath this 
level. So, if the spinal cord be attacked with disease which causes destruction 
of or pressure on the spinal cord at a certain spot, all parts below are deprived 
of sensation and the power of motion, more or less completely. As a rule, 
sensation is less affected than motion. It goes last if the malady is progress- 
ive, and returns first if the patient begins to improve. There is a form of par- 
aplegia, however, which depends on no disease of the cord or its surroundings, 
but rather upon disease of some of the abdominal organs. This form of the 
malady is called reflex paraplegia, and is most frequently produced by disease 
of the urinary organs, of the womb, or rectum. It is important to be able to 
recognize it, as it may be readily curable, removal of the local malady being 
commonly sufficient for that purpose. See Paraplegia. 

From what has been hinted rather than said above, paralysis may depend 
on disease of the nervous substance itself, or pressure on it interfering with 
the due fulfillment of its functions. But in a great number of cases, perhaps 
the majority, the paralysis depends rather on the latter than the former cause. 
Say a man is advanced in years, with weak arteries, and from some cause or 
other too much pressure is applied to them. They give way, blood is poured 
out, a clot is formed, and stops the bleeding. As a consequence of this acci- 
dent, he has what is sometimes called a '.' paralytic stroke ; " but this loss of 
power of sensation and consciousness is due merely to the pressure of the clot, 
not to any disease of the nerve substance. Subsequently the clot may soften, 
and surrounding portions of the brain substance soften with it ; but the origi- 
nal cause of the paralysis was pressure only. There are, however, other causes 
of paralysis : the nerve substance itself may decay, or soften, as it is called, 
and if it does so there is little hope of its recovery ; or yet again, the ner- 
vous tissue may gradually waste away. Both of these forms of disease are 
such as give rise to progressive symptoms ; but this is the grand rule in study- 
ing nervous maladies — that the kind of lesion, except as giving the symptoms 
a progressive or retrogressive character, is of but little importance in producing 



PAR 589 PAR 

symptoms. That depends almost entirely on the site of the mischief. Thus 
injuries to or disease of certain parts of the brain give rise to symptoms of one 
kind, and those of others to symptoms of a totally different kind. We have 
described certain forms of paralysis, which most commonly originate from in- 
jury to or pressure on nerve substance ; we may now briefly allude to certain 
of a different kind, such as locomotor ataxy and wasting palsy. 

Locomotor Ataxy, or, as the malady used to be called, tabes dorsalis, is a form 
of disease apparently depending on wasting of the posterior portions of the 
spinal cord or of the nerve-roots arising thence. This malady can hardly with 
accuracy be called a paralysis, and yet it undoubtedly depends on loss of nerve 
power, especially in conducting impressions from the extremities to the nerve 
centres. Thus, let us say a man is standing up and is asked to walk ; he lifts 
his feet, but he has lost that power of telling exactly how far to lift them, and 
when they reach the ground, without looking at them. He must see his feet 
to tell him whether they are on the floor or not. But the great loss is a want 
of power of coordinating the muscles — that is, of compelling them to combine 
efficiently for the accomplishment of any given movement, as if one muscle 
was ignorant of what the others were doing, and so was compelled to act to a 
certain extent independently. This is first seen in walking, so that the pa- 
tient staggers along, and when made to shut his eyes is like to fall. This grad- 
ually gets worse, till at last the patient may be quite unequal to a walk from 
one side of a room to the other. Yet this is due to no lack of strength, but 
simply of the power to use it, for the patient, if made to lie down, may use his 
legs as powerfully as ever, so that it may be hardly possible to turn them 
against his will. There is commonly, too, very considerable pain experienced 
in the parts affected. This is described as neuralgic, for want of a better 
name. Withal the disease progresses steadily, and ends fatally. See Loco- 
motor Ataxy. 

Wasting Palsy, also known as Progressive Muscular Atrophy, is a malady in 
some respects similar to the former, in some totally different. In it the mus- 
cles waste and lose their power. They become subject to tremors, but only of 
parts of muscles — twitches they might be called. There is no loss of sensa- 
tion, but the part becomes weakened and withered. Of course from the wasted 
muscles the parts refuse to fulfill their functions, so that there is real paraly- 
sis, though dependent rather on the muscular than the nervous element. The 
muscles themselves undergo fatty degeneration. The origin of all this is 
doubtful, but most facts point to its being nervous. After death the spinal 
cord has been examined and found to be degenerated. (See Wasting Palsy.) 
Besides these there are a great variety of forms of paralysis, the exact nature 
of which, as far as their pathology is concerned, is not clear. 

In Hysterical Paralysis there is of course no disease to be detected, and on 
probing the story told by the patient, it will usually be found that there are 
discrepancies in it altogether irreconcilable with the malady being of an ordi- 
nary kind. On inquiry, too, it will be found that the patient has at some for- 
mer time suffered from hysteria. Sometimes the supposed paralysis has been 
brought on by some definite cause, as fright, or over-excitement — causes quite 
inadequate to the production of paralysis, but quite sufficient to evoke some 
characteristic symptoms from an hysterical woman. The forms of paralysis 
assumed are of all kinds, but perhaps paraplegia is the favorite. There is no 
difficulty about it; the patient has only to refuse to move the legs, and there it 
is. Hemiplegia is different : there are little points about the eyes and mouth 
which are not easily mastered, the tongue too is a difficulty which these pa- 



PAR 590 PAR 

tients cannot get over ; nevertheless we have seen instances of patients the 
subjects of hysterical paralysis who had managed to impose not only on friends, 
— though that is not saying much, — hut also on medical attendants. These 
are the class of patients who make the fortunes of quackish impostors if they 
fall into their hands, and so wise men will beware of allowing them to do so. 
Frequently the relations are fully confirmed in their belief as to the reality of 
the malady, and any brusquerie on the part of an attendant is likely to secure 
his dismissal — not, however, if they are wise. Far better is it, having made 
out the malady to be what it is, quietly to take the patients in haud and sub- 
ject them to the remedies most likely to benefit their hysterical condition. 
These of course are good nourishment, steel, cod-liver oil, galvanism espe- 
cially, quinine, and mix vomica. The bowels have to be seen to carefully, cold 
or tepid baths given regularly, applying friction to the limbs or parts affected. 
But moral control is the great thing: let the patients fairly know that you are 
aware of any attempted imposture, let them feel you know it, and afford them 
every opportunity of giving it up without creating anything like scandal, and 
success is tolerably certain. Nevertheless, there are some of these patients 
who do not get better, who take to their bed and keep (here, making a little 
court round about them : any encouragement to this kind of thing is most per- 
nicious, and ought to be instantly put a stop to. Make such patients invalids, 
by all means, but furnish them with no enticements to continue such. These 
patients are rarely if ever wholly well — that is not to be forgotten; they are 
really ill, and must be treated kindly, not harshly. On inquiry it will generally 
be found that the womb is wrong or the menstrual function is disordered. 
Usually, too, there are pains in the back and loins. There is indigestion, and 
in all probability constipation. All these must be remedied before the patient 
is well, only it is mainly, but not entirely, to these and not to the paralyzed 
parts, attention is to be directed. 

Rheumatic Paralysis is a form of the disease not very well understood. It 
affects the muscles of the extremities for the most part, especially those of the 
lower extremities or the muscles which raise the arm. It is by no means clear, 
however, that this paralysis is due to nerve change, many facts pointing rather 
to the conclusion that the change lies in the muscle itself or the nerve sheath. 
There is usually pain along with the inability to move the parts, and this pain 
is increased on pressure. It may come on suddenly after exposure to cold, or 
it may creep on more gradually. These cases are best treated by hot mineral 
waters, Ems or Wiesbaden being best, but if dealt with at home the hot douche 
and friction with stimulating liniments do most good. Iodide of potassium in 
five-grain doses and cod-liver oil should be given internally. A third form of 
paralysis of uncertain nature is that which is called diphtheritic, from its follow- 
ing the disease diphtheria. This paralysis, which mainly affects the tliroat or 
the muscles of swallowing, may come on during the disease, perhaps just after 
the throat is cleared and convalescence sets in, or it may appear later, when the 
patient is getting about. If, however, it comes on so late as this, it merely 
affects the extremities, so that for a time the patient can hardly walk. The 
main point is that if the symptoms can for the time be overcome, the patient 
is almost sure ultimately to get well, though for a time the health may be deli- 
cate. When, however, paralysis comes on in the last stage of the malady, it 
is a somewhat serious matter, because it is just then that nourishment is most 
valuable, and the paralysis sadly interferes with the power of taking it. The 
soft palate is paralyzed, and so are the muscles of the upper part of the gullet, 
but the tongue and cheeks are not. Hence, as the mouthful of food and still 



PAR 591 PAR 

more of liquid is passed backward, the soft palate does not close the posterior 
orifice of the nostrils, whilst the muscles of the gullet refuse to pass it on ; it 
is therefore compelled to regurgitate through the nostrils. This of course is ex- 
cessively unpleasant and not a little alarming. The only remedy is to pass the 
food so far downwards as to be beyond the influence of the paralyzed muscles. 
This may be done by means of a tube, but it is not pleasant to have to pass a 
tube clown a passage of raw flesh, which is the condition of the throat after 
the diphtheritic sloughs have peeled off. Accordingly, should the paralysis 
come on so early, it may be desirable for a time to give nutrient enemata. 
Care must be taken in feeding those the subjects of this form of paralysis, as 
the sensibility as well as the motor powers of the parts may be lost, so that 
there is risk of cramming food into the gullet so as to press on the windpipe 
fatally, rather than into the stomach. 

As for remedies, the chief are time and good nourishing food and port 
wine, with strychnine and the use of galvanism. 

Infantile Paralysis, also called the essential paralysis of children, no imme- 
diate cause of it being ascertainable as far as the brain and spinal cord is con- 
cerned, is a disease peculiar to childhood, and though not fatal to life, is often 
of a most inveterate description. This paralysis often seizes upon one limb, 
less frequently one arm, or a single group of muscles. Sometimes it gives 
rise to hemiplegia ; sometimes, and more frequently, to paraplegia. This form 
of paralysis is not unfrequently the source of very great deformity, for it be- 
gins early in life, and the parts not only cease to grow in due proportion, but 
also waste. If this condition becomes permanent, the limb is utterly dwarfed 
compared with the other ; or if a group of muscles are affected, their antago- 
nists are so much more powerful as to drag the limb over to one side. This 
form of paralysis may come on suddenly ; the child will be noticed to drag the 
limb ; if it is lifted, it will fall as if dead, and though sensation remains, yet 
it seems useless. Very often this condition comes on after one of the eruptive 
fevers, when the dregs of the fever are described as lodging in that limb ; or, 
yet again, it may appear during teething, when the nervous system generally 
is in an irritable state. 

Such paralyses have been mistaken for hip-joint disease, but the absence of 
pain is a sufficient guide to discrimination. Sometimes the unfortunate child is 
supposed to be playing at make-believe, and punished. Fortunately, this is 
not very often the case, at all events with parents interested in the welfare of 
their offspring. When paralysis occurs at the period of the first dentition, 
and the child recovers, there is a risk that it may occur again with the second. 
If so, the second attack is more likely to be permanent. Infantile paralysis 
passes away in the majority of cases, but in a good many it does not, and as 
there is no very good test for those cases which are likely to get well, anything 
like a forecast must be received not exactly with doubt, but with a knowledge 
that it may prove wrong. 

As to treatment, one remedy here is of undoubted efficacy, and has done 
more good than, perhaps, all the others put together ; that is electricity, in the 
form of continuous currents. If this be not available, the health must be at- 
tended to, the parts daily bathed, and kept as near their normal state by friction 
as possible. The limb should be wrapped in flannel, to keep it warm. The food 
must be good; tepid salt bathing is most useful. Finally, strychnine or nux 
vomica in small doses is likely to give rise to good results. Cod-liver oil and 
steel must not be neglected ; but, with all, recovery may fail to take place, and 
permanent deformity result. 



PAR 592 PAR 

Facial Paralysis in some respects resembles infantile paralysis, inasmuch as 
what is called facial palsy, in contradistinction to that paralysis of the face 
which depends on disease or injury to the brain, seems to depend rather on 
local than central change. The nerve affected is the motor nerve of the whole 
face, and, its power over the muscles being destroyed, that side of the face is a 
blank, whilst the muscles on the opposite side being unopposed, that side is more 
or less contorted by dragging. The angle of the mouth is accordingly dragged 
over to the sound side, and on the side which is paralyzed the patient is unable 
to purse up the eyelids as in grinning. In the same action, too, the mouth is 
drawn up on one side, and not on the other, giving the individual a very pe- 
culiar appearance. The mouth droops at the paralyzed side, and the patient 
has difficulty in pronouncing lateral consonants. Double-facial palsy is rare, 
and most commonly the palsy on one side is due to exposure to cold air, es- 
pecially draughts. Sometimes, like neuralgia, it may be due to stumps or bad 
teeth, so the mouth should be carefully examined. Inflammation of the cavity 
.of the ear, or of the bones behind the ear, may lead to a less tractable form of 
the malady. This simple variety of facial palsy does not last long, and a lit- 
tle attention to the diet and bowels, a few doses of strychnine, with the ap- 
plication of the galvanic current, will most probably soon restore the functions 
of the part. 

Labio-ylosso-laryngeal Paralysis is a very peculiar form of paralysis, well 
illustrating certain facts already alluded to, illustrative of the phenomena of 
paralysis generally. As its name implies, this form of paralysis affects specially 
the lips, tongue, larynx, and gullet, but often it may affect many other organs 
in the chest, the heart especially. In it the voice is lost, the power of swal- 
lowing is lost, and the lips can no longer retain the saliva, which constantly 
dribbles from the mouth. In other respects, the patient may be said to be well. 
Ultimately, however, in most cases the malady carries him off, sometimes 
from one cause, sometimes from another. 

We have already indicated that the site of an injury to the brain is the great 
thing in giving rise to symptoms ; the nature of the lesion may influence their 
permanency or their progressive character, but the great thing is the site. 
Now it so happens that the nerves which preside over all the parts already 
mentioned originate close together in one small spot. If, therefore, that spot 
is injured, the symptoms we have enumerated are bound to follow. But the 
injury may be produced by a blood clot, a syphilitic node, or softening of the 
brain- substance itself. If this originate in a blood clot, or in a syphilitic node, 
the malady may pass away ; if in softening, it is most likely to be progressive, 
and gradually to implicate other organs. 

It is hard to say what is the most prominent symptom in the disease. To 
the patient himself it is loss of the power to swallow, for not even the saliva, 
which is abundantly secreted, can be got over ; it dribbles from his mouth ; 
any attempt to give him food occasions great discomfort, and even risk of 
clicking. If it comes on suddenly, then all these things appear at once, and 
there may be risk of starvation ; in that case, the patient must be fed by the 
stoinach-pump, passed downwards far enough to reach the oesophagus, but not 
the stomach. It is useless to speak here of the remedies for such a malady ; 
this must depend on the causation. 

Scrivener's Palsy is an exceedingly curious form of nerve affection, which, 
fortunately, is not very common. It is also called writer s cramp, apparently 
from the fact that it most commonly attacks those who have long used the pen ; 
but it is by no means confined to these, and may attack any handicraft worker 



PAR 593 PAR 

almost. The mischief seems to lie in a want of coordinating power in the 
muscles, which have long been accustomed to fulfill one definite function. Each 
one seems to act independently, and so it becomes quite impossible to call them 
into simultaneous or concerted play. 

At first there is merely unsteadiness or stiffness after a long day's work, 
which speedily passes away, but by and by this makes mischief, for the writer 
scrawls at some point perhaps where he wished to be most particular, the pen 
darting away out of his hand. As the disorder advances, the patient gets 
worse ; as soon as the pen is touched, off starts the arm, so that it is quite im- 
possible for him to write even legibly. At the same time, curiously enough, 
he may be perfectly able to use his hand for other purposes ; but the moment 
he takes a pen in hand it becomes altogether unmanageable. Now as to the 
remedy. There is only one — that is, giving over the kind of work which has 
brought on the malady. The patient may do anything else he likes, but it is 
useless to attempt to carry that one on. and though it appears late in life the 
patient must seek another vocation. The sooner this is fairly faced the bet- 
ter. If it comes on in one who can afford complete relaxation, who can go off 
abroad and travel for a time, he may come back perfectly well and able to 
take pen in hand again for a moderate time only. Not so one who can only 
take partial rest ; that is simply useless. Many poor clerks, compelled to give 
over work, put themselves under treatment, and just when they begin to get 
well, they have exhausted all their means. Better for them had they at once 
taken to something which would have permitted them to use the other hand 
until the affected one got well. The great remedy is the continuous galvanic 
current and rest. Cod-liver oil, good food, and strychnine, with change of air, 
should be had if possible. 

Paralysis agitans, in common language called palsy, or shaking palsy, is a 
malady in certain respects resembling that just discussed. The disease con- 
sists in a want of power in coordinating the muscles, and also, it may be said, 
of keeping them at rest. The shaking commonly begins by affecting the 
hands and arms, but later it may seize any part of the trunk or limbs. Very 
often the head is early affected ; later, even the jaws may become so. This 
agitation is increased by mental effort, especially an effort to use the mus- 
cles impaired. The disease is progressive, and by and by the whole body be- 
comes affected, so that the patient can hardly walk, being always induced to 
run. All this time the senses are unimpaired, and the patient is acutely sen- 
sible of his misfortune, which often sadly interferes with his occupation. His 
bodily powers by and by become impaired, for he is often unable to sleep at 
night, and even unable to take his food in comfort from the unceasing agitation. 
These cases commonly occur in men advanced in life, and in them little bene- 
fit is to be hoped for ; but it may occur earlier, and then we may hope to alle- 
viate, if not to cure, the condition by the use of strychnine, iron, and galva- 
nism, especially of the continuous current. Even in the most favorable cases 
the prognosis is bad ; but with care a long life may be possible, and as the 
intellect is quite clear much good work may be done. 

There are still certain other forms of paralysis. These are due to mineral 
poisons slowly imbibed until the system becomes impregnated. The mineral 
poisons thus giving rise to nervous symptoms are lead and mercury. Lead 
occasions paralysis through the wasting of the muscles, affecting first of all the 
muscles which raise the forearm and arm, and afterwards those of other por- 
tions of the body. The malady is always symmetrical. Mercury gives rise to 
tremors rather than to paralysis. Its effects are best observed in miners, or in 



PAR 594 PAR 

artisans who gild looking-glasses by the old process. See Lead aud Mer- 
cury. 

Paraplegia denotes paralysis, or loss of power, over the lower extremities 
and lower half of the hotly, and it is always dependent upon some change in 
the nervous system, and generally on some disease in the spinal cord. The 
spinal cord may be looked upon as a prolongation of the brain ; like the lat- 
ter, it is made up of nerve fibres and nerve cells, and it also sends forth a 
vast number of nerves of motion and sensation to the trunk and extremities. 
When, however, these nerves or their nerve centres are destroyed, the power 
of motion or sensation, or of both, is lost, and paralysis ensues. 

Causes: Inflammation of the spinal cord or its membranes (spinal myelitis 
and spinal meningitis) ; cancer of the cord, or any other tumor pressing upon 
it, or growing into its substance ; fracture or dislocation of the vertebras or 
bones forming the spinal column ; a stab or gunshot wound of the spine ; 
haemorrhage into or softening of the spinal cord, are among the chief causes 
of paralysis. It may come on in cases of hysteria without there being any 
true paralysis at all ; and, finally, a person, for various reasons, may be malin- 
gering and simulate paraplegia. 

Symptoms : In most cases there is tingling and numbness of the legs and 
feet, occasional twitchings, followed by loss of the power of moving them; 
sensation is generally interfered with, but not absolutely gone. If the cause 
be due to an accident, the paralysis may appear at once ; if to cancer or any 
tumor, the symptoms may come on gradually ; if to inflammation, as after ex- 
posure to cold and wet, or from syphilis, the paralysis may occur in a very few 
days, and often terminate fatally from its extending upwards and involving 
most important parts. In most cases the bladder is also paralyzed, so that there 
is retention of urine ; and as the patient has no control over that organ, it 
becomes full and distended ; the urine remains there and decomposes, be- 
coming thick and purulent, and having a strong ammouiacal odor. It often 
happens that the patient's urine is constantly dribbling away, but this is due 
to the bladder being too full, and the overflow, as one may term it, comes 
away. The patient generally loses power over his bowels, and the stools may 
pass away unconsciously. If the affection spread upward, the abdominal and 
intercostal muscles become involved, and there is great distress in breathing; 
presently the arms are paralyzed, and the patient dies of suffocation, as he 
cannot expand his chest. This happens chiefly in the inflammatory cases, 
while, if the paralysis be due to other causes, the parts affected will be below 
the seat of injury, and the sufferer may go on for many months and even 
years ; but then, in most cases, he is an invalid, and can hardly help himself 
about at all. Those cases which depend upon a syphilitic state of the consti- 
tution, may generally be much benefited, if not cured, by iodide of potassium. 
In many cases a certain amount of power is regained ; but, as a rule, even in 
cases of so-called recovery, there is an impaired gait, and the use of the legs 
is never fully regained. The danger depends much upon the cause. Any 
fracture or dislocation of the spine is always serious, but even then life may 
be prolonged for many weeks ; as a rule, the higher the injury the greater the 
danger. A tumor of the cord will gradually make its progress onwards and 
finally kill. Inflammation of the cord is generally fatal within a week or a 
fortnight ; otherwise, a slow recovery may be looked for. When the cause 
depends on syphilis or rheumatic fever, great improvement may sometimes 
proceed from treatment. In hysterical cases the patient is generally of the 
female sex, very emotional aud excitable in her nature, and generally the sub- 



595 




Fia. cvi. 



PLATE XX. 



PAR 597 PAR 

ject of deep religious impressions. There is no true disease of the spinal cord, 
but the patient will not exercise her will to move the limbs. Such cases gen- 
erally do not suffer in health much ; they can eat well and remain well ; pitied 
by their friends, they are commonly made worse by sympathy, and in some 
cases they have been made the means of extorting charity from a credulous and 
ignorant public. Malingerers of this affection are not common, and may gen- 
erally be detected. 

Treatment : In all cases of paraplegia, the patient should lie on a water- 
bed, if possible, so as to prevent the formation of bed-sores, which are very 
liable to occur in this disease. Great cleanliness must be observed, and any 
excreta removed when passed. A draw-sheet must be placed beneath the pa- 
tient, and removed when required. The urine must be drawn off by a cath- 
eter, at least twice a day, if the patient cannot pass it, or if it dribbles 
away ; often, too, it is a good thing to wash the bladder out night and morn- 
ing with warm water. The feet should be kept warm in hot flannels, but the 
heat must not be too great, or the feet are very liable to blister in this affec- 
tion. The diet must be light and nourishing, and modified to suit the patient's 
palate in long-standing cases. No bleeding must be used; no mercury is to 
be given, except in cases of a syphilitic origin, and not always then ; no blis- 
ters need be applied, as they do no good. For acute cases, an ice-bag may be 
laid along the spine, and this gives relief sometimes. In chronic cases, when 
the paralysis is made out clearly to be incurable, the ouly thing one can do is 
to make the rest of life as easy as possible for the patient. In hysterical 
cases, treatment is of much avail. It is too common for people to look upon 
a case of hysteria as synonymous with a case of shamming ; but this is a to- 
tally wrong view to take of the subject. It is very common amongst both 
sexes, and especially amongst young women, to find cases in which the emo- 
tional faculties seem developed out of proportion to the intellectual ones ; such 
people are what are ordinarily called of a nervous and excitable temperament ; 
they often indulge in emotional excitement, and this generally assumes a relig- 
ious aspect, varying in its development according to the people associated with 
the patient in ordinary life. Intense mental worry, great grief, loss of a rela- 
tion, and numerous other causes tend to produce an excitement of the emo- 
tional faculties, while at the same time they are not duly balanced by a well- 
taught intellect; this is what is meant by "giving way to the feelings." In 
some cases, this goes on to such a degree that the will is not exerted by the 
patient, and cannot be exerted unless some strong stimulant, as electricity, etc., 
is given to the nervous system. At one time, the voice is lost, or an arm is 
palsied ; in another case the leg is paralyzed, and it is put down often as hip- 
joint disease. These cases do not occur because the patient will not use the 
limb ; it is because she cannot, unless you apply a shock. Such cases are 
nearly always worse in young people, and their state, which when once rec- 
ognized is easily cured, is often pronounced incurable, and the poor creature 
falls into the hands of quacks and wise women ; while, if her tone of thought 
has taken a religious turn, she is looked upon by the sect as one specially 
afflicted by divine Providence. It frequently happens that hysterical para- 
plegia may be cured suddenly; and then, to the surprise of surrounding friends, 
she who had been confined to bed for months is suddenly able to walk. Of 
this nature are the reputed cures and miracles which now and then are heard 
of ; and undoubtedly recovery does occur, because a mental shock is really 
given in those cases. Intense faith, a sudden fire, and a shock of electricity 
all act in a similar way, and most cases of recovery are brought about by one 



PAR 598 PAR 

or other of these means. Telling a patient she will recover on a certain day 
has sometimes a similar effect, and the more especially if it is said by some 
one who harmonizes in her train of thought. The best treatment for such 
cases is not to oppose their views, nor, on the other hand, sympathize with 
them too much. Daily reading some sensible book, removing all trashy nov- 
els, trying to engage the mind on some amusing topic, avoiding all excitement, 
and some light occupation, as sewing, knitting, or wool-work, will be most 
likely to do good. Cold bathing, electricity for a short time every morning, 
and firm but kind discipline will promote a cure. In malingering cases there 
is generally some object to be obtained, as avoiding a conscription, or trying 
to obtain damages from a railway company. Most people of this class overdo 
their symptoms. An intelligent medical man generally finds out the imposi- 
tion by carefully watching the case ; but no rules can be laid down for its de- 
tection, as each individual case will vary. See Paralysis. 

Parasites are animals or vegetables which live upon other organisms. The 
mistletoe, which grows upon the oak-tree, is a familiar example. Those found 
in man are of two kinds : (1) animal ; (2) vegetable. 

The animal parasites may affect the skin, hair, intestinal canal, or almost 
any internal organ. Those which attack the skin are the Acarus scabiei, or 
itch insect, the pediculus, or ordinary louse, the flea, and the bug. The 
tape-worms ( Taenia solium and Tcenia mediocanellata, and Bothriocephalus 
latus), the round worms (Ascaris lumbrico'ides), and the thread-worms (Oxyuris 
vermicularis) are met with in the intestinal canal. The hydatids are animals 
like bags or bladders of water, which occur in the internal organs of the body, 
and more especially in the liver ; they are produced by ova, which, escaping 
from the tape-worm of the dog (Tcenia echinococcus), are swallowed in drink- 
ing water, and, passing into the system through the alimentary canal, become 
developed into cysts or bags containing fluid. Another worm, the Trichina 
spiralis, is sometimes met with in the muscles of the body. It is caused by 
eating diseased pork or sausages, and much excitement was produced in Ger- 
many some years ago by a number of persons eating half-cooked sausages, and 
becoming the victims of this disease. 

In tropical regions, and chiefly on the coast of Guinea, a slender, round 
worm, Filaria medinensis, like a fiddle-string, and varying in length from a 
few inches to ten or twelve feet, has been found under the skin, where it has 
burrowed ; it is most common in the legs, but it may penetrate anywhere over 
the surface. It is called the Guinea worm. The only cure for it is its gradual 
and complete extraction. The natives have an ingenious way of winding it, 
day by day, round a small stick, care being taken that the worm is not broken 
in the process. The irritation produced by its presence is very annoying, and 
may even prove dangerous from violent inflammation of the part. As extrac- 
tion is the only cure, means should be tried to prevent the worm entering ; 
cleanliness is very important, and especially so in the case of troops. Assa- 
fcetida is said to prevent it, and the Brahmins of India, who use this drug 
largely, are exempt from the affection. 

Since all these parasites are produced from preexisting living organisms, 
and enter the human body from without, it is most important to note in what 
way they enter, and to take proper precautions. Drinking contaminated water 
and eating food which is affected with the parasite are the most common causes 
of this disease. Hydatids, for instance, are descendants of the tape-worm of 
the dog, wolf, or other animal ; this tape-worm infests the alimentary canal of 
those animals, and the ova or eggs which are met with in the last segments of 



PAR 599 PAR 

the worm pass at different times out of the intestines with the excreta; then 
they are probably washed by the rain into a dyke or running stream, and a 
person drinking the water may become affected ; or else he may eat some water- 
cresses, or some plant which has been growing in the water and on which the 
ova have settled, and so they enter the system. 

It is remarkable that these ova do not produce in man a tape-worm, but are 
developed into bags or cysts in some internal organ, and these, when swal- 
lowed by a dog, will reproduce the entire worm. This disease is very common 
in Iceland. It is necessary, therefore, for uncooked vegetables to be most 
carefully washed in clean water before being eaten ; and whenever a dog is 
seen to pass a worm the parasite should at once be burnt or thoroughly de- 
stroyed, so as to remove all source of danger. 

Tape- worms may be produced by eating the raw meat of the pig, ox, or cow; 
all such meat should be well cooked ; but neither that nor salting is quite 
preservative, though the danger is much lessened. Smoking appears to kill 
the worm, and also a temperature equal to that of boiling water. But it is not 
proper to eat of such meat at all unless dire necessity compels. 

The presence of tape-worms may be known by persons passing small pieces, 
consisting of one or moie segments, of a white color, longer than they are 
broad, and not unlike pieces of tape. There is generally more or less hun- 
ger, unsatisfied appetite, and a feeling of discomfort in the stomach. The 
worm affects the adult more commonly than children ; various remedies have 
been recommended, but it may generally be easily got rid of by a dose of a 
preparation of male fern taken early in the morning, while the individual has 
been fasting a few hours previously. 

It should be remembered that the worm diminishes in breadth near the 
head, and the neck is therefore long and slender ; and so when the parasite 
escapes this part should be carefully sought for, as then the patient may be 
sure that the white worm has been expelled and will trouble him no more. 
Pieces several feet in length may come away, while the head still remains to 
form a fresh worm afterwards. The parasite should be burnt when it is ex- 
pelled. 

The round worm in shape, size, and general appearance is very much like 
the common earth-worm, but the latter is redder and not so pointed at its two 
extremities ; the earth-worm, also, has little projections on its under surface, 
which probably aid it in locomotion, while they are absent in the parasite. It 
is found in the- small intestines, or that portion of the alimentary canal which 
is next to the stomach. It may occur singly or several together, and is 
either vomited up or passed by the bowel ; it is more common in children than 
in adults. A purgative or a close of rhubarb or aloes will usually suffice to* 
get rid of the worm. When the worm is present the patient generally has 
colicky pains in the stomach, fetid breath with nausea or vomiting, and bad 
appetite. 

Santonin is perhaps the medicine most certain to expel this worm ; it may 
be combined with a purgative ; it forms the chief ingredient in the so-called 
" worm powders." 

The origin of parasites which affect the skin is of course well known. In the 
case of itch there are two kinds of insect, male and female ; these burrow a 
short way into the skin, and there the female lays her eggs, which in a short 
time become developed into their mature form ; they are chiefly met with be- 
tween the fingers, and on the arms and trunk ; they are not common on the 
head or face ; they produce an intolerable itching, and the patient vigorously 



PAR 600 PAR 

scratches the affected parts. They are produced by dirt and direct contact 
with clothes or people similarly affected. 

Sulphur made into an ointment with common lard will destroy the insect if 
well rubbed into the skin ; the surface should then be thoroughly washed with 
coarse soap and hard water, and scrubbed well with a flesh brush. This 
process should be continued night and morning until all the parasites are de- 
stroyed. 

The under-clothing should be well steeped for some time in boiling water, or 
perhaps, better still, it should be destroyed. The complaint may affect people of 
all ages, but it is most common in children. The greatest care should be taken 
to prevent other children coming in contact with an affected child, as without 
such precaution a whole school might be attacked. It is a troublesome but 
simple complaint, and may be prevented by ordinary attention to cleanliness. 
See Itch. 

There are several varieties of the pediculus or louse ; they affect the hair 
of the head or genitals, or they may attack the whole surface of the body, or 
only the arm-pits. 

Developed in dirty people, they are met with at all ages, and are readily 
communicated from one person to another. These small insects cling very 
tenaciously to the lower ends of the hairs, and cannot be removed by mere 
washing with soap and water; they form a small sac intimately clasping a 
hair, and in this is deposited an egg, which in a few days forms a fresh 
louse ; to this sac, with the contained ovum, the name " nit " is applied. 

As a rule, those insects which are found in one part rarely go to another, 
except in the case of body-lice, which may crawl anywhere. They cause 
an intolerable itching, and scratch-marks may be found over the skin they 
attack. When they occur on the head in children, they often cause a trouble- 
some eruption, which scabs over, and, mixed with the dirt, entangles the hair in 
a filthy mass. The complaint may be at once recognized by seeing the in- 
sects crawl about, and by the presence of the nits attached to the hairs. 

The best thing is to wash the part affected with a solution of carholic acid ; 
one part of acid to eighty of water will suffice ; by this means the insects are 
at once killed, and great relief is immediately given ; when the head is affected, 
and there is matting of the hair, it is best to shave the scalp or cut the hair off 
as close as possible, and then wash it again thoroughly with the carbolic acid 
solution. This, however, will not destroy the nits ; for this purpose a small 
quantity of white precipitate ointment may be rubbed in every night, and the 
disease may be at once eradicated. Yet in the case of adults, care should be 
taken not to rub in too much of the ointment, as serious results have arisen 
from want of caution. Perfect cleanliness should be attended to, to prevent 
a recurrence of the complaint. The under-clothing should be soaked for a 
short time in weak carbolic acid, so that any stray lice will be killed, and thus 
prevent a future spread of the parasite. See Ectozoa. 

- Paregoric Elixir is the name commonly given to compound tincture of 
camphor, a preparation which owes its activity to opium. This elixir is some- 
times ordered for children, under the belief or pretense that it contains no 
opium, but the modern paregoric elixir contains one grain of opium in half an 
ounce of the elixir, so that a teaspoonful or two of it is a tolerably full dose. 
In Scotland a preparation called paregoric is the modern ammoniated tincture. 
Formerly it was stronger than it now is, and often gave rise to mishaps. 

Pareira is the wood of the root of the Cissampelos Pareira, a climbing 
plant growing in Brazil. It occurs in cylindrical pieces, sometimes split, and 



PAR 601 PAR 

covered with a moist, peculiar bark, if such it can be called ; its substance is 
vascular and porous. It has a sweetish odor and taste, and contains a principle 
which has been called cissampeline and pelosine. These preparations are con- 
tained in the Pharmacopoeia, a decoction, an extract, and a liquid extract, or 
concentrated decoction ; of these the first and the last are mainly used. Pareira 
contains a bitter substance, and may act like columba, but is chiefly used in 
maladies affecting the bladder, especially chronic catarrh of that organ. Some- 
times it is combined with an acid, especially nitric acid ; sometimes with an 
alkali, especially liquor potassae ; seldom alone. Opinions consequently differ 
vastly as to its efficacy in such complaints as those of which we have spoken, 
which, be it said, are commonly very intractable ; some thinking it of vast, and 
others maintaining that it is of little or no value. In the mean time, we can 
hardly be said to know if it has any influence at all beyond serving as a vehi- 
cle to the potent remedies mentioned. The dose of the decoction is about two 
fluid ounces, of the liquid extract two fluid drachms. 

Paronychia. See Whitlow. 

Parotid Glands. These are two in number, one on each side, just below 
and in front of the ear. They secrete a great portion of the saliva, and are 
most active when mastication is going on. When inflamed they become pain- 
ful, and form the disease known as " mumps ; " the patient is then unable to 
open the mouth for a few days, but the disorder will soon pass away. See 
Mumps. 

Parotitis. See Mumps. 

Parsley is Petroselinum sativum, and belongs to the order Umbelllferce. 
It is a hardy plant, and has become almost naturalized in England and Scot- 
land, having been first brought from Sardinia in 1548. It is a well-known 
seasoning herb, and was at one time included in the materia medica. It 
possesses certain medicinal properties, which might be turned to account when 
other remedies are not at hand. Parsley acts on the system as a diuretic, em- 
menagogue, and carminative. In all affections of the bladder and kidneys, 
in gravel or stone, this plant was formerly very largely used, while the seeds, 
taken two or three times a day, are said to exert a powerful effect on the uter- 
ine secretions. At one time a poultice made of the bruised leaves and stems, 
with vinegar and water, was considered a specific for the- bites of all venomous 
reptiles. Parsley chewed has the property of destroying any fetor in the 
breath, or the smell imparted to it from spirits, onions, or other articles. 
Among the ancient Greeks and Romans parsley always formed a part of their 
festive garlands, on account of regaining its color so long ; and Pliny states 
that in his time there was not a salad or sauce presented at table without it. 
The ancients supposed that its grateful smell absorbed the inebriating fumes 
of wine, and by that means prevented intoxication, but of this we have no 
knowledge. It is certain, however, that nothing is more effectual for prevent- 
ing the smell and after-taste of onions than a few leaves of parsley. In Corn- 
wall it is much esteemed and largely used in parsley pies, which are peculiar 
to that part of England. If dried and preserved in bottles excluded from the 
air, it retains its flavor for a long time, and is very useful in flavoring omelets 
and similar dishes. 

Parsnip. The cultivated variety of the wild parsnip — Pa stinaca saliva. 
It belongs to the order TJmbelliferos. It has long been used as an article of 
diet. On account of the woody fibre it contains it is less digestible than pota- 
toes. It contains also less sugar, starch, and flesh-forming matters. It has a 
peculiar flavor, which is much liked by some people, and it still continues to 



PAR 602 PAU 

be used as an article of diet, especially with boiled salt fish and beef. Accord- 
ing to Pliny, parsnips were held in such repute by the Emperor Tiberius that 
he had them brought to Rome annually from the banks of the Rhine, where 
they were then successfully cultivated. In Holland parsnips are much used in 
soups, whilst in Ireland cottagers make a sort of beer by mashing the roots 
and boiling them with water and hops, and afterwards fermenting the liquor. 
A kind of marmalade preserve has also been made from parsnips, and even 
wine, which in quality has been considered to approach the far-famed malmsey 
of Madeira. 

Parturition is the process of giving birth to a child, and is synonymous 
with the term labor or confinement. See Labor. 

Patella is the anatomical name for the knee cap. See Knee-Joint. 

Pauperism. The question of pauperism is one of peculiar interest to the 
social economist, and it has an important bearing upon the well-being of a 
country. In every nation there will always be a number of people who, 
through misfortune, folly, disease, or old age, are incapacitated from obtaining 
a livelihood, and there can be no doubt as to tbe duty of a community to sup- 
port their weaker brethren. On the other hand, there is always a large num- 
ber of improvident and lazy people, who, preferring an idle life, swell the list 
of paupers ; nor can it be denied that an able-bodied pauper is more or less a 
disgrace in an industrious community. There is also a large class amongst the 
working population who go on the pauper list directly they are taken ill or are 
out of employment ; sometimes the wages obtained by these people are so 
small as to prevent them saving up anything for a rainy day ; at other times, 
many who might save prefer to waste their surplus wages in drink, or in some 
other folly. Many old and decrepid people are paupers because their children 
will not give anything out of their wages to support their parents in their old 
age. In this way an enormous number of paupers are to be met with in this 
country, and many endeavors have been made to lessen this dead-weight on a 
nation's progress. An increase in the rate of wages, a diminution of intemper- 
ance, a greater sense of self reliance, a better system of moral and intellectual 
education, — such are the measures to be looked for, if we wish to diminish our 
pauper population. Among other remedial means may be mentioned the 
stamping out of beggars and vagrants, and this can only be done by the good 
sense oj: the public. Many a one gives a penny to a beggar, with the idea 
that " it can do me no harm, and it may do him good ; " this is a most mischiev- 
ous delusion, for by doing so we are keeping up and daily manufacturing pau- 
perism and encouraging idleness. Many beggers live uncommonly well after 
they have spent their day in one of the most demoralizing employments that 
an able-bodied adult can indulge in, and if at any season their trade is slack 
they can increase their income by stealing. It is clear that if no one gave any- 
thing to beggars the race would at once be extinguished, and it is equally clear 
that any able-bodied person ought not to live on charity, but to work and earn 
enough to keep himself; while for those who are ill and destitute there is the 
system of poor law relief and charitable societies. 

Our reformatories and industrial schools are valuable means of removing 
children from the pernicious influence of their homes, and rearing them up to 
be laborers, etc., and instilling into them not merely the rudiments oi : education, 
but that higher spirit of independence and self-reliance which makes a man 
ashamed to live upon the charity of others. These institutions are all the 
more valuable, as they deal with the raw material, and will materially diminish 
the pauperism of the next few years. 



PAU 



603 



PAU 



Great Britain deals with the pauper question in a most enlightened manner, 
as may be seen from the following. Besides all private efforts, there is the 
public system of poor law relief, presided over by the Local Government 
Board, and administered by Boards of Guardians all over the country. In Eng- 
land and Wales there are 649 unions and parishes presided over by the above- 
named boards, which are elected by the rate-payers and vestries, and are gen- 
erally made up of some of the influential men in a parish. Under them is a 
medical officer for each union, who sees the sick paupers, prescribes and gives 
them medicines, and orders them extra diet when necessary. In each union is 
a relieving officer, who goes round the different parishes at stated times, and 
arranges about the proper distribution of money and food ; the poor can also 
go to him for an order for medical relief. Subordinate to these are the over- 
seers (two in number generally) in each parish, who are really local relieving 
officers, and from whom or from a guardian an order can be obtained for med- 
ical relief in cases of emergency. There is in all parishes a permanent list of 
old and decrepit paupers, while the number of ordinary paupers varies from 
time to time. In each union is a workhouse, wher^ male and female paupers 
are kept at the public expense, and to each is attached an infirmary for those 
who are ill. A good system has been lately adopted of boarding out pauper 
children, and chiefly those who are orphans, with people in the country ; in 
this way a healthy life and pure air is given them, and they are removed from 
many bad influences. 

The Public Health Act, 1872, has in many respects modified the duties of 
Boards of Guardians. The Metropolitan Asylums Board, formed of late years, 
is composed of members from each Board of Guardians in the metropolis : 
they have the power of building lunatic asylums for pauper lunatics and im- 
beciles ; hospitals, in cases of severe epidemics, so as to isolate disease as far 
as possible ; and for various other sanitary and beneficial purposes. The num- 
ber of paupers in receipt of relief in the several unions and parishes, constituted 
under Boards of Guardians in England and Wales, was as follows on the first 
day of January for the ten years from 1860 to 1870 : — 



Years. 


Number of Unions 
and Parishes. 


Adult Able-bodied 
Paupers. 


All other Paupers. 


Total. 


1861 


646 


150,526 


739,897 


890,423 


1862 


649 


167,646 


778,520 


946,166 


1863 


653 


253,499 


889,125 


1,142,624 


1864 


655 


186,750 


822,539 


1,009,289 


1865 


655 


170,136 


801,297 


971,433 


1866 


655 


149,320 


771,024 


920,344 


1867 


655 


158,308 


800,516 


958,824 


1868 


655 


185,630 


849,193 


• 1,034,823 


1869 


655 


183,162 


856,387 


1,039,549 


1870 


649 


194,089 


885,302 


1,079,391 



The numbers above specified are exclusive of vagrants and so-called casual 
poor, to whom temporary relief is given. In 1869 there were about 990,000 
paupers in England out of a population of 21,487,688, and about 143,000 
paupers in Wales out of a population of 1,216,420: thus in England 1 in 
every 21.7 of the population was a pauper, while in Wales it had reached the 
enormous proportion of 1 in every 8.5. An improvement, however, has taken 
place the last three years, according to the report of the Registrar-General 
for England and Wales. The average number of persons relieved on the last 



PAU 



604 



PAU 



day of each week in each of the quarters ending 31st December, 18G7, 1868, 
1869, 1870, and 1871, respectively, was as follows: — 





In-door. 


Outdoor. 


Quarter ending 31st December, 1867 

Quarter ending 31st December, 1868 

Quarter ending 31st December, 1869 

Quarter ending 31st December, 1870 

Quarter ending 31st December, 1871 


145,886 
152,733 
151,996 
150,729 
140,955 


771,754 
797,546 
813,315 
802,291 

758,474 



The years 1867 and 1868 were periods of commercial depression, while the 
last two years were times of great national prosperity: the great decrease in 
the out-door paupers, coincident with an ever-increasing population, is a most 
gratifying sight, and many causes have helped to bring about this result. The 
decrease has taken place unequally over the country, being most marked in 
the south. A great improvement has taken place in the metropolis in this 
respect, although the population of London is rapidly increasing. The total 
pauperism of the metropolis, out of a population of 3,251,804 (census of 1871) 
was as follows : — 





Number of Paupers. 




In-door. 


Out-door. 


Total. 


First week of October, 1 869 .... 
First week of October, 1870 .... 
First week of October, 1871 . . . . 
First week of October, 1872 .... 


33,973 
34,031 
32,724 
32,579 


94,907 
93,753 
84,689 
68,534 


128,880 
127,784 
117.413 
101,113 



This number is exclusive of vagrants ; it is also a more favorable return 
than can be expected in the winter months, when distress is more prevalent. 

Pauperism in Scotland. The number of registered paupers and their de- 
pendents, exclusive of casual poor, who were in receipt of relief in parishes of 
Scotland during 1860-69, on the 14th of May in each year, is shown in the 
subjoined table : — 



May 14. 


Number of Parishes. 


Paupers. 


Dependents. 


Total. 


1860 


883 


77,306 


36,903 


114,209 


1861 


883 


78,433 


38,680 


117,113 


1862 


884 


78,724 


40,204 


1 1 8,924 


1863 


884 


78,717 


41,567 


120,284 


1864 


884 


78,682 


42,023 


120,705 


1865 


884 


77,895 


43,499 


121,394 


1866 


885 


76,229 


43,379 


119,608 


1867 


885 


76,737 


44,432 


121,169 


1868 


887 


80,032 


48,944 


128,976 


1869 


887 


80,334 


48,005 


128,339 



During this period the population of Scotland rose from 3,062,294 in 1861, 



PEA 



605 



PEL 



to an estimated population of 4,205,481 in 1869 ; the latter number, however, 
is below the actual number ; about 1 in every 25 is a pauper. 

Pauperism in Ireland. The subjoined table gives the number of paupers in 
receipt of relief in unions in Ireland at the close of the first week in January 
in each of the ten years 1861-70: — 



Years ; 


In-door Paupers. 


Out-door Paupers. 


Total. 


1861 


47,352 


3,331 


50,683 


1862 


55,168 


4,373 


59,541 


1863 


60,038 


5,809 


65,847 


1864 


59,867 


7,753 


68,136 


1865 


59,498 


9,182 


69,217 


1866 


54,435 


10,163 


65,057 


1867 


54,930 


13,291 


68,650 


1868 


56,663 


15,830 


72,925 


1869 


56,934 


17,320 


74,743 


1870 


53,687 


19,720 


73,921 



The population in the same time decreased from 5,798,967 in 1861 to an 
estimated population of 5,525,210 in 1870. 

The paupers were thus distributed over the country in 1871 : — 



Division. 


Population. 


Paupers. 


Leinster 


1,335,966 

1,390,402 

845,993 

1,830,398 


104,050 

94,208 


Connaught 

Ulster 


24,794 
63,595 








Total 


5,402,759 


286,647 







Thus, about one person in every nineteen is a pauper in Ireland. 

Peas. The product of various species of the genus Pisum, belonging to 
the leguminous order of plants. Both in a fresh state and when dried they 
are a valuable article of diet, and contain a large quantity of caseine in a di- 
gestible form. The green pea contains more sugar and less caseine than when 
dried. Dried peas are a wholesome and nutritious addition to other kinds of 
food. When added to soup they are agreeable and economical, and in the 
form of flour when ground they may be advantageously made into puddings 
or bread with wheaten flour. 

An analysis of 100 parts of dried peas gives the following constituents : — 



Water 14.1 

Flesh formers 23.4 

Heat givers 60.0 

[ Mineral matter 2.5 



Caseine 


... 23 4 
. . . 37.0 




. . . 2.0 1 




. . . 9.0 • 


Fat 


. . . 2.0 


Woody fibre . . . 
Mineral matter . . 


. . . 10.0 
. . . 2.5 



Pectoriloquy. See Stethoscope. 

Pellitory, or Pyrethrum, also known as Pellitory of Spain, 



the root 



PEL 606 PEM 

of a plant, Anthemis Pyrethrum, growing along the coast of the Mediterranean, 
and imported from its eastern shores. The root is spindle-shaped, and is ordi- 
narily cut into pieces two or three inches long. It has a thick brown bark, 
and breaks with a resinous fracture, dark brown in color, with black shining 
parts. Its tincture is the preparation used, but even that is seldom employed, 
and then only as a gargle. Chewed, it gives rise to a feeling of pricking in 
the mouth and a flow of saliva. Hence it is called a masticatory. It is only 
used as a local stimulant. 

Pelvic Cellulitis. This is an inflammatory symptom of the cellular tissue 
which surrounds the bladder and womb. It may come on after a difficult 
labor, or after an abortion, or after an attempt tcprocure premature labor. 

Symptoms: It is characterized by great pain in the lower part of the abdo- 
men, with loss of appetite and strength. There is always a good deal of fever 
attending it, and the patient is generally worse at night. Shiverings and 
rigors cause much distress ; the patient feels weak and prostrate, and loses 
color, so that the face has a sallow, earthy look. This disease is very apt to 
go on for several weeks, during which time the patient becomes emaciated, 
and of course is obliged to keep her bed. Very often the inflammation goes 
on to form an abscess, and in time this points and discharges a great deal of 
matter. It may burst inwardly, or sometimes in the skin over the groin, and 
the escape of pus is generally attended with relief. The convalescence is, 
however, very prolonged, and it may be weeks or months before the woman 
finally recovers her former strength. 

Treatment: The patient must be placed in bed in a cheerful and well-venti- 
lated room. Her diet must consist of milk, beef-tea, broth, eggs, jellies, etc., 
and while it is light and nourishing it should be given in abundance so as 
to keep up her vital powers ; a small chop or a piece of sole can be taken if 
desired by the patient, but on no account must the woman be kept too low. 
Three or four glasses of port wine a day will do much good, or some bottled 
stout may be given if preferred. To relieve the pain, hot fomentations or hot 
linseed-meal poultices must be applied, but they should be made as light as 
possible, as their pressure may cause pain. It is useful also to remove the 
weight of the bed-clothes from the abdomen by placing an ordinary fire-screen 
or some similar contrivance over the body. Great care should be taken to 
prevent the formation of a bed-sore ; for this purpose great cleanliness must 
be observed, and the patient should lie on a water-bed or water-cushion. (See 
Bed-sores.) At first saline medicines and anodynes may have to be given, 
afterwards quinine, or some other tonic. Convalescence will be much aided 
by change of air, and especially by residence at the sea-side if not too cold. 
If an abscess form it will either burst or have to be opened, and be treated in 
the usual manner. 

Pelvis. This is a space formed by the haunch bones and lower part of 
the spinal column which communicates freely with the abdominal cavity above, 
but is elsewhere closed. It contains the bladder in front, and the rectum be- 
hind, besides several important vessels and nerves ; in the female it contains, 
in addition, the uterus or womb, which is situated between the bladder and 
rectum. The pelvis is wider and shallower in the female than in the male, 
and in this way the process of parturition is facilitated; from this cause, also, 
the hips are wider apart than in man, and this makes the difference in the gait 
between the two sexes when walking. 

Pemphigus, or Pompholyx, is a skin disease characterized by the pres- 
ence of large blisters called bullae on the surface of the skin ; often the arms 



PEN 607 PEP 

and hands or the lower extremities are more affected than the trunk ; the dis- 
ease may be either acute or chronic, and sometimes is very difficult to heal. 
The bulla? or blisters are surrounded by a narrow red raised aureole, or ring ; 
when the blisters burst a scab may form, and that spot may heal while a fresh 
one will form elsewhere. Zinc ointment must be applied externally, and small 
doses of arsenic may be given internally ; the general health must be improved 
by a light and nourishing diet. The bulla? should be pricked with a needle to 
let the fluid escape. 

Pennyroyal, the Mentha pulegium, is only employed in medicine in the 
form of oil ; even that is not now officinal. The oil, which is yellowish and 
of a peculiar odor, is obtained by distillation from the plant. The oil is used 
in the same cases as peppermint and spearmint. The herb itself has obtained 
a false reputation as an abortive. 

Pepper. This substance is the fruit of the Piper nigrum, a shrub be- 
longing to the family Piperacece. It grows both in the East and West Indies. 
There are two sorts sold in the markets — " white " and " black." The white 
is produced by the same plant as the black, and consists of the berry from 
which the skin or bark has been removed. The pepper berries contain an 
active principle called pipeline, and an acrid resin as well as a volatile oil. 
The name pepper is sometimes applied to the Capsicum family of plants. 

Peppermint, the Mentha piperita, is only used nowadays as oil obtained 
by distillation from the well-known plant. This oil is colorless, turns palo 
yellow by keeping, and has a warm aromatic taste and the odor of peppermint. 
Peppermint water is now made by distilling together a large quantity of water 
and a small quantity of the oil. The essence of peppermint consists of the 
oil dissolved in a small quantity of rectified spirit. The spirit is exactly sim- 
ilar, but much weaker. Peppermint water is largely used as a vehicle, but to 
some people the odor and flavor are both very disagreeable, and should be 
avoided. The essence may be given dropped on sugar to infants for spasms 
or gripes, and many adults find the same prescription grateful. The oil is 
used as an adjunct to purgatives to prevent their griping. 

Pepsine is a modern remedy, if, indeed, it can be called a remedy at all, 
seeing that it consists as far as possible of the digestive principle secreted by 
the stomach, made use of to aid digestion. It is not yet officinal. There are 
various plans of preparing pepsine, but in all the mucous membranes of the 
stomach are more or -less disintegrated, and so the digestive principle is set 
free. This is treated with some substance to purify it, and finally is dried. 
The best pepsine is made from pigs' stomachs ; it is known as Pepsina porci ; 
it is free from acid and starch, and has an odor by no means disagreeable. 
The pepsine most frequently used is of French origin, — the Pepsine Boudault, 
— and is obtained from the stomach of the calf. It is also largely mixed with 
starch, so that it is, comparatively speaking, inert. It is grayish-white in 
color, always acid, and very often its smell is quite disagreeable. It should 
not be used when Morson's or Bullock's pepsine can be obtained. Pepsine 
has this peculiarity, that when acidulated with hydrochloric acid greatly diluted, 
and kept at a temperature of 100° Fahr., it speedily dissolves all albuminous 
substances, reducing all to a compound of nearly uniform character called 
peptone. This differs altogether in its character from any other albuminous 
substance, in that it is easily miscible with water and readily diffusible, re- 
sembling in this a saline substance. Other acids, especially lactic, have the 
same power as hydrochloric, but in a much less degree. If the acid is neutral- 
ized during the process, the digestive or solvent action is arrested, but not 



PER G08 PER 

finally stopped ; for if acid be again added, the process again goes on. A 
higher temperature arrests its action ; 112° Fahr. will affect it; 120° will stop 
it almost entirely. 

The value of pepsine in a certain number of cases is undoubted ; but the 
exact cases for its employment are not yet quite manifest. It has been mainly 
used in cases of dyspepsia, where there was reason to believe that the secretion 
of gastric juice was imperfect. It should in these cases be given during or 
after a meal. Sometimes it is made up in the form of a lozenge, to be swal- 
lowed just after food ; but this is not, perhaps, the best way. Pepsine has this 
peculiarity, that when it acts on albuminous substances it does not itself become 
destroyed, but is quite capable of acting on quantity after quantity of the al- 
buminous or fibrinous material, provided only a sufficiency of dilute acid be 
supplied. Apparently, therefore, the best plan would be to give this substance 
in a dose of three or four grains along with food, and from time to time there- 
after to swallow small quantities of diluted hydrochloric acid, a few drops at a 
time, until digestion is complete. In cases of great debility of stomach, espe- 
cially in old people, the habitual use of pepsine may render life easy and pleasant 
where formerly it was unendurable. It will be of great value where" there is 
regurgitation of half-digested or half-putrid food, especially in cases of obstruc- 
tion at the pylorus ; for it has been tolerably clearly proved that substances 
which are digested in the stomach are absorbed there, so that if albumen be 
converted into peptone, and there absorbed, there will be no necessity for it to 
pass the pylorus, nor will there be time for it to undergo decomposition. After 
a time, a few drops of weak carbolic acid might be given to prevent putrefaction 
of what remains. 

There can be no doubt but that the use of this substance is not yet fully de- 
veloped ; many cases which as yet are not treated by its means will be so. It 
has recently been proposed in certain cases to digest food outside the body be- 
fore administering it, and this may prove of service, especially when nutrient 
enemata have to be administered. 

Percussion. By this term is understood the art of ascertaining the 
state of internal organs by means of the sound produced by striking the part 
over them with the fingers, or by means of striking on a little ivory plate 
placed over the part. It requires a delicate ear and much practice to be able 
to use percussion skillfully. See Stethoscope. 

Pericarditis is an inflammation of the pericardium or membrane which 
envelops the heart. Involving so important an organ as the heart, and inter- 
fering so gravely with its action, it is therefore a disease of serious significance. 
No accurate data exist at present which will show how large a proportion of 
the thousands of deaths which take place yearly from heart disease is really 
due to pericarditis, as the latter disease is so frequently classed under the 
former. Pericarditis very rarely comes on as a primary disease ; it gener- 
ally comes on as a secondary complication in the course of rheumatic fever 
or Blight's disease. More rarely it occurs by the spread of inflammation 
from adjacent parts, as in cases of pleurisy and pneumonia ; sometimes from 
the presence of an aneurism or other tumor in the chest, and still more rarely 
from external injuries, as gunshot wounds, stabs, etc., for these generally prove 
fatal before there is time for the inflammation to appear. 

Symptoms : It will be most convenient to give the signs of pericarditis as 
they occur in a case of rheumatic fever. In such cases the patient will have 
had pain and swelling of the joints some days previously ; the skin will be hot 
and perspiring freely, while the temperature may have riseu to 102° or 103°, 



PER 609 PER 

or even higher. There will be loss of appetite, thirst, headache, and a white, 
furred tongue. If now pericarditis should come on, the temperature will rise 
higher by a degree or two : the pulse will be quick and excited ; there will be 
pain across the chest, which is worse when the patient takes a deep breath ; the 
face will be pale, the breathing shallow and hurried, as the pain is worse on 
inspiring deeply ; the patient will lie flat on his back and feel faint if any at- 
tempt is made to raise him. If now one listen over the region of the heart, a 
rough sound will be heard, because the opposed surfaces of the pericardium are 
no longer smooth, but rough. In a day or two there will also be signs that the 
cavity of the pericardium is full of fluid, and as this, pressing upwards and 
laterally, displaces the lungs, the breathing is still more interfered with. There 
may also be heard numerous new sounds, called rales, over the chest, for the air- 
passages contain more mucus, and the air, in passing over them, causes these rat- 
tling noises. These symptoms are generally attended with an abatement or even 
cessation of all pain in the joints. So the patient goes en for a few days, when, 
if recovery takes place, the temperature begins to decline, the breathing is easier, 
the pulse lessens in frequency, and a general improvement may be noticed. If, 
however, the case goes on from bad to worse, there is generally low, muttering 
delirium ; weak and muffled sounds are heard over the heart ; there is greater 
prostration, and the patient dies from exhaustion or syncope. In all cases of 
recovery the absorption of the fluid is a slow process, and convalescence is re- 
tarded. In many cases, as the pericarditis abates, there may be signs that the 
endocardium, or lining membrane of the heart, is also affected, and so, while 
there is recovery for a time, there is left behind much serious mischief, which 
will sooner or later shorten the life of the patient. It is a remarkable fact 
that in some years it is much more common for inflammation of the heart to 
accompany rheumatic fever than at other times, nor there is at present any 
satisfactory explanation to be given. In some instances the muscular wall of 
the heart is inflamed as well as the outer covering, and as this seems to be true 
in most cases which are fatal, it adds to the danger of a case. In Bright's 
disease, when pericarditis comes on, it is generally found that the patient has 
suffered from the chronic form of this disease for a long time, and it generally 
supervenes in those who are the subjects of the gouty and contracted kidney. 
There is great pain over the front of the chest, and the rubbing sounds may be 
heard on placing the ear to the chest ; in other respects the symptoms are very 
similar to those mentioned above. Nor in those for whom there is some other 
cause for the inflammation are there any other marked symptoms than those 
described ; but in addition there will be the evidence of an aneurism, pleurisy, 
pneumonia, stab, wound, etc., according to the nature of the cause. 

Treatment: In all cases perfect rest must be enjoined in bed, and the hori- 
zontal position kept ; in some cases, however, of old standing heart disease the 
patient cannot lie down, and then must be propped up with pillows. No ex- 
ertion should be made by the sufferer, nor should he attempt to rise for any 
natural purpose ; nor should he be moved from bed to bed in the early days of . 
the illness, for whenever movement is made the heart is called upon to do more 
work, and in its weak, inflamed state it may cause a fatal faint, or syncope. 
The diet must consist of milk, an egg beaten up in milk, beef-tea, broth, etc., 
but no solid food should be given, nor anything which distends the stomach. 
Stimulants must be given according to the requirement of each case,, and accord- 
ing to the age of the patient ; but no rules can be laid down here as to the 
quantity to be taken daily. The nurse and medical man should look out care- 
fully for any signs of bed-sores, and try and prevent their forming by perfect 
39 



PER 610 PER 

cleanliness and a smooth bed ; they are very apt to form in these ca«es. (See 
Bed-sorks.) When the pain is great across the chest, and the breathing very 
quick, four or six leeches will give a great deal of relief by abstracting the 
blood ; then a hot linseed-meal poultice, not too heavy, should be laid across 
the chest and changed every three hours; but care should be taken that the 
leech-bites have stopped bleeding, or otherwise the moist heat will make them 
bleed more, and exhaust the patient too much. Cotton wool may be applied 
to the chest in some cases instead of a poultice. As such patients sweat pro- 
fusely, the chest should be wiped dry, and gently, just after the poultice is 
removed, or the moisture soon cools, and makes an uncomfortable feeling. 
Bleeding from the arm is not wanted in these cases, and no one nowadays 
adopts this practice ; calomel and mercury are also of no value in checking the 
mischief ; nor does there seem to be any drug which is capable of doing much 
good in this affection. Opium may be given at bed-time to procure sleep, but 
with great care in such as have affection of the lungs at the same time. Xow 
and then, in the course of rheumatic fever, the pulse and temperature suddenly 
rise, and there is intense headache and delirium. In these cases of hyperpyrexia, 
or excessive fever, the thermometer may rise to 107°, 109°. or even higher. 
Most of these prove fatal, but some cases have lately been cured by the use of 
the cold-bath, or by packing in sheets dipped in cold water, and often renewed. 
The great principles of treatment in pericarditis are : (1.) To gdve the patient 
light but very nutrient diet. (2.) To avoid all exertion. (3.) To try and abate 
any pain,congh, or other troublesome symptoms. (4.) To sustain the patient's 
strength until such time as the acute inflammatory symptoms have abated. 
The period of convalescence follows, and those tonics may be given, and the 
rules adopted, which are laid down in the article on Fevers. 

Pericardium. This is the name given to the membrane which surrounds 
the heart and incloses it in a bag. Thus there are two opposed surfaces, each 
of which, in health, is perfectly smooth, and enables the heart to move freely 
with the least amount of friction. The sac or bag secretes a small quantity of 
fluid, so as to lubricate the parts, and this is much increased in quantity in cases 
of hydro-pericardium, when there is a dropsical accumulation of the fluid ; this 
condition arises in cases of disease of the heart, kidneys, and lungs, and it is 
generally associated with a dropsical condition of other organs. 

Pericranium is the tissue which overlies the skull, and aids in nourishing 
the bone which lies beneath it. 

Perinaeum. This name is applied by anatomists to the region at the lower 
part of the body which is perforated at its centre by the anus. It is bounded 
in front by the genitals, behind by the buttocks, and at the sides by the inner 
surfaces of the chighs. It corresponds to the outlet of the pelvis, or bony 
gristle at the lower part of the trunk, this outlet being bounded in front by 
the pubic bones, behind by the coccyx or terminal bone of the spinal column, 
and at the sides by portions of the pubic and ischial bones, and by a fibrous 
structure called the great sacro-sciatic ligament. In the deep parts of this 
region are contained the lower portions of the rectum and the generative and 
urinary organs, with their appendages. At the surface it measures four inches 
from before backwards, and from two to three and a half inches in breadth at 
its widest part. The skin is loose, dark in color, and covered by short hairs ; 
around the anus it is puckered by radiated folds, and it is traversed from 
before backwards, exactly in the median line of the body by a prominent line 
called the raphe. This region is one of great importance ami interest to the 
surgeon, as it is here that the incisions are made through which a stoue can be 



PER 611 PER 

removed from the bladder. It is occasionally the seat of abscess, connected 
in most instances with perforation of the walls of the rectum or urethra, and 
terminating in the one case in fistula, and in the other in urethral or perineal 
fistula. Injuries, and especially heavy falls upon some hard body, are quite 
dangerous in this region, as they often cause laceration of the urethra and re- 
tention of urine. 

Periosteum. A delicate covering of the bones ; it is richly supplied with 
blood, and takes an important part in the proper nourishment of bone. 

Peritoneum. This is a serous and smooth membrane which forms the 
outer coat of the stomach, liver, intestines, and some other organs of the abdo- 
men and pelvis ; it also lines the wall of the abdominal cavity ; in this way a 
cavity is formed between its two surfaces, and this only contains a little fluid, 
just enough to moisten the opposed surfaces and to enable the intestines, etc., 
to glide over each other with the least possible amount of friction. When this 
membrane is inflamed it gives rise to great pain and sets up peritonitis. (See 
Peritonitis.) When fluid accumulates in the cavity formed by the perito- 
neum, as in cases of dropsy, ascites is then produced. Cancerous growths may 
be found in this membrane, causing a form of peritonitis, and also deposits of 
tubercle may be met with. Any injury to the membrane, as stabs or wounds 
from without, may set up a serious inflammation. 

Peritonitis. This is an inflammation of the peritoneum, or the membrane 
which lines the cavity of the abdomen, and covers the intestines. Its danger 
will vary with the cause; it may be produced by external injuries, as a stab or 
gunshot wound in the abdomen. These cases are often fatal. Cancer and 
tubercle may bring it on, but this is generally only a part of the malady, and 
the chief seat of disease is elsewhere. Any tumor of any organ in the pelvis 
or abdomen may cause it, as hydatid cysts, ovarian tumors, etc. Stricture, 
hernige, and ulceration of the intestinal canal will bring it on, and it is often 
associated with typhoid fever. 

Symptoms : Pain over the abdomen, vomiting, and a raised temperature are 
the chief symptoms ; the pulse is quick and small, the countenance anxious 
and sunken, the legs drawn up, so as to relieve the pain. The pain is worse 
on any movement, and is very wearing to the patient. In some cases of blood- 
poisoning, as in pyaemia and puerperal fever, etc., there may be peritonitis, 
and yet no pain. Colic, which often comes on in lead-poisoning, must not be 
mistaken for this disease. There will be no fever then, while there will be 
the occupation of the patient to guide one, and the individual will have a blue 
line on the gums. Some cases of hysteria may simulate peritonitis ; here, 
again, the temperature is normal, and there are the usual signs of hysteria. 

Treatment: Perfect rest in bed must be enjoined; hot fomentations, made 
as light as possible, must be applied over the abdomen ; the weight of the bed- 
clothes should be taken off from the patient as far as possible. Opium must 
be given to relieve the pain. Cooling, saline drinks and iced water may allay 
the thirst and sickness, while milk and beef-tea must be given every three hours 
or oftener, so as to keep up the patient's strength. But each case will vary so 
with the cause that any given case might require a somewhat different line of 
treatment. The only thing that a good nurse can do is to see that the room 
is cool and well ventilated, to secure perfect cleanliness, to give light and nour- 
ishing diet, and to enjoin perfect rest. Peritonitis often forms a serious com- 
plication in cases of typhoid fever. See Typhoid Fever. 

Perityphlitis signifies inflammation around the caecum. It may come on 
after taking an indigestible meal, as partaking freely of nuts, etc.; or a foreign 



PER 612 PET 

body, as a pin, cherrystone, etc., may lodge in the vermiform appendix, and 
set up inflammation around. The symptoms are great pain on the right side 
. of the abdomen and fullness there, great tenderness on pressure, sickness, 
faintness, furred tongue, and fever. The treatment will be the same as that 
recommended in cases of peritonitis. See Peritonitis. 

Perry. See Cider. 

Perspiration, or Sweat, is the secretion which is always taking place from 
the skin. Under ordinary circumstances, it is not perceptible on the sur- 
face of the skin unless very active exertion be made. The quantity secreted 
varies very much according to the temperature and moisture of the air, and the 
state of the blood and nervous system. A small quantity of carbonic acid and 
urea is excreted, but the greater part by far is water ; the secretion is acid, 
and contains fatty matters derived from the sebaceous glands of the skin. See 
Skin. 

Pertussis. See Whooping-cough. 

Peruvian Bark. See Cinchona. 

Pessaries are instruments intended for introduction into the vagina for 
maintaining the womb in its proper place and attitude. These are of various 
shapes and characters, but it is needless to describe them here, since almost 
every practitioner has got some notion of his own on the subject of which are 
best for each particular case, and such mechanical appliances must always be 
selected and adjusted by a practitioner. The pessaries we here refer to are what 
are called medicated pessaries, and consist of some drug made up into a conical 
mass, and introduced into the vagina in cases of disease of the womb. These 
are sometimes capable of giving great, relief, and are never to be neglected, 
especially where it is found necessary to employ sedatives locally. The best 
material for making these pessaries is the hard oil obtained from the fruit of 
the cacao-tree, which is separated in preparing some of the varieties of cocoa 
in ordinary use. This oil is hard as frozen butter, but is easily melted; mixed 
with a little olive oil or other similar substance it easily takes up the remedy 
when stirred with it, and when introduced melts slowly, so as to allow of the 
remedy being gradually absorbed. Perhaps the best sedatives to be mixed with 
cacao butter are extract of belladonna and extract of opium. Acetate of lead 
and sulphate of zinc may also be added if it is necessary to arrest discharges. 
Tannic acid, too, is very usefully combined with it, as is alum or similar sub- 
stances. In most cases injections do better than pessaries, but when sedative 
applications are desired the pessary allows of their reaching the parts more 
gradually and in more divided doses. 

Pestilence. See Fever, Plague. 

Petechias are spots which make their appearance in certain diseases where- 
in is much disorder of the blood. Chief among these are typhus fever, pur- 
pura, and scurvy. In typhus, the spots begin as irregular patches of a dusky 
hue, which may be elevated above the skin, so as to be perceptible to the 
finger. If there is much blood derangement, these spots are very dark in color, 
and it is these dark-colored spots, indicative of blood effusion and alteration, 
which are called petechial. There is a variety of this fever which is denomi- 
nated, from the occurrence of these spots, petechial. In scurvy and purpura 
the patches are very much 1 irger than in typhus, but in patients who have 
been exposed to the conditions which give rise to scurvy or purpura any 
acute disease may produce petechial spots in the skin and mucous membranes. 
Petechia? on the surface of the pleura? are indicative, after death, of violent suf- 
focation. 



PHA 613 PHA 

Phagedaena. This term, derived from the Greek word <£ayoj, to gnaw, is 
used to express a variety of ulceration which destroys the tissues more rapidly 
and to a greater extent than ordinary forms of ulcer. The subjects of this 
local affection are usually individuals who have been debilitated by some severe 
febrile disorder of a typhoid character, or who have been subjected to the in- 
fluence of cold and wet, foul air, bad and insufficient food, fatigue, and excess- 
ive indulgence in spirits. It is generally preceded by some sore or wound, 
and its local causes are irritation of the open surface and gross neglect of 
cleanliness. A. very superficial sore, such as that formed by the application 
of a blister, may, under the above-mentioned constitutional and local influences, 
rapidly become phagedaenic, and produce much destruction of the soft parts. 
It has been most frequently met with in connection with venereal ulcers, 
especially in those cases in which the patients have been submitted to a pro- 
longed and excessive use of mercury. Phagedaena varies in intensity in differ- 
ent cases ; it is sometimes so mild as to be scarcely distinguishable from ordi- 
nary ulceration, and in other instances it sj>reads with so much rapidity and 
destroys so great an extent of the surface of the body that there seems to 
be very little difference between it and the affection known as hospital gan- 
grene. This latter form of phagedaena is met with in noma, cancrum oris, and 
the sloughing throat of scarlatina. It is believed by many surgeons that 
phagedaenic ulceration is caused by poisoning of the blood, in consequence of 
the absorption of putrid matter. 

In phagedaena there is a large and rapidly-spreading ulcer, the edges of 
which are formed of sharply-cut, indented, and undermined skin. The surface 
of this ulcer is uneven and of grayish color, and is covered by a dark-colored, 
thin, and very fetid discharge, which is often marked by streaks of blood. The 
integument surrounding the ulcer is swollen, and of a dusky red color. The 
ulcerative process is attended with severe gnawing pain. 

In the treatment of this affection it is necessary that the patient be supplied 
with good nourishment, and that alcoholic stimulants be given freely, but at 
regular intervals. Opium is generally administered for the purpose of reliev- 
ing the severe pain and of allaying nervous irritation. The diet should con- 
sist chiefly of fluid food, such as milk, beef-tea, and strong broths. The patient 
should be kept in bed in a large and well-ventilated room The bowels should 
be kept open by mild purgatives, but great care must be taken to avoid 
diarrhoea, as the subjects of phagedaena may rapidly sink under any excessive 
drain upon the system. The local treatment consists in cleansing the surface 
of the ulcer by frequently syringing it with some disinfectant lotion, as a solu- 
tion of carbolic acid, of permanganate of potash (Condy's fluid), or chloralum, 
and in relieving the pain by the application of poultices or poppy fomentations. 
In severe cases, where the ulceration, in spite of this treatment, is spreading 
with rapidity and attacking important parts of the body, the surgeon often 
finds it necessary to apply the actual cautery, or some strong caustic. Of 
caustic applications, fuming nitric acid seems to be the one most in favor. 

Phalanx is a technical term for the small bone of a finger or toe ; each 
finger and toe, therefore, has three phalanges. 

Phantom Tumors are among medical curiosities. They commonly occur 
in females, who, examined one day, might seem to have a large abdominal 
tumor ; examined next day, nothing is felt. The size of these tumors varies 
much : in some it amounts only to the size of a fist ; in another it may amount 
to that of a fully distended uterus, near the full term of pregnancy. These 
tumors have not unfrequently been mistaken for a true pregnancy, and every- 



PHA 614 PHL 

thing been prepared for the birth of a child. Nay. the woman herself has 
been apparently in labor, and yet there has been neither conception nor even 
enlargement of the womb. The shape of the tumor may remain long un- 
changed, or may vary from day to day. Sometimes the patient complains 
of acute pain on examination ; at other times she is completely insensible. 
Again, and perhaps most frequently, these tumors seem to disappear under 
prolonged and gentle pressure, but they return next day or the day after. 

Now, as to the cause of such tumors, or rather perhaps we ought to say 
their natures. In a goodly number of instances they consist of flatus, limited 
to one particular portion of the bowel by contraction of the gut above and 
below. In other cases it is said that the muscular wall of the abdomen is 
concerned in their production, but the cases we have seen have been of the 
former kind, especially if the walls of the abdomen and the omentum were 
loaded with fat. 

The diagnosis of these tumors is more a curious problem to the physician 
than of practical interest to the public. Their existence is a fact which, how- 
ever, should never be forgotten, as their appearance may give rise to hopes 
which subsequent experience will dash to the ground. In almost all the sub- 
jects of phantom tumor there is indigestion, corpulence, and deranged men- 
strual functions. These are the things to be remedied, — the tumor will take 
care of itself. 

Pharynx. The upper part of the gullet ; it may be seen at the back part 
of the mouth behind the tonsils. It communicates in front with the mouth, so 
as to allow the food to pass down into the stomach; above, with the nose, as 
is well known in cases of vomiting ; and below and in front of it lies the larynx 
or windpipe, from which food is prevented from entering by means of the 
epiglottis. The Eustachian tubes, one on each side, also enter the pharynx, 
and connect it with the ear ; it is along these tubes that inflammation may ex- 
tend when the throat is affected, as in cases of common cold or scarlet fever, 
and so give rise to deafness. 

Phenic Acid. See Carbolic Acid. 

Phlebitis means strictly an inflammation of a vein ; in cases of pyaemia a 
clot may form in a vein and give rise to some of the symptoms; but it is 
doubtful if actual inflammation of the walls of a vein ever occurs. See 
Py.emia. 

Phlebolithes are small concretions or particles made up chiefly of cal- 
careous matter, which now and then form in the small veins. They are seldom 
recognized during life, and rarely give rise to any symptoms. No treatment 
is required, and the only result of their presence is that the circulation through 
that vessel is obstructed, and the blood has to go round another way. 

Phlebotomy means cutting a vein, as in the ordinary operation of bleed- 
ing or venesection. See Bleeding. 

Phlegm is a common name for expectoration. See Expectoration. 

Phlegmasia Dolens, also known as white leg or milk leg, is a malady 
affecting women, in childbed especially. It is most likely to occur in women 
who have been weakened by flooding or other causes. It sometimes occurs 
towards the latter stages of cancer of the womb. One or both extremities 
may become affected, and it is said that the left is more frequently its subject 
than the right. The limbs become brawny, but do not pit on pressure, and 
from altered conditions of the circulation the parts become quite white. It 
has been assumed, rather than proved, that it depends on coagulation of the 
blood in the veins, and it has been called obstructive phlebitis. Others, again, 



PHO 615 PHO 

have said that the obstruction in the veins is quite a secondary matter. Be 
that as it may, the disease commonly occurs in a first pregnancy, mostly within 
a month after labor. The symptoms of phlegmasia may be thus enumerated : 
They begin with fever, headache, and pain, not unfrequently preceded by a 
rigor. In about four-arid-twenty hours the limb begins to swell ; the two 
limbs are seldom affected together. This swelling commences in the foot or 
ankle, and gradually creeps upwards. Sometimes, however, it begins in the 
thigh, and passes downwards, or all parts may be nearly simultaneously affected. 
The limb is hot and tender, swollen to nearly twice its size, pale white in 
color, tense, shining, and elastic, but not bagging on pressure. This acute 
stage may remain three weeks, or longer, but the limb remains useless a very 
much longer time, only gradually recovering its normal size, power, and pli- 
ability. The treatment may be said to be, in the main, prophylactic ; that is 
to say, it should be the aim to prevent such an accident, if there be any like- 
lihood of its occurring; and if it threatens, the aim should be to an est the 
malady as speedily as possible. The great thing is absolute rest ; the patient 
must not be moved. Bran poultices should be applied the whole length of the 
limb, or hot- water fomentations freely employed ; but the former are best, as 
necessitating less inconvenience to the patients. Opium should be given in- 
ternally to soothe pain, or chloral may be used for a like purpose. At a later 
period, good food, wine, bark, and iron are to be given, and bandages and hot 
fomentations, with gentle rubbings, applied to the stiffened limb. The malady 
rarely, if ever, proves fatal. 

Phosphoric Acid, in its diluted form, is used in medicine, but not very 
extensively. It may be prepared directly from phosphorus by oxidation, by 
means of nitric acid. The liquid thus obtained when diluted is colorless, and 
has an agreeable taste. Its reaction of course is acid, and generally it may be 
said to act much in the same way as sulphuric acid, but is not nearlj- so as- 
tringent. It may be given in good large doses, and it has been suggested that 
this would render it of value when combating the tendency of urine to become 
alkaline in the urinary passages. It is a good cooling medicine when freely 
diluted with water, the pleasant acid taste rendering it agreeable to many 
parched invalids. To many it may be given freely as a drink, sufficient only 
being added to the water to render it pleasantly acid. The ordinary dose is 
about half a drachm diluted. A number of compounds of phosphoric acid are 
employed in medicine. Phosphate of ammonia is chiefly for aiding the solu- 
tion of uric acid in the urine, where there is a tendency to the formation of uric 
acid calculi. Phosphate of soda, or tasteless purging salts, is a capital laxative 
for children, and may be given in their food with ease. Phosphate of iron is 
a remedy of undoubted value as a ferruginous tonic, whilst it wants the bind- 
ing and irritating qualities of some- other iron salts. The syrup of the four 
phosphates, also known as Parrish's Syrup and Chemical Food, is an invaluable 
remedy for delicate children, especially when recovering from severe disease, 
or where there is a tendency to scrofula. Phosphate of lime or bone earth is 
combined with iron in Parrish's Syrup ; it is of much value in children when 
there is a tendency to rickets. 

Phosphorus is a waxy-looking substance, of very peculiar properties, ob- 
tained from bones. The bones are, first of all, acted on by oil of vitriol, and 
the solution which is thus formed is subsequently distilled with charcoal. The 
phosphorus, which is volatile, passes over, is collected in a cool receiver, and 
subsequently moulded into sticks. These it is necessary to keep under water; 
otherwise they would take fire. When freshly prepared, phosphorus is color- 



PHO 616 PHT 

less and serai-transparent, but after a time a film forms on its surface. When 
set on fire it burns Avith a bright flame, giving rise to fumes of phosphoric acid. 
It may be converted into a peculiar form, known as red or allotropic phos- 
phorus, which possesses properties quite distinct from those of the common 
variety. Ordinary phosphorus readily takes fire; the other form does not till 
it has been heated to a high temperature, and it is said not to be poisonous, 
whereas the ordinary variety is intensely so. Phosphorus is not often given 
internally; if taken in large doses it acts energetically as a poison, and seems 
almost invariably to give rise to a form of degeneration of the liver. In 
smaller doses it has been given in nervous diseases, and as a stimulant in low 
nervous fevers. It has also been given in other diseases with no very 
marked benefit. Indeed, it may be said that up to the present time no malady 
has been treated with any peculiar benefit by phosphorus. Moreover, it is 
dangerous and unpleasant, and, except some other use be found for it, perhaps 
it had better be left out of the list of available remedies. Nevertheless, we 
are in hopes that it may ultimately be found beneficial in some form of disease. 
The dose is about one-fifteenth of a grain, and should be given dissolved in 
olive oil. 

Photophobia, or dread of light, is a symptom common to a good many 
diseases of the eye. The patient, its subject, shuns light in every way, and if 
introduced into a room with a bright light obstinately shuts the eyes, and can- 
not be persuaded to open them. It is characteristic of no one disease. See 
Eye Disease. 

Phrenology. A system of mental philosophy. The believers in this sys- 
tem maintain that it is an infallible index to the mind, and that the elevations 
or depressions in the head exhibit to the student of phrenology the whole nat- 
ure of the mind, as on a map or chart. The brain in phrenology is divided 
into three parts — the anterior, middle, and posterior. The anterior, or front 
portion, is supposed to contain all the intellectual and perceptive faculties. 
The moral sentiments or emotions are situated in the middle region, and the 
animal propensities are confined to the back of the head. Each of these por- 
tions of the brain are divided again into iudividual organs, having special func- 
tions assigned to each. Phrenologists enumerate about forty different organs 
or bumps, as they are familiarly called, each independent of the other, and 
capable of development or repression as the character is governed and con- 
trolled by the educated will. These dispositions are said to be affected by 
constitutional temperament, of which three varieties are recognized. The vital 
or vigorous and powerfully physical temperament ; the motive or bilious, 
characterized by dark hair and eyes, bony structure, and muscular develop- 
ment ; and the mental or nervous temperament, distinguished by delicacy of 
body, great susceptibility, and a light elastic frame, with fair hair and eyes. 
Phrenologists divide the mental organs into five groups, and there are many 
drawings and casts of the head illustrating this division and the situation of 
each faculty. Phrenology was at one time more studied than it is at present, 
but associated with mesmerism and electro-biology, as it is called, it has yet 
many votaries. 

Phthisis, or Phthisis Pulmonalis, is the technical term commonly ap- 
plied to pulmonary consumption or wasting disease of the lungs. The subject 
is one of vast importance, but it has been so fully discussed under the heading 
Consumption, that we shall do little more here than indicate by a bare out- 
line the chief particulars which it is of interest for the public to know. 

Up to a very few years ago the common notion was that all phthisis was 



PHT 617 PHT 

due to the deposit in the lungs of a morbid product called tubercle. This, 
after being deposited in the substance of the lung, underwent softening; the 
neighbouring portions of lung substance also softened and broke down. The 
products of the softening process usually made their way into one of the air- 
tubes, and were coughed up and expectorated. This process sadly interfered 
with health ; the body wasted away, especially under the influence of night 
sweats and an incapacity to take food, until at last death from sheer exhaus- 
tion sometimes followed. Not unfrequently the history of the case varied : the 
ulcerating or softening process going on in the lung encountered one of the 
numerous vessels which ramify through its substance ; this was eaten through, 
as were the surrounding tissues, and so suddenly an escape of blood might 
carry off the patient by choking, or by the enfeebling consequences of a large 
haemorrhage. 

Although in a certain number of cases such a history is still accepted as the 
true one, it has become more and more manifest that it does not apply to all. 
In a good number of cases the malady seems to begin as inflammation of the 
lung substance, which we call pneumonia. This does not clear up, but assumes 
a chronic character, and by and by portions of the substance of the lung break 
down, leaving cavities. But the presence of this morbid material is not with- 
out effect ; it seems to affect adjacent organs, or even organs at a distance, 
and to produce in them the bodies formerly described as gray tubercles, which 
were at one time supposed to be the starting-point, not the product, of the 
disease. 

This change of doctrine implies important changes in practice. Formerly 
we were accustomed to dread any interference with nutrition which seemed to 
favor or occasion the deposit of tubercle. Any tendency to colds or other form 
of chest malady seemed in our eyes to be due to the presence of the tubercle 
in the lung. Now, however, we look with much greater dread on any passing 
cold, or exposure to cold, fearing lest it may become the source of fatal disease 
of the lung, in the course of which tubercle may or may not appear as a com- 
plication. The change may not seem great, but it carries with it important 
deductions. To us the beginnings of consumption are less fearful when they 
come as distinct and well-recognized maladies of the lung, which we may hope 
to cure, than as an insidious poisoning of the organ, so to speak, the presence 
of which is heralded only by signs which show that its evil influence has be- 
gun. Moreover, we were taught to believe that in the great majority of in- 
stances this malady was incurable, that our art might at best only stave off the 
evil day; that once the tubercle was deposited there could be but one end, and 
that death. Now our views are much more hopeful. We know that a certain 
individual has inherited, among other personal peculiarities, a weak chest ; 
we know the risk to which this weak chest exposes him should he ever catch 
cold, and so that is to be most carefully guarded against. Should a cold de- 
clare itself in such an individual, we do not trifle with it, but if necessary 
secure a change of climate, so as effectually to get rid of it. It is the early 
treatment which these new views render so much more hopeful, and to this 
stage, therefore, increased attention is necessary. 

As to the treatment itself, there is, perhaps, nothing in the early stage so 
beneficial as change of climate, provided the appropriate one be chosen for the 
individual. In the later stages, to remove an individual from the comforts of 
home and the society of friends, to die among strangers, is simply cruelty. 
The whole subject is fully discussed in the articles Consumption and Cli- 
mate. 



PHY 618 PIG 

Physiology is the science which treats of the history and functions of the 
human body and its several parts. It teaches the function and nature of every 
texture and portion of the body, and enlightens us as to the economy and use 
of the organs of the human system. Physiology is divided into animal and 
vegetable, and again into human and comparative physiology. 

Physostigma, better known as the Ordeal bean of Calabar, in West Af- 
rica, is a substance recently introduced into practice ; and though it has had 
the advantage of an unusually careful and accurate physiological investigation, 
it has not yet come fairly into general use. The beans are the fruit of a tree 
belonging to the leguminous order, and each contains two lobes easily reduced 
to powder, and having a taste somewhat similar to that of other seeds of the 
order, which are wholesome enough. The active principle has been called 
physostigmine. It is mostly contained in the kernel, and may be extracted by 
alcohol. This extract is officinal, and is the only preparation wliieh is so. 
When taken internally these beans, or even a portion of one of them, give rise 
to serious symptoms. The bean was used at Old Calabar and in neighboring 
countries as a test for witches ; hence the title Ordeal bean. If any one 
accused of this (in the estimation of the savages there) horrid crime could de- 
vour a bean and still live, the charge was repelled ; but if, as most frequently 
happened, the trial was attended with fatal results, then general suspicion was 
supposed to be confirmed. In point of fact, if an excessive dose was taken, the 
patient sometimes recovered by vomiting ; but if only a moderate dose was 
swallowed, then death most surely followed. It seems to act especially on the 
heart and spinal cord, paralyzing the former, and arresting the functions of the 
latter. The spinal cord under its influence seems to lose the power of fulfill- 
ing its functions, the afferent nerve ceasing to act before the efferent. The 
most apparent action of the Calabar bean is, however, to cause contraction of 
the pupil of the eye. It has accordingly been used in certain forms of long- 
sight, to remedy that by applying it locally to the eye. It has also been given 
with some apparent success, real or fancied, in tetanus, even in the traumatic 
variety; but so many remedies have been vaunted for this — none having been 
found really efficacious — that men are skeptical. The dose of the extract is 
from one-sixteenth to one-fourth grain internally, given as pill. 

Pia Mater. One of the coverings of the brain and spinal cord. See 
Brain and Spinal Cord. 

Picrotoxine is an active principle contained in Cocculus Indicus, which, 
as already pointed out. is mainly used for nefarious purposes. It is added to 
beer for the purpose of making it more intoxicating, and it is employed by 
poachers to destroy fish. Picrotoxine is not used in medicine. Even coccu- 
lus has been used mainly for destroying vermin. 

Pigeon-breast. A condition of the chest due to malformation, generally 
indicative of deficient respiratory space. In pigeon-breast the chest, instead of 
being more or less rounded or flattened from before backwards, is flattened 
from side to side, and projects in front. This renders the chest exceedingly 
narrow from side to side, and causes the breast-bone to project as it does in 
birds, so as to form a ridge in front. This arrangement sadly cramps the 
space available for the lungs, for the size of the heart does not greatly vary. 
Moreover, the shape is unfavorable to chest movements, and is accompanied 
by other imperfections of build, which indicate weakness of constitution. The 
shape of the chest is mainly of importance as indicating a tendency to con- 
sumption, which is very unfavorable to the subject of lung disease. 

Pigment is the coloring matter which is found in the blood, bile, urine, and 



619 




Fig cx 



PIL 621 PLA 

in nearly all the fluids of the body ; it gives the color to the skin, and is of 
course most abundant in the negro, being deposited in the rete mucosum of 
the skin ; it is due to the action of sunlight upon pigment that people are 
liable to become tanned. It is present in excess in cases of Addison's disease 
and in leucoderma, and sometimes in pregnant women. It is in excess, also, 
in cases of melanotic degeneration. (See Degeneration.) It is more 
abundant in old age than in youth or childhood, and it gives the iron-gray color 
to the lungs in advanced age. 

Piles. See Hemorrhoids. 

Pimento is the unripe fruit of the Eugenia pimento, or allspice-tree, which 
grows in the West Indies. An oil is distilled from the fruit. The pimento 
is a small, round berry, brown and rough on the surface, having the remains 
of the calyx manifest on it. The oil is yellow, and heavier than water. Like 
the oil of cloves it appears to consist of two ingredients, similar in composi- 
tion. The odor is aromatic, and the taste hot and pleasant. It is mainly used 
as a flavoring ingredient in cooking, but the oil may be added to purgatives 
to prevent griping. The only officinal preparation is pimento water, mainly 
used as a vehicle. 

Pins and Needles is a popular phrase applied to that peculiar numbness 
and pricking of the arm, hand, foot, or leg which is so commonly felt after 
pressure or a long-continued constrained attitude. It is caused by some inter- 
ruption to the circulation, and is generally removed by rubbing or exercise. 
If it should continue, it may be the precursor of some more serious attack, and 
medical advice should be sought. 

Pitch, or, as the officinal variety is more strictly termed, Burgundy pitch, 
is the resinous exudation from the spruce fir, imported from Switzerland. It 
is hard and brittle, yet gradually takes the form of the containing vessel. Gen- 
erally it is of a dull reddish-brown, of a peculiar odor and taste. It is not bit- 
ter. It consists almost entirely of a resin, but a little volatile oil is also 
contained in it. This gives it its perfume. The resin is similar to that ob- 
tained from other plants of the turpentine group. The only preparation is the 
well-known pitch plaster, which is intended as a slight stimulant to the skin. 
The pitch plasters ordinarily sold often contain no pitch whatever. 

Pityriasis. This is a trifling redness of limited portions of the skin, with 
a futt'uraceous or brawny condition of the cuticle covering the part. It is most 
common on the head, and is known to nurses as scurf and dandruff. The head 
itches, and directly it is rubbed quantities of little scales, formed of epithelium, 
are detached. A similar affection is sometimes found at the bends of the 
joints and on the trunk. When it occurs in a severe form the hair grows thin 
and comes off in considerable quantity, but not sufficiently so as to cause bald- 
ness. A solution of borax and mild astringent ointments are often found 
enough to cure this condition ; hard friction to the skin must be avoided. It 
must not bo confounded with pityriasis versicolor or chloroma, which is a par- 
asitic disease. 

Placenta. This is a flat, rounded body which is formed in the womb dur- 
ing pregnancy, and which serves to connect the circulation of the mother and 
child, and so enable the latter to carry on the function of nutrition and respi- 
ration until birth. This structure comes away a few minutes after delivery, 
and it is commonly known as the after-birth. The placenta is often diseased in 
cases of abortion and premature birth. 

Plague. This is a form of low fever associated with swellings of the 
glands, carbuncles, and petechias, or haemorrhage in the substance of the skin. 



PLA 622 PLA 

It has been known for many years under different names, as the black death, 
Levant Plague, pestilential fever, and glandular pestilence. 

History : Before the end of the seventeenth century this disorder seems to 
have prevailed in many countries of Europe, and to have been endemic, occa- 
sionally bursting out over a wider area. In London, for the first seventy 
years of the century, not a year passed by without a few deaths being recorded 
as due to this disease, while it appeared in an epidemic form in 1603, 1625, 
1636, and 1665. The last epidemic was so terrible in its consequences as to be 
known as the Great Plague, but it was followed by a marked decline, and the 
deaths afterwards became fewer and fewer, and after 1679 none have been re- 
corded in the metropolis. During the eighteenth century, although there was 
a marked diminution in the frequency and extent of the epidemic, yet there 
were several outbursts in Europe. In Poland and in some parts of the Baltic, 
in 1710; in Provence, Marseilles, and other parts of Southern France, in 
1720-71 ; at Rocliefort in 1741, in Sicily in 1743, in several districts of Portu- 
gal in 1757, in Wallachia, Podolia, etc., in 1770, and at Moscow in 1771. In 
the present century the disease has chiefly broken out in Egypt, Syria. Asia 
Minor, and the coast of Barbary. The '• Pali Plague " was first noticed in 
India, in Cutch, in the summer of 1815, after a period of great scarcity and 
distress. From that time until 1826 it prevailed in different places in Guzerat, 
spreading to Scinde in a north westerly direction, and also toward Ahmedabad, 
and other places in the British possessions eastwards. After the beginning of 
1821, there was no recurrence of the fever until 1836, when it was observed 
in the town of Pali, then the principal depot of traffic between the coast and the 
northwest provinces of India. It spread to numerous places in Marwar in that 
year, and in 1837, and for the first half of 1838. in 1849 there was a similar 
fever in Grumah and Kumaon, on the southern slopes of the Himalayas, and in 
1853 in Rohilcund. 

Causes : Certain conditions have always been found to favor the development 
and spread of this disease. Residence upon marshy alluvial soils along the 
Mediterranean, or near certain rivers, as the Nile, Euphrates, and Danube; 
low, overcrowded, or badly ventilated dwellings ; a warm, moist atmosphere ; 
decomposing animal and vegetable matter ; insufficient and unwholesome food ; 
and physical and moral wretchedness. Those who have lived in an elevated 
situation have escaped the disease when it has appeared in the district. The 
Plague, like typhus, has often followed in the wake of famine and other 
calamities. In the neighborhood of Bengazi, on the African coast, between 
Alexandria and Tripoli, an outbreak occurred in 1858; but for two or three 
3 r ears previously there had been an unusual drought, and the cattle had per- 
ished in an unusual degree. In 1857, the destitution of the Bedouin tribes be- 
came extreme, and then the pestilence commenced. The Plague has generally 
been preceded by a great prevalence of the ordinary fevers, bowel complaints, 
pulmonary affections, and catarrh. In the spring of 1 665, catarrhs and lung 
affections were very common in London, and in the middle of the summer the 
Plague appeared. In the third week of September, 1665, no less than 8000 
deaths occurred in the course of the week, although two thirds of the inhab- 
itants had fled by that time from the city. The influence of season on the 
Plague seems to be very marked. In England the pestilence was most severe, 
in the four epidemic years above mentioned, from the middle of July to the 
first or second week in October. The Plague at Marseilles was most fatal in 
the autumn months, and this was the case at Moscow in 1771, when more 
than 1200 deaths took place for several days out of a population of 150,000. 



PLA 623 PLE 

Cold weather seems to put a stop to the progress of this epidemic disorder. 
The terrible mortality that ensues from this pestilence renders it very impor- 
tant that quarantine should be strictly enforced, and that the most stringent 
rules should be made and carried out for the protection of other countries from 
its introduction by shipping and other channels of intercourse. 

Symptoms : This disease seems to vary in its characters somewhat in each 
epidemic, and even in the same outbreak, but the older records are not suffi- 
ciently clear to be thoroughly trustworthy, and the absence of it from Eng- 
land for so many years has prevented medical men in modern times from ob- 
serving its course. Swelling of glands comes on in the groin, arm-pits, and 
neck. The carbuncles are generally on the upper or lower limbs, less fre- 
quently on the chest, back, or cheek. They may vary in number from one or 
two up to a dozen ; they vary also in size and in their tendency to become 
gangrenous. The petechia? are small haemorrhages into the skin, and may be 
found scattered all over the body. The fever symptoms are chiefly those of 
shivering, nausea, vomiting, lassitude, headache, and giddiness ; the counte- 
nance is heavy and stupid, and the eyes suffused and watery. There is then 
heat of the skin, great thirst, frequent vomiting, a coated tongue, fetid breath, 
a weak pulse, and great prostration. In some there is excitement and delirium, 
in others heaviness and stupor. The bowels are generally relaxed, and the 
stools dark and offensive. The urine is passed in less quantity than usual, and 
may even be bloody. Bleeding may also occur from the mouth, stomach, bow- 
els, and air-passages. In some the intellect is clear to the end, and in other 
cases convulsions and coma may come on. 

Treatment : Not much can be done when an outbreak occurs with respect 
to giving any medicine with a beneficial effect. But much may be done by 
avoiding any over-active measures, and allowing the patient a pure air and an 
equable temperature. Bleeding, active purgation, and the use of mercury must 
be carefully avoided. The diet must be light and nourishing, and the patient's 
strength supported as far as possible. The treatment, in fact, is the same as 
that which will be prescribed for typhus. (See Typhus Fever.) The great 
object, however, should be to carry out such sanitary measures as may prevent, 
and to avoid those unhealthy districts which favor, an outbreak. 

Plasma is the name given to the colorless fluid of the blood in which the 
corpuscles are suspended. See Blood. 

Plaster of Paris. This is sulphate of lime, known as gypsum, and is 
found in large quantities in the neighborhood of Paris. It is used, when mixed 
with water, after being reduced to a powder by heat, for making casts of any 
object, and it is a most useful material in the hands of the anatomist, to retain 
casts of interesting anatomical or surgical cases for reference and for study. 
It is much used as a dressing for fractures, instead of splints. 

Plasters. There are many kinds of plasters, or, as the Pharmacopoeia has 
it, Emplastra. We have a recognized formula for at least a dozen different 
sorts. They consist of an adhesive mixture spread when warm on leather, 
linen, or paper according to requirements. The common plaster known as di- 
achylon is made from litharge or oxide of lead. The objects for which plas- 
ters are used are to promote absorption, to support a part, or to keep the two 
edges of a wound together. (See Diachylon.) A plaster of resin is called 
adhesive plaster, and another with soap is called soap plaster. 

Plethora. A fullness of blood, which may arise from many causes. — ex- 
cess in the amount or quality of food and drink partaken of. Persons most 
subject to plethora are those of a corpulent and florid nature, and such as are 



PLE 624 PLE 

inactive and not willing to take out-door exercise. Judicious diet, abstinence 
from malt liquors, wine, and spirits, except under certain restrictions, sponge 
baths and friction of the skin, and daily exercise, are tlie best remedies. 

Pleura. This is a serous membrane which covers each lung, and also lines 
the inside of the chest or thorax. It is a thin fibrous tissue, covered with a 
very smooth layer of epithelium, which in health secretes a small quantity of 
serous fluid, and by moistening the opposed surfaces causes the lungs to ex- 
pand and glide over the chest-wall with the least amount of friction. Some- 
times this membrane is inflamed, and the patient is then said to have pleurisy ; 
or there is an accumulation of serous fluid in the pleura, as in some cases of 
dropsy, from disease of the heart or kidneys, causing hydrothorax ; in these 
cases the lung is compressed from the presence of the fluid in the pleural bag 
or cavity. When blood is effused into the pleura, it is called ha? mo thorax, 
and this is a very fatal disease ; it may be caused by a large vessel in the chest 
giving way and rupturing, or by a stab or wound from the outside through the 
chest-wall. Air is found in the pleura in cases of pneumothorax, and this con- 
dition, although of rare occurrence, may come on in the course of consumption, 
when a cavity in the lung becomes ruptured. Empyema is the name given to 
the disease in which pus is found in the pleural cavity. 

Pleurisy is an inflammation of the pleura or serous membrane which cov- 
ers the lungs and lines the greater part of the cavity of the chest. In health 
this membrane is quite smooth, and lubricated by a small quantity of fluid, so 
that the lungs can move upon it with the least possible amount of friction. 
When this membrane is inflamed, however, it becomes roughened, and in most 
cases a large quantity of fluid is secreted, in consequence of which the lung on 
that side is compressed against the spine, and there is much distress of breath- 
ing, as the patient has only one lung available for the purposes of respiration. 
In those cases in which both sides are affected with pleurisy it follows that 
there is imminent danger of suffocation, as the lungs are unable to aerate the 
blood properly, and so, unless relief be afforded, or the inflammation subside 
quickly, death is very likely to ensue; but fortunately double pleurisy is of 
very rare occurrence. 

Causes: Exposure to wet and cold is the most common cause ; but it may 
come on after an accident in which the ribs are broken, or in cases of stabbing 
in the chest or from a gunshot wound, and other external injuries. In nearly 
all cases of pneumonia, or inflammation of the lung itself, there is more or less 
pleurisy ; but then very little fluid is effused. If the patient be in bad health 
previously, the effused fluid is apt to be purulent, and then the case is called 
empyema. (See Empyema.) This is not uncommon in children after scarlet 
fever. In cases of pyaemia, pericarditis, phthisis, and many blood diseases, 
pleurisy is apt to supervene and to add to the danger. 

Symptoms : The patient first complains of a severe catching pain on the af- 
fected side, and this is made worse on taking a deep inspiration, or on cough- 
ing ; the pain is usually confined to one spot, and on listening there one may 
hear a rubbing sound, due to the roughened surfaces moving on each other. 
There is also a feeling of weakness and lassitude, the pulse quickens, the 
tongue is coated white ; there may he headache, thirst, and loss of appetite ; 
the temperature is raised, and the usual febrile symptoms appear. In a day or 
two the breathing becomes worse, because effusion of fluid is now going on ; 
the sufferer keeps to his bed, and lies on his back in a diagonal position, to 
enable the healthy lung to expand, while the affected one is too sore to rest on. 
These symptoms go on for several days without much change being observa- 



PLE 625 PLE 

ble ; but they vary in intensity according to the amount of the effusion ; in 
some very bad cases there is much distress and anxiety of countenance, the 
respirations are quick and shallow, the face is pale, and the lips are livid ; any 
exertion, as moving in bed or talking, increases their discomfort. In less se- 
vere cases the distress lessens as the fever abates, and the breathing becomes 
more regular. Then comes the time when the fluid begins to be absorbed, 
and when the lung commences to expand again ; but this takes up a very varia- 
ble time, so that no rule can be laid down as to the duration of a pleurisy, some 
being of a very slight nature, while others may take weeks or even months 
before they are really cured ; but long before this the severe symptoms have 
; abated, and the chief trouble is shortness of breath on any exertion being- 
made. In most cases the patient is liable to pain in the chest afterwards, and 
to a recurrence of pleurisy on being overheated, or on exposure to cold and 
wet. If the inflammation be due to cancer of the pleura, or to an aneurism of 
the aorta, or to phthisis, the symptoms peculiar to those diseases will also be 
present, and tend to aggravate the complaint and increase the danger. There 
are doubtless many cases in which people have dry pleurisy or inflammation 
without effusion, and in these the chief symptom will be pain in the side. But 
it must not be imagined that pain in the side always means pleurisy, as it may 
arise from many causes — as shingles, muscular exertion, indigestion, etc. 
See Pleurodynia. 

Treatment : The patient must at once be placed in bed in an atmosphere of 
about 60°— 65° Fahr., and the air should be tolerably moist. This can be ef- 
fected by boiling some water in a kettle on the fire, and letting the steam occa- 
sionally escape into the room. The main thing is to avoid great variations 
of temperature, and especially any chilling of the surface of the body. Nor 
should the patient be moved about from one room to another if such movement 
cause any distress, nor should he be allowed to talk more than he can help. 
Three or four leeches applied to the spot where the pain is greatest will give 
much relief, and then when the bites have finished bleeding a large hot linseed- 
meal poultice should be applied to the chest ; but care must be taken that the 
bleeding does not recommence on applying the heat, as too much blood may 
in that way be drawn, and tend to exhaust the patient and make him feel faint. 
Cotton wool may also be applied for a similar purpose. It is best to lie on a 
mattress rather than on a feather bed ; as the body is then kept cooler, and it 
is easier to get at the patient. Light food must be given, and milk is generally 
borne the easiest in the early or febrile stage of the complaint ; a light pud- 
ding, eggs, beef-tea, broth, jelly, and fish may be given when the appetite re- 
turns, and the tongue begins to clean. Stimulants should be given in much 
moderation, as in the majority of cases they are not much needed, and if given 
in excess tend to oppress the patient and hurry the breathing. Restlessness 
at night is a common symptom, but this must be borne as well as possible, for 
any anodyne, as opium, etc., only tends to increase the difficulty of breathing, 
and add to the distress. Bleeding from the arm and the administration of 
mercury are measures to be avoided. Blisters should not be applied in the 
early stage when there is any fever, but they must be used later on, so as to 
hurry the absorption of the fluid, or tincture of iodine may be painted over the 
affected side for the same purpose. In cases of double pleurisy it may be re- 
quired to tap the chest and let the fluid out, and in some cases bleeding from 
the arm may then be attended with benefit. During recovery, the patient 
should be careful about not going out too soon, and the more especially if the 
weather is cold, foggy, or wet. He should sit up at first in the afternoon, 
40 



PLE 626 PLE 

and may go from one warm room to another ; but he should not exert him- 
self too much if the breathing becomes hurried in doing so. Tonics may 
then be given to improve the general health, and the patient may return to his 
ordinary diet. He should be careful for some weeks to avoid exposure to bad 
weather, should not go out after sunset if possible, avoid getting overheated, 
and always wear flannel next the skin. 

Pleurodynia signifies pain in the side. It is a symptom produced by 
several conditions. It may be caused by an attack of pleurisy or inflammation 
of the lining membrane of the chest-wall ; the pain is then of a shooting char- 
aracter, increased on taking a deep inspiration, and accompanied by a furred 
tongue, quick pulse, high temperature, and the usual symptoms of a febrile 
condition. The application of four or six leeches, followed by hot fomenta- 
tions or hot linseed-meal poultices, will relieve, if not remove, the pain in many 
cases. (See Pleurisy.) Pleurodynia is often met with in women who suf- 
fer from over-lactation or leucorrhoea, or who have borne children fast, or who, 
from any cause, are in a nervous and debilitated condition ; such women gen- 
erally have the pain on the left side, or under the left breast ; they often have 
a headache, pain on pressing on each side of the spine, pain across the loins, 
and sometimes a choking feeling in the throat ; they feel weak and nervous 
and low-spirited. This pain is not inflammatory in its origin, and seems to 
depend upon an altered nutrition of the nervous centres ; its treatment will 
consist in rest, fresh air, removal of any mental worry, good and light diet, and 
tonic or strengthening medicines ; often a pill of assafoetida, taken three or 
four times a day, will relieve the distressing nervous symptoms. Pleurodynia 
may come on when shingles or herpes are present. In this disease the pain 
generally precedes the vesicular rash, and may be persistent for some time 
after its disappearance. The internal administration of quinine will do good, 
while locally an anodyne liniment may be rubbed in night and morning. Pain 
in the side is also an accompaniment of a fractured rib or a blow on the side. 
A wide flannel bandage, or strips of plaster passed half-way round the chest, 
so as to prevent the affected side from moving more than possible, will give 
relief. Pleurodynia is a symptom also in those who have a troublesome -cough, 
and their distress is increased by the pain which each paroxysm of coughing 
brings on. The pain seems due to the intercostal muscles becoming tired with 
their undue exertions. It is similar to the stiffness which one feels after a ride 
on horseback when not accustomed to the exercise. The treatment must con- 
sist in relieving the cough, and applying a flat, wide flannel belt or bandage 
round the chest, which will support the chest wall, and give great comfort to 
the patient. Sometimes pleurodynia is caused by a neuralgia of the intercostal 
nerves, and is worse at certain points when touched. The hypodermic injec- 
tion of morphia will give relief, or the side may be rubbed with a liniment 
containing opium. Lastly, pleurodynia may be caused in some cases of disease 
of the heart and stomach. When the heart is affected the treatment will con- 
sist in rest, in quieting the heart's action, and in applying a belladonna plaster 
to the side over the seat of pain. If the stomach is the seat of disease, the case 
has generally to be treated as one arising from indigestion. Whenever the 
pain is inflammatory, leeches, mustard poultices, hot fomentations, turpentine 
stupes, and other counter-irritants are useful; when it is non-inflammatory, 
and depends upon an anaemic and weakened state of the constitution, tonics, 
and especially quinine, are useful. See Pain. 

Pleurosthotonos is a term applied to the lateral convulsions sometimes 
seen in cases of tetanus, when the patient throws himself from side to side. 



PLI 627 PNE 

Plica Polonica is the name given to a curious condition of hair, in which 
the whole becomes matted and tangled together in most inextricable con- 
fusion, mixed with a large quantity of dirt, and often containing parasites. 
It is not known in this country, but it is found in some parts of Poland, Livo- 
nia, some parts of Russia and Tartary, and there only amongst the very poor 
and dirty Opinions differ as to whether the state is produced by parasites, or 
whether the mass, having been produced by dirt, the parasites flourish there as 
on a favorable soil The nature of the disease is, however, not yet made out. 
It is usually confined to the head, but it may appear on the chin and pubes. * 
There is pain and tenderness of the scalp, which bleeds at the least touch. 

Plumbers' Gout is so called because men working with lead in any shape 
are more liable to attacks of gout than those in other occupations ; it is not a 
separate disease from gout, but it signifies the mode in which the disease has its 
origin. See also Lkad-poisoning. 

Plumbism is a condition in which the individual having been exposed to 
the action of lead has brought his system under the influence of that poison ; 
plumbers are more liable to gout than painters ; the latter are more liable to 
colic. See Lead-poisoning. 

Plummer's Pill. See Mercury. 

Pneumonia, or Inflammation of the Lungs, may come on of itself, 
or it may follow in the course of some other disease, and the symptoms 
may then differ somewhat. Pneumonia is often associated with many of the 
fevers, as typhus, typhoid, and measles, also with pyaemia and some other blood 
disorders, and in these cases it adds to the gravity of the complaint ; but the 
main symptoms of pneumonia are then either .masked or modified by the- asso- 
ciated disease under which the patient is suffering. Simple, uncomplicated 
pneumonia of one lung, or part of a lung, is not a formidable affection, and 
about nine-tenths recover with proper treatment. 

Symptoms: The fust symptoms that appear are shivering or severe head- 
ache, pain on one side of the chest, furred tongue, and a high temperature ;■ in 
the course of a day or two the skin will be hot and burning, the lips dry, the 
tongue covered with a white, moist fur ; the patient breathes quickly, and is 
glad to be quiet in bed, and not be disturbed by talking ; he feels a sense of 
pain and tightness on the affected side of the chest ; he has a troublesome cough, 
and spits up frothy, viscid phlegm, tinged with blood; the urine is high-colored 
and diminished in quantity. In children the wings of the nostrils are dilated 
at each inspiration, and they breathe very rapidly. In four or five days the 
symptoms are at about their height ; on the seventh or eighth clay, in most 
cases of recovery, the temperature falls rather rapidly, the febrile symptoms 
abate, and the patient feels much better ; his tongue cleans, the appetite re- 
turns, and the breathing is easier. For some time, however, he feels short of 
breath, and some weeks may elapse before the lung clears up and becomes 
sound again. In some severe cases, such a favorable termination must not be 
looked for; the inflammation may spread to the other lung, and cause great 
distress of breathing, and bring on a livid condition of the lips ; there may be 
much delirium, and more so in those of intemperate habits; and at times the 
inflammation does not clear up, but passes into one of the forms of consump- 
tion. 

Treatment: The patient must at once be put to bed in a room with a tem- 
perature of from 60° to 65° Fahr., and the air should not be too dry. Hot 
linseed-meal poultices or hot stupes must be applied to the chest, and changed 
when they become cool. If there is much pain, a few leeches to the side will 



PNE 628 POI 

give relief. For these cases the same rules as to diet, medicines, and precau- 
tions during convalescence may be laid down as are described in the article on 
Pleurisy. In very severe cases the treatment must vary with the special 
requirements of the- case. 

Pneumothorax. This is a condition in which there is air in the cavity of 
the pleura. In consequence of this the lung collapses, and the patient is un- 
able to use the lung on the affected side. The most common cause of pneu- 
mothorax is when a cavity in the lung in a case of consumption bursts into the 
pleura; less frequently, an abscess of the lung may bring on a similar result. 
In addition to the symptoms of the disease under which the patient has been 
previously suffering, tliere will be sudden pain on the affected side of the chest, 
great pallor of the face, much difficulty and distress in breathing, and a general 
collapse of the vital powers. In most cases such an accident puts an end to 
the life of the sufferer. Pneumothorax may also be produced by external 
conditions, as when a man is stabbed between the ribs, or when the chest is 
perforated by a pistol shot, etc. In both cases air enters the cavity, the lung 
collapses, and the patient breathes with the greatest difficulty. Such cases are 
of a very serious nature, and generally prove fatal in the course of a day or 
two. Very little can be done, except keeping the patient quiet in bed, and 
covering over the wound. In such cases surgical aid must at once be sought. 
See Lungs, Wounds of. 

Podophyllum is the dried under-ground stem of the Podophyllum pelta- 
tum, the American May apple, also known as mandrake. From it is extracted 
a resin much more extensively used than the native plant. This resin, known 
as podophyllin resin, or better as podophyllin, has also been called vege- 
table mercury, from its influence on the liver. Podophyllum is exported in 
thin rootlet-looking pieces, brown and jointed. Its powder is grayish-yellow, 
with a sweet odor, and a taste first sweet, then bitter. From the powder of 
these rootlets podophyllin is obtained by exhaustion by means of alcohol. 
This strong tincture is then distilled so as to recover the spirit, and the remain- 
ing fluid added to water containing hydrochloric acid. This effectually throws 
down all the resin, which is then collected, washed, and dried. Besides this 
resin, the root contains a substance called berberin. The resin is used as a 
powerful purgative, resembling the resins of jalap and scammony. It seems, 
however, to act more on the liver than these do ; at all events, it usually empties 
the gall bladder, and so makes a show of acting on the secretions of the liver. 
It commonly gives rise to griping, and for this reason is seldom used alone, 
being commonly combined with other purgatives, or such substances as bella- 
donna. It is best, however, to give a small quantity of this remedy, say the 
eighth of a grain, along with another, say the compound extract of colocynth, 
so as to increase the efficiency of the former, or to continue its action over a 
longer period, for podophyllin is always long in acting. It is, too, by itself, 
very uncertain ; at one time causing hardly any motion of the bowels, at an- 
other an excessive flow. It is a bad remedy to take habitually, as it very 
soon seems to lose its influence. It is commonly used when it is desired to 
empty the bowels thoroughly, and so relieve the portal system, and to empty 
the gall bladder. It may be given along with bitartrate of potass in dropsy ; 
a useful adjunct is an alkali of some kind, such as Rochelle salts. 

Poisoning might be defined as the untoward results of any substance given 
internally, or absorbed from the external surface. More briefly stillj it might 
be defined as the evil effect resulting from the administration of a poison ; 
but this necessitates a definition of the word poison, which it is hard to give. 



POI 629 POI 

Almost any substance we can mention, if given in too great quantity, or if the 
quality has deteriorated by keeping, may produce poisonous effects ; and as 
these are usually unmistakable enough, it may be best to confine our attention 
to them. It is, however, generally agreed to limit the term poison to such 
substances as give rise to symptoms of illness by virtue of their own inherent 
properties, and not to qualities merely superadded for the time being. Thus, 
boiling water, if swallowed, would be quite as fatal as any poison could be ; 
but this being no inherent quality in the water, but simply dependent on the 
heat added to it, we could not speak of the evil results as poisoning. Usually, 
too, it is customary to limit the idea of a poison to such substances as give rise 
to injurious effects when taken in small doses ; but there are substances which, 
given in considerable quantity, are exceedingly fatal, whilst given in small 
quantity they produce no symptoms of importance. 

The symptoms, then, which constitute those of poisoning, that is, the product 
of a substance which we agree to call poisonous, vary greatly in kind and 
character. Some substances act almost entirely on the parts with which they 
are brought in contact, and the symptoms which arise from such we designate 
as local ; but others have little or no influence on the part to which they are 
applied; they act only when they have passed into the blood, and reached 
some remote organ, usually the brain. Such action would be described as 
remote. 

The local effects of poisons of course vary exceedingly; some, like strong 
sulphuric acid and caustic potass, act on the internal organs as they would on 
the external — they burn or corrode them, and thus cause their destruction 
or death. But there are weaker substances, chemically speaking, which yet 
cause death, though not exactly in the same way. Thus arsenic, when intro- 
duced into the stomach, sets up much inflammation, and the result of this 
inflammation may be death of the part and of the individual. In both cases, 
death is due to injury to the stomach, but in the case of the corrosive sub- 
stance it is from chemical action ; in that of the irritant, like arsenic, it is 
due to the inflammation set up from irritation by the substance. There are, 
however, certain local effects of a totally different kind. Thus aconite pro- 
duces a numbness and tingling in the parts with which it is brought in contact, 
whilst opium undoubtedly allays pain and irritation when it is applied. 

The remote effects of poisons also differ among themselves. Thus, the 
effect produced by an injury to such an organ as the stomach is similar to the 
shock produced by a railway injury to a limb, and sometimes kills in exactly 
the same way ; but in the case of arsenic there is something more, for not only 
does arsenic set up inflammation of the stomach, — vomiting, purging, and the 
like, — but it is capable of acting through the nervous system so as to bring on 
convulsions or paralysis. Here it might be said that we have three different 
kinds of effects : first, the inflammation of the stomach and bowels, giving rise 
to symptoms similar to what might be caused in many other ways ; then the 
constitutional depression produced by these, the quick pulse, symptoms of 
fever, etc. ; and, Anally, the peculiar nervous effects already alluded to. It was 
for a long time disputed whether a poison acted on remote parts by means of 
the nerves or by means of the blood, and many experiments were performed 
to settle the question. This was at length fairly done, and now we hold that 
for a poison to exert its dangerous effects upon a remote part it must be ab- 
sorbed and carried thither. It is quite true that a poison may kill without 
this, as in the case of* strong sulphuric acid, where the injury done to the stom- 
ach causes death ; but to enable opium, say, to produce more than a merely 



POI 630 POI 

local effect, it must pass into the blood and reach the brain through that me- 
dium. The view that certain poisons do act directly upon and through the 
nerves is mainly borne out by the rapidity with which some poisons, as prussic 
acid, prove fatal. This is so great as almost to preclude the possibility of its 
reaching the brain through the blood ; but the rate of circulation is great, and 
even in poisoning with prussic acid there is time for the poison to reach the 
central nervous system. There are many things which influence the action of 
a poison, perhaps the most important being the quantity or dose; for many 
poisons are in small quantities valuable remedies, though in larger they kill. 
flabit, too, has a most important influence. Thus, opium-eaters consume with 
impunity quantities of the drug which would kill one not habituated to its use. 
There is, however, a notion that certain drugs prove cumulative, as it is called 
— that is, when given for any length of time, they produce suddenly a poison- 
ous effect. Digitalis is said to act in this way, but our experience does not 
incline us to take that view. As a rule, mineral substances cannot be taken 
in constantly increasing doses. Lead, for instance, being introduced into the 
system, tends to accumulate there, and ultimately to give rise to symptoms of 
poisoning; arsenic is eaten in quantities by the Styrian peasantry without evil 
consequences ; whilst the stomach becomes more and more impatient of anti- 
mony as it is given, until at last, worn out by constant sickness and vomiting, 
the patient succumbs. 

To the public, however, it is of far more consequence to be able to form 
some idea of the diagnosis of poisoning than to be acquainted with details of 
this kind. The thing which ordinarily suggests the idea of poisoning in the 
mind of the public is the sudden onset of illness in a man up to that time in 
perfect health, especially if this illness follows shortly on eating and drinking, 
and if it proceeds rapidly and regularly to a fatal termination. Of course the 
origin of the notion of poisoning will be greatly influenced by a knowledge of 
the individual's relations in society ; in short, the question of motive com- 
monly enters largely into the idea of poisoning as framed by the public. If it 
is known that the death of any one is desired, or likely to be desired, and the 
individual be taken suddenly ill, the notion of poisoning is very apt to enter 
the public mind. Formerly — that is to say, in times now long gone by — it 
was sufficient for an individual of high station to die suddenly for the suspicion 
of poison to be spread abroad ; but at the present day, with a better notion of 
what poison can do and cannot do, these wild suspicions are much rarer ; we 
are more familiar with causes of death natural in themselves, which proceed 
as steadily and rapidly to a fatal issue as do the results of any poison. It 
may, however, be surmised that an individual is suffering from the effects of 
some poisonous substance if, shortly after taking food or drink, he be seized 
with violent pain in the stomach, witli vomiting and purging, especially if con- 
vulsions or paralysis are present, or if the patient suffer from great giddiness 
or delirium, or if there be a great tendency to sleep. It is chiefly in a com- 
bination of these three that we must rely for a certain diagnosis, and sometimes 
any diagnosis is impossible during life, however strong suspicion may be. 
Sliould suspicion of poisoning enter into the mind of any one, it would be his 
duty promptly to arm himself with further aid and support, by having recourse 
to the services of the best medical practitioner within reach, and, if necessary, 
to communicate his fears or suspicions to the gentleman so called in. This is 
of the utmost importance for the safety of the patient, and of course secures 
the individual from a charge of officiousness, to say nothing worse. If any one 
is suspected, their conduct is to be narrowly watched, for that often gives the 






POI 631 POI 

clew desired; very few guilty people are able to dissemble so, as to give rise to 
no suspicion ; generally their part is overdone, whether that be pretended in- 
terest or callousness. This of course refers to criminal poisoning, for in cases 
of accidental poisoning, as soon as suspicion is aroused aid is most eagerly 
sought, and information and assistance are eagerly proffered. In the former 
case, the skill of the detective is required, as well as the special knowledge of 
medicine necessary to distinguish a case of poisoning from a case of disease, 
and of the treatment required in any given case. It is really this last which is 
of most value. Accidental poisoning may occur at any time, so many poison- 
ous substances are now employed in the arts and manufactures, and a knowledge 
even of general principles may be of exceeding great value when life and death 
are hanging in the balance. 

Taking it for granted that we have to do with a case of poisoning, we shall 
proceed to lay down certain rules which apply, more or less, to all cases, and 
which may be called into play by any one. Suppose an individual has swal- 
lowed poison, accidentally or purposely, and it becomes necessary for the by- 
standers to interfere for his safety, three things have to be done: (1) To get 
rid of the poison ; (2) to stop its effects ; and (3) to remedy the evil it has 
done. One or other must come first, but it does not greatly matter which of 
the first two really is first attended to ; the first always comes best. When 
the question arises whether we are to get rid of the poison before stopping its 
action or after, one rule enforces itself ; that is, to save time. " Whatever is 
readiest is best " is emphatically the rule in dealing with poisoning. Better 
the poorest remedy given at the moment, than the very best given an hour 
later. There is this, however, to be said, as far as the public are concerned, 
that they always have the means of getting rid of the poison by them, but not 
always the means of stopping its action or remedying its effects ; so that, gen- 
erally speaking, the former should be attempted in the absence of skilled aid. 
A considerable number of all poisons are what might be styled self-evacuat- 
ing ; having been taken, they set up vomiting and purging, and are thereby 
eliminated. In such cases, all that is necessary to be done is to aid the self- 
evacuating process ; especially to aid the vomiting, and so perhaps get rid of 
the poison altogether. Ordinarily two kinds of means are employed to get rid 
of the poisonous substance in the stomach : these are the stomach-pump and 
vomiting. It requires considerable skill to use the stomach-pump, and usually 
where one is to be obtained, there is also to be obtained the skilled aid neces- 
sary for its employment. In passing the tube down into the stomach, the 
grand rule is to use as little force as possible, and to make the point of the 
tube slide along the posterior wall of the gullet. Occasionally grievous acci- 
dents have arisen from unskillful use of this instrument ; and so any one not 
acquainted with it, and attempting to use it, should attend implicitly to this 
rule. The great advantage of the stomach-pump is that it allows you to wash 
the stomach out. With a properly constructed instrument it is possible to re- 
verse the current, and so to wash out the stomach effectually. There are, how- 
ever, certain cases — as where violent corrosives have been swallowed — where 
the tissues are so much softened that an attempt to pass the stomach-pump 
would very likely end in driving it through them, and so such an attempt 
must be strictly avoided. The advantage of the stomach-pump is that it re- 
quires no action on the part of the stomach to empty that organ. . In cases 
where the stomach is paralyzed, as it sometimes is in opium poisoning, this is 
of very great importance. 

In cases where, from whatever cause, the stomach-pump cannot be employed, 



POI 632 POI 

we have left to us the self- evacuation known as vomiting. This sometimes is 
one of the results of the poison itself ; in others it must be excited. If, as 
most irritants do, the poison have given rise to vomiting, it may only be neces- 
sary to encourage it. This is best done by tickling the fauces with a feather, 
and by copious draughts of lukewarm water. This process, though exhaust- 
ing, must be continued until everything seems expelled from the stomach. 

Sometimes, however, there is no vomiting, and then something must be given 
to cause the stomach to get rid of its contents. Here the same rule that the 
readiest is best prevails. It is useless, or worse than useless, to wait till an 
emetic is brought from the chemist's shop ; if that be far away the resources 
of the locality must suffice. Three things may be made use of as emetics, 
which are to be found almost everywhere. These are mustard, salt, and 
smelling-salts, besides the stimulation of the fauces with the finger and the 
use of lukewarm water. Smelling-salts are not suitable for all cases, but are 
good in a certain number of cases of poisoning, especially by vegetable sub- 
stances, which give rise to narcotic symptoms. The dose of this is a teaspoon- 
ful given in a pint of lukewarm water, to be followed up by large draughts 
of the same. Mustard is a better emetic, and is generally to be had ; its use 
is limited to those cases where there is no violent irritating effect caused by 
the poison. Usually it suits best where there is a sedative effect produced by 
the poison, and the stomach requires a stimulant to call its action into full 
play. The dose of mustard is a tablespoonful mixed up with a pint of luke- 
warm water, to be followed by copious draughts of the same. Salt can always 
be had, and a handful of this dissolved in water will usually suffice to produce 
copious vomiting, and so the evacuation of the stomach contents. Ipecacuanha 
is a most useful emetic in cases where the stomach has been already irritated, 
and it is desirable effectually to get rid of any irritant substance which may 
remain. It is best given as ipecacuanha wine, half an ounce for a dose. 

When the poison has been administered locally, as in snake- bite, it may be 
necessary to scarify the wound, so as to make it bleed freely, to suck it, and 
if necessary to apply a ligature round the limb, higher up and nearer the heart, 
if the wound be so situated as to admit of this, so as to prevent the passage of 
the poison upwards towards the heart and nervous centres. Washing, too, 
should be freely employed, especially by means of a heavy stream of water. 

Frequently, however, the simple plan of getting rid of the poison will not 
suffice. Its effects have to be neutralized or remedied. That means, practi- 
cally, that some antidote must be given. Now no one antidote is suited to all 
emergencies ; the antidote must be suited to the poison, and accordingly we 
must consider each poison or group of poisons separately with this view. The 
object of most antidotes is to render the active poison an inert substance, after 
which treatment may be employed to remedy the mischief already done. 
Most antidotes, therefore, are chemical agents which attack the poison, and 
render it insoluble, and so inert ; but some are of a kind whose virtues seem 
to be opposed to those of the poison — in short, what used to be called a 
counter-poison. 

The ultimate end of all treatment is to keep the patient alive : much may 
therefore require to be done to obviate the tendency to death which we cannot 
here recapitulate or even include in the treatment of poisoning, being common 
rules in the treatment of all diseases. To allay sickness and vomiting, if ex- 
cessive ; to preserve strength ; to procure rest in one set of cases, to keep the 
patient awake and from yielding to the sedative influence of the drug in 
another ; in all, to carry him through the period of danger, which varies in 



POI 633 POI 

length in the case of many poisons, but which may be said to be distinctly 
limited, and to constitute one of the elements of safety in all, — such are, gen- 
erally speaking, the ends to be kept in view in dealing with a case of poisoning. 

The classification of poisons into certain groups has long been of the crudest 
description, and is still exceedingly imperfect. Long ago they were spoken 
of as mineral, vegetable, and animal. Even now some adhere to that group- 
ing. It is, however, desirable to arrange them in some fashion, however im- 
perfect, according to the effects they produce, and so the old crude classification 
into irritants, narcotics, and narcotico-irritants is better than none. We have in- 
cidentally pointed out certain broad distinctions which enable us to give some 
better idea, however. Some poisons, we pointed out, like sulphuric acid, when 
strong act chemically by destroying the vitality of the parts to which they 
are applied. Snch we may call corrosives ; others act as irritants, especially to 
the stomach, and may be called irritants ; but of this kind there are at least 
two groups : those which irritate the stomach, but do not produce any other 
symptom than would an acute inflammation of that organ, howsoever caused ; 
and those which, like arsenic, not only give rise to inflammation of the stomach 
with its sequences, but also produce certain'specific effects characteristic of their 
action. Jn the case of arsenic, these are mainly nervous ; in the case of mer- 
cury,, they are salivation or sloughing about the mouth ; in the case of anti- 
mony, intense prostration of strength, and so on. These we may call specific 
irritants. After these come a great group which affect the nervous system in 
various ways, some producing sleep, others delirium ; some calming nervous 
action, some exciting it, and giving rise to convulsions. All these had better 
be classed together, in the' first instance, as neurotics — substances, that is, 
affecting the nerves. Each of these has its appropriate symptoms, and often 
an appropriate antidote. 

The corrosives, as we have already shown, are poisons which act by vir- 
tue of their chemical properties. When swallowed, they destroy the surface 
and sometimes the. deeper parts of all the organs with which they are brought 
in contact. The consequences of such injury, in short, are as violent as may 
follow destruction of a pair of limbs. They speedily bring about death. 

The chief corrosives are the three strong mineral acids, sulphuric acid, nitric 
acid, and hydrochloric acid. The three chief alkalies act in a somewhat similar 
fashion : these are caustic potass, soda, and ammonia. Moreover, these same 
substances, if diluted so as not to occasion softening and perforation of the 
stomach, may yet be sufficiently powerful to give rise to fatal inflammation. 
These poisons give rise to tolerably characteristic symptoms. The symptoms 
begin immediately after swallowing ; the taste and feel are characteristic. 
Whatever they touch is altered, and they commonly occasion a vomiting of 
bloody matter. The remedies to be applied differ in the case of the acids and 
alkalies, the one being in point of fact a kind of antidote to the other. The 
strong mineral acids cause vomiting, and less frequently purging, and the lips 
and tongue are commonly marked. First of all they are white with sulphuric 
and hydrochloric acid, and afterwards they become black. Nitric acid always 
gives rise to a yellow mark. 

The best remedy for these acids is some weak alkali, not caustic potass or 
soda, nor even their carbonates, but some such substance as magnesia, beaten up 
with water or milk, and given in considerable quantity. The carbonate of 
magnesia is not so good as the calcined magnesia for this purpose, as it sets free 
a large quantity of carbonic acid, which may prove troublesome by distending 
the stomach. 



POI 634 POI 

The alkalies must be dealt with in exactly the opposite fashion — they must 
be neutralized by some weak acid ; vinegar is perhaps the best thing to give, 
but any weak acid, like acetic acid, citric acid, or tartaric acid, may be given. 
Oxalic acid must not be given, being itself a deadly poison. For alkalies and 
acids, too, oils may be given with advantage. With neither acids nor alkalies 
must the stomach-pump be used. The vomiting which commonly follows the 
exhibition of such substances should be fostered by diluent drinks, as linseed- 
tea, gruel, exceedingly thin arrow-root, etc. 

Sometimes these poisons attack the larynx where it joins the gullet, and may 
even cause suffocation. Should such a fate impend, it is quite proper to open 
the wind-pipe by laryngotomy or tracheotomy. Finally, we must note that these 
substances frequently cause death long after they have been swallowed. They 
destroy the tissues with which they come in contact ; the consequence is that, 
if the patient recovers and these sores heal in the gullet, the coats, as is usual, 
contract. This goes on, the gullet becoming narrow and narrower, till at last 
the patient may perish of actual starvation. This is a danger not to be over- 
looked, and so the medical attendant will do well in a case of this kind to pass 
a probang from time to time, to make sure that the gullet is not contracting. 

Some vegetable acids must not be overlooked. Chief among these is oxalic 
acid, which is one of our most deadly poisons if given in quantity. This acid 
is frequently used to remove iron stains from linen, etc., or to clean brass ves- 
sels, so that accidents may result from it at any time. Vomiting commonly 
follows ; if not, a little warm water should be given ; but neither alkalies nor 
the stomach-pump should be used. The best thing to give is lime — even 
common plaster knocked down from the wall and ground up with milk or water 
suffices. For all the acids hitherto mentioned whiting in water is a capital 
remedy — perhaps the best. 

Together, after this, we may group nearly all vegetable irritants and a good 
many mineral ones, including the salts of zinc, tin, silver, chrome, and iron. 
These act by giving rise to vomiting and purging, the common irritant symp- 
toms, and the best way of dealing with them is to promote the vomiting in the 
first instance, and afterwards give demulcent drinks, or eggs beaten up with 
milk. Sometimes a substance containing tannin, as oak bark, catechu, kino, etc., 
had better be prescribed, especially for zinc and silver ; but for the last common 
salt furnishes the best antidote. As regards simple vegetable irritants, includ- 
ing gamboge, scammony, elaterium, croton-oil, castor-oil seeds, euphorbium, etc., 
the grand rule is to favor vomiting till everything seems ejected, and then to 
treat the case like one of inflammation of the stomach and bowels. 

There are some peculiar substances to which a word more is due. Phos- 
phorus, for instance, seems a most extraordinary kind of poison. It gives rise 
to symptoms of a very peculiar kind, specially affecting the liver. For it, un- 
fortunately, there is no true antidote ; the great thing is to get rid 'of the sub- 
stance, and that is best done by making use of the stomach pump ; chalk and 
water and magnesia had also better be given. The vomited matters in this 
form of poisoning gleam in the dark. 

Arsenic gives rise, as we have seen, to mixed symptoms, some dependent on 
irritation of the stomach, some on its peculiar influence on the nervous system. 
It is not possible here to lay down the marks diagnostic of arsenical poisoning, 
but its treatment consi-ts in aiding the escape of the poison from the stomach 
by giving diluents and favoring vomiting. Raw eggs, beaten up with milk, are 
also useful. Animal charcoal, calciued magnesia, and a variety of other sub- 
stances have also been recommended. The best antidote of all is the hydrated 



POI 635 POI 

oxide of iron. This may be prepared by taking a chemist's stock bottle of 
tincture of the perchloride of iron, and adding to that liquor potassse or caustic 
ammonia. The whole should then be run through a tow filter (made by 
stitching a morsel of tow or hemp in a funnel), and washing the filtrate. The 
solid part is to be used. The same may be given for poisoning by prussic acid. 
Nowadays, many chemists keep this remedy ready for use. 

Antimony is peculiar, as we have pointed out, in that it produces extreme 
depression. The best remedy for poisoning by most antimonial preparations 
is some substance which contains tannin. Black tea does so to a large extent 
when boiled : in case of difficulty, therefore, a few ounces of tea should be 
thrown into boiling water, or, better, a small quantity of boiling water added 
to it ; the whole boiled for a few minutes, strained, reduced with cold water till 
fit to drink, and swallowed. Magnesia should also be given, if chloride of an- 
timony has been the substance used. 

Mercury is poisonous mainly in one form — corrosive sublimate. This gives 
rise to symptoms a good deal resembling those of ordinary corrosive poisoning ; 
but speedily the mouth becomes affected, and salivation or even sloughing 
follows. For corrosive sublimate, albumen is the best antidote. To that end 
white of egg should be beaten up with milk and freely administered. 

Lead differs from most substances of its class in that it gives rise to constipa- 
tion rather than purging. This rule is not, however, by any means absolute. 
Should the bowels be confined, castor oil must be given ; but acute poisoning 
from lead is, comparatively speaking, rare ; chronic poisoning is that which 
we most frequently encounter. See Lead-poisoning. 

Of the poisons called neurotic, opium occupies the chief place. The symp- 
toms it gives rise to are totally different from those alluded to in the foregoing 
section. Soon after it is swallowed the patient becomes drowsy, and gradually 
deep sleep comes on, till he can hardly be aroused : if not roused in time, he 
sleeps the sleep of death. It is in such cases that the use of the stomaclvpump 
and emetics is most beneficial. Without them the patient would almost cer- 
tainly sink; but when the poison is removed from the stomach, provided the 
individual can be kept alive for a few hours, he will recover perfectly. If any 
emetic is given, it should be mustard or sulphate of zinc. The patient must be 
kept moving about, for if he sleeps he dies. Strong coffee and the galvanic 
battery are also useful adjuncts. 

The treatment of opium poisoning is also the treatment of the great class of 
substances which it represents, but some of these admit' of special treatment; 
and even opium poisoning itself may sometimes be managed by the use of a 
special remedy — belladonna. In almost every instance neurotics have got a 
certain period within which they prove fatal ; that being passed, the patient 
gradually recovers. Now as regards opium, this is certainly within twenty-four 
hours ; if, therefore, the individual can be kept alive during that time he is safe. 
Very often a full dose of belladonna assists greatly in this. 

There is a group of poisons often held to be allied to opium, but in reality 
widely different ; in point of fact, they produce delirium rather than sleep, and 
have hence been called deliriants. These include hyoscyamus, belladonna, 
stramonium, and datura. All of these substances are poisonous, though no 
death is recorded as the result of hyoscyamus. The treatment of these is in 
many respects similar to that to be adopted for opium. Emetics are to be 
promptly given ; if the substance has been given for some length of time, and 
debility has set in, so that the stomach does not. readily react, then the stomach- 
pump should be used. The 'emetics, too, should be stimulant, as sulphate of 



POI 636 POI 

zinc or copper, mustard, or common salt ; never ipecacuanha or tartar emetic. 
Moreover, it may be necessary to give something to stop the action of the poison ; 
some substance containing tannin, as tea or coffee, is best ; not prepared as for 
ordinary use, but boiled as hard as may be. 

In some respects the actions of aconite and prussic acid are alike : both pro- 
duce speedy and deadly results ; both seem specially to influence the heart. 
The treatment for aconite is similar in all respects to that just recommended 
for belladonna and its allies, but that for prussic acid is different. In point of 
fact, prussic acid proves so speedily fatal that there is seldom time to do more 
than give the patient some ammonia. Were there more time, and were any 
hydrated pei'oxide of iron, such as is used in arsenical poisoning, at hand, it 
ought to be given ; but such is the deadly power of the poison that there is 
seldom time to treat it ; not that prussic acid is so speedily fatal as is sup- 
posed, for a man has had time to run up and down two flights of stairs, and 
even then a considerable time elapsed "before death, after a very large dose. 
Cold affusion has been recommended, but we fear would be like most other 
remedies for the poison — a remedy too late to be of any use. Iron and a 
free close of ammonia should be the remedies. 

There is another very fatal group of poisons, of which nux vomica, with its 
alkaloid strychnine, is the type. These poisons give rise to violent convul- 
sions, similar to those produced by tetanus ; hence we conclude that this poison 
acts mainly, if not entirely, on the spinal cord. Here, too, we must try to get 
rid of the poison as speedily as possible, if that be in our power ; but if the 
patient is ah-eady fully under the influence of the drug any attempt to use 
the stomach-pump is sure to bring on a fit of spasms, which will alike prevent 
its passage and exhaust the patient. An emetic might be used, or, at all 
events, tried ; but the patient should he kept as quiet as possihle. There is no 
antidote. Animal charcoal may he used, so may tannin, and a hundred other 
things ; but the only hope we can have is in enabling the patient to weather 
the storm by giving him, from time to time, a whiff of chloroform and ether 
mixed, so as to allay the spasm, to prevent suffocation in it, and to avoid the 
danger of fatal collapse from exhaustion in the interval. All these poisons 
are of a kind with which we have not much to do ; hut they introduce us to a 
fresh group, to which most of us are liable some time or other. Anaesthet- 
ics and noxious gases, at least of one kind, are closely allied. The anaesthet- 
ics in common use are chloroform and ether, or a mixture of the two. Now, 
no case whatever of anaesthesia from these agents is absolutely without risk, 
and so men ought to be chary of recommending their use, save in serious cases. 
When it is merely to remove a tooth or to cut off a bit of skin, it is far better 
to suffer the pain than to risk the dangers of anaesthesia. Recently another 
anaesthetic, nitrous oxide, has been reintroduced. This, no doubt, is very use- 
ful for short operations, as removing teeth; but it is unsuited for more pro- 
longed ones. 

Anaesthesia depends on reducing the oxidation of the blood to a minimum, 
or, at all events, that enters into the phenomena of its production, and so it is 
akin to poisoning with gases, like carbonic acid. Carbonic oxide, which is the 
main element in causing death from charcoal fumes, is a different kind of agent. 
Carbonic acid inhaled simply seems to prevent the entire evolution of carbonic 
acid by the lungs ; carbonic oxide, on the other hand, seizes upon the blood- 
corpuscles or coloring matter, fixes them, and renders, them unable to take up 
or give off oxygen. In all cases except a few where the heart is paralyzed, 
as in some chloroform cases, the danger is an arrest of the respiratory process. 



POL 637 POR 

That may depend on paralysis of the muscular power necessary to effect the 
movements of the chest, and to the change of the air, or on some other cause. 
Be that as it may, in any danger from anaesthesia, we have mainly to direct our 
attention to this — to see that the air-passages are clear, that the tongue does 
not occlude them, and to persist in those movements which we know as arti- 
ficial respiration. (See Respiration.) Stimulants, too, should be used. If 
the heart has been brought to a stand-still, galvanism may be used ; but the 
grand remedy is merely artificial respiration, which we must endeavor to 
effect as thoroughly as possible. 

Most of the poisons here treated of are dealt with under separate headings, 
and fuller instructions are there given as to how we can obviate their tendency 
to produce death. 

Polydipsia is a technical terra for excessive thirst ; in some cases of dia- 
betes an immense quantity of fluid is taken in the course of twenty-four hours. 
This symptom, however, is occasionally observed in other cases in which there 
is no sugar in the urine. 

Polypus. This is generally a pear-shaped tumor, attached by its thin 
end or stalk to some mucous membrane. Polypi are covered by mucous mem- 
brane, and within have a kind of semi-gelatinous contents. They may be de- 
tached by pulling them down with a pair of forceps, and strangling the stem 
with a piece of wire. They occur most frequently in the nose and in the 
womb, and in both situations give rise to troublesome symptoms. Removal is 
the best kind of treatment when it is possible. 

Polyuria is a term to signify an excessive flow of urine, as in some cases 
of diabetes. See Diabetes. 

Pomegranate-root Bark is a remedy said to be of very great value 
against worms when it can be obtained fresh ; where it is only possible to ob- 
tain it dried, it has not come up to the encomiums passed on it. The fruit of 
the pomegranate is tolerably well known. The rind of the fruit was at one 
time used as an astringent, and may yet be so wljere no better is to be had ; 
but as it owes its efficacy to thu tannin which it contains, the latter substance 
is preferable. There is an officinal decoction of the bark of the root ; but it 
is rarely, if ever, employed. Indeed, it is mainly of use medicinally, as already 
said, for its astringent properties. 

Pompholyx is another term for pemphigus. See Pemphigus. 

Poppy Capsules are the capsules of the opium poppy grown in this coun- 
try, and gathered before they are quite ripe. They therefore contain a little 
opium, and the numerous seeds in their interior, called maw-seeds, contain a 
bland oil ; consequently a decoction of these capsules contains a doubly sooth- 
ing property from the opium and from the oil. This decoction is the mode in 
which poppy capsules are mainly employed. A warm fomentation is prepared 
by boiling some of these capsules in water, and an injured part is bathed with 
the fluid while yet warm. Sometimes a poultice is made from this fluid, and 
applied to bruises and other injured parts where the skin is whole. The 
quantity of opium contained in these capsules is very small and very variable. 
No preparation of the capsules ought to be used internally, though two of- 
ficinal preparations of them still remain which are intended for this purpose, 
namely, an extract and syrup. This syrup used to be given to children, but 
its use ought to be entirely abandoned — it is dangerous. Far better use 
laudanum or morphia, and then we know what we are dealing with. 

Porrigo, or Scald Head, was commonly applied in former times to any 
affection of the head where there were scabs and a moist discharging surface. 



POR 638 POT 

The term is now applied to cases in which impetigo has been irritated, and the 
small pustules have run together, and made an angry, red, and raw surface, 
which scabs over and discharges a watery fluid. It is a disease common in 
childhood, and often occurs on the chin, or round the corners of the mouth, or 
on the head. It looks like an eczema eruption. The part should be washed 
often with oatmeal and hot water, so as to remove the scabs; then olive oil or 
zinc ointment should be freely smeared over the raw surface ; soap ought not 
to be used. The bowels should be opened by Gregory's powder, or a mixture 
of rhubarb and magnesia ; the diet should be light and nourishing, and, since 
such children are generally pale and unhealthy, a little iron wine should be 
given two or three times a day. See Impetigo and Eczema. 

Port. See Wines. 

Portal Vein. This is the important vessel which, receiving the venous 
blood on its way from the stomach, spleen, and intestines, carries it on to the 
liver, to be distributed through that organ. See Liver. 

Porter. See Beer. 

Potass is the hydrated oxide of the metal potassium, or kalium, which, it- 
self, is oidy a chemical curiosity ; but its salts are of. unspeakable value to 
mankind. 

Liquor potassce, or solution of potass, is prepared from carbonate of potass, 
by adding to its solution quicklime ; when heated, after a time carbonate of 
lime forms, and the clear fluid is caustic potass in solution ; this diluted to the 
proper strength is liquor potassre ; evaporated to dryness, and cast into moulds, 
it constitutes solid caustic potass, which is used for a variety of purposes. 

Liquor potassaj is colorless, very acrid, and has a soapy feel. If kept in 
glass bottles containing lead, it attacks them; hence it is usually kept in 
bottles of green glass. Large doses of this substance may do much injury, 
and even a small dose, if concentrated, may prove fatal. The dilute solution 
used in medicine is a very valuable antacid, not only as neutralizing any free 
acid, but as tending to bring the stomach to a normal condition, being a 
sedative to its lining membrane. Sometimes a weak solution of caustic potass 
is used as a wash in certain forms of skin disease. 

Caustic potass, in the form of stick, is usually met with in little pieces about 
the size of a pencil. These should be quite white, but usually have a grayish 
tinge ; they speedily melt when exposed to the atmosphere, and therefore re- 
quire to be kept in closely-stoppered bottles. This substance speedily dissolves 
animal tissues, forming a kind of soap with them. Another preparation, for- 
merly a good deal used for a similar purpose, was potassa cum calce — potass 
and lime : this does not melt so readily. It is sometimes used for making 
openings over abscesses when the patient dreads the knife, but always leaves 
an indelible scar. Caustic soda is now a good deal used in place of caustic 
potass, as it is a good deal cheaper. 

Carbonate of potash is made from pearl ashes ; these again from the ashes 
of wood. It occurs in small white grains, somewhat crystalline in appearance, 
and strongly alkaline. It attracts moisture from the atmosphere sufficient 
after a time to melt it; it must therefore be kept in carefully-stoppered bottles. 
Carbonate of potash is less alkaline than caustic potass, but is too much so to 
be freely used internally; in point of fact, it is chiefly used as alkaline lotions, 
which are applied to the skin in certain forms of disease of that part of the 
body, and in rheumatism and gout. 

Bicarbonate of potash is made by passiug a stream of carbonic acid through 
a solution of the former salt. It occurs in large crystals, which do not absorb 



POT 639 POT 

water from the atmosphere, and which have a mildly alkaline taste ; the crys- 
tals are readily soluble in water. Bicarbonate of potash is largely given in- 
ternally, and may be taken in large doses, which speedily make the urine 
alkaline, and frequently increase that secretion. This is perhaps the favorite 
preparation of an alkali for internal use. 

Alkalies have, indeed, a most extensive and most important application in 
medicine. Thus, taken into the stomach they induce a copious flow of the 
digestive fluid ; and, though alkaline themselves, give rise to a powerful acid 
secretion in abundance, thereby materially aiding digestion. 

The strong caustic alkalies, as already said, may be used, and often are used, 
for the destruction of warty growths, the hard edges of sores which will not 
heal, and so on. It must, however, be borne in mind that these substances 
readily permeate the tissues, and soak into and destroy them, sometimes to a 
much larger extent than is desired. The fluid, too, formed in rubbing into the 
skin or other parts, is apt to run, and precautions must be taken to avoid that. 
It is perhaps best to use a piece of blotting paper to surround the part which 
we desire to destroy ; and as soon as we think the destructive action has gone 
far enough, it is best to wash the surface with vinegar and water. It must 
also be borne in mind that the parts are destroyed to a much greater extent by 
using this caustic than would be imagined. Sometimes a large extent of sur- 
face sloughs after it has been applied a little too vigorously. The carbonate of 
potass, in the proportion of a drachm to a pint of water, is an admirable appli- 
cation in certain forms of skin disease. In nettle-rash and prickly heat there 
is nothing nearly so good, and even in the malady called eczema there is no 
application so valuable. It may be tried in all cases where there is much 
itching, and if crusts be present it will speedily remove them. It is in the 
stage where the whole skin seems to weep that this application is most bene- 
ficial in eczema ; later, when there is rawness only, it ceases to be of use. 

In that peculiar skin disease common in young people about puberty, where 
the face is covered over with little red dots with yellow tops, this plan will be 
found most useful. Strong yellow soap should be plentifully used, or the pus- 
tules should be touched with a rather sti'ong solution of carbonate of potass ; 
at all events, the yellow tops ought to be kept from forming. Alkaline lo- 
tions, similar to those mentioned, are employed to remove the chalk stones of 
gout. The swellings should be kept enveloped in cotton wool or lint soaked 
in such a lotion, and kept moist by a covering of oiled silk. 

Internally, besides being used to help digestion, alkalies may be given to 
neutralize acidity : but as a rule such treatment is a mistake. The cause of 
the acidity should be dealt with, not the acidity itself. They are also em- 
ployed, mainly as carbonate or citrate, internally to increase the alkalinity of 
the blood and urine. In the system they seem to favor the conversion and 
oxidation of various substances, and so seem useful in various ways ; partly 
by helping oxidation, partly in rendering the products of oxidation more 
soluble. 

When there is excess of uric acid in the urine, whatever may be its origin, 
bicarbonate of potass may, as a rule, be given with benefit ; some prefer the 
citrate of potass. In any case the object will be best attained by giving the 
alkali in the form of an effervescing draught, say 20 grains of the bicarbo- 
nate of potass with a little sugar, to which, when dissolved, a tablespoonful of 
lemon juice may be added, and taken when effervescing. In this case the cit- 
rate is swallowed, but in the blood it is converted into a carbonate, and as such 
appears in the urine. The alkaline is, in the mean time, the favorite mode of 



POT 640 POT 

dealing with rheumatic fever. There is considerable doubt as to whether this 
plan enables the individual to recover more promptly, or saves him from the 
risk of heart disease ; certainly, as a rule, it diminishes the pain and adds to 
his comfort ; 20 or 30 grains should be given every three hours, so as to keep 
the urine alkaline. As to the influence of alkalies on the urine in increasing 
or diminishing the amount of its products we can say little. It is usual to 
give acetate of potass and citrate of potass as diuretics ; but it is usual to give 
many things the efficacy of which rests on no solid foundation. 

Acetate of potass is prepared by adding acetic acid to bicarbonate of potass, 
or rather vice versa. It appears as beautiful white foliated satiny masses, 
neutral in reaction, and very readily absorbing water from the atmosphere. 
When taken internally, it is absorbed, and appears in the blood as carbonate 
of potass. Its action is commonly reckoned to be diuretic ; in very large 
doses it is slightly purgative. It is most frequently used as a diuretic, but 
sometimes also to render the urine alkaline, which it does, though itself neu- 
tral through being converted into a carbonate. The dose is from 20 to GO 
grains. 

Citrate of potass is prepared much as the acetate by neutralizing carbonate 
of potass by citric acid. It is a white crystalline powder, which tends to deli- 
quesce, and is slightly acid to the taste. Citrate of potass is pleasant to the 
taste, and agrees better with the stomach than most other preparations of the 
alkali. It is given in fevers as a cooling drink, and being, like the acetate, 
converted in the blood into carbonate, renders the urine alkaline. It is used, 
therefore, in various maladies when this is desired, especially in the form of 
an effervescing drink. 

Tartrate of potash, which is not often used, is made by neutralizing the acid 
tartrate by means of carbonate of potash. It exists as small crystals, without 
any distinguishing shape. In small doses it is diuretic, being, like the other 
vegetable salts of potash, converted into the carbonate. In large doses it is 
purgative, and is added to vegetable purgatives to increase their action. To 
this end it is usually given in doses of from two drachms to half an ounce. 

Acid tartrate of potash, better known as cream of tartar, is a native product, 
being thrown down in wine casks whilst wines are maturing. It is, of course, 
at first stained with the color of the wine, but is purified from this, and is a 
white gritty powder, or may also be obtained in cakes or in small crystals. Its 
reaction is acid, and it is barely soluble in water. In small doses cream of 
tartar is mainly used as a refrigerant, and sometimes it is ordered as a diuretic. 
It is best given as a drink, of which the patients may partake freely, and in 
this way it is of undoubted service in dropsies. The best plan of making this 
drink is by adding half an ounce of the cream of tartar to a pint of water, 
with some sugar and a few pieces of lemon-peel. Cream of tartar is also of 
great service as a purgative, not by itself, but when added to other remedies, 
especially of a vegetable nature. The cream of tartar seems to have the 
power of causing a free flow of fluid into the intestines, but it is necessary to 
add something to cause this to be ejected. It is, therefore, most frequently 
k given as compound powder of jalap, or along with senna, or in the confection 
of sulphur. The dose, as a purgative, is from two drachms to half an ounce. 
It is mainly prescribed as a purgative, which gets rid of a large amount of 
fluid, especially in dropsies, renal or otherwise, and in these it is of the great- 
est value, whether prescribed as a diuretic or as a purgative. 

Sulphate of potass is a waste product in the manufacture of nitric acid. 
The residue is the acid sulphate, so some further steps have to be taken to 



POT 641 POT 

render it neutral and pure. It is of no great value in medicine ; from its ex- 
cessive hardness it is sometimes employed to aid in the trituration of vegetable 
substances. In this way it is employed in compound ipecacuanha powder and 
compound colocyuth pill. The old compound ipecacuanha powder (Dover's 
powder) contained nitrate of potass (saltpetre) instead of this salt, and there 
is some reason to believe that it was more efficacious than the more modern 
preparation. 

Nitrate of potash, or saltpetre, is perhaps better known from its commercial 
uses than its medicinal properties ; nevertheless these are considerable. It is 
procured largely from India by treating the washings of the soil with wood- 
ashes, after which the saltpetre is crystallized out. It occurs in crystalline 
masses or cakes, or in broken six-sided prisms, striated lengthwise. It is tol- 
erably soluble in water, and has a peculiar cooling taste. It seems, when 
given in large doses, to act on the heart ; but in smaller doses it is of some 
value as a cooling remedy. Some authorities value it highly in acute rheuma- 
tism ; but its efficacy, like that of most other remedies in this malady, is more 
than doubtful. It has also been given in dropsies with a view to act upon the 
kidneys. The dose is ordinarily about 20 grains, and, if intended as a refrig- 
erant, ought to be given while dissolving, not after being made into a solution. 

Chlorate of potass is made by passing a stream of chlorine gas through 
a mixture of carbonate of potass and slaked lime. In this way chlorate of 
potass, chloride of calcium, and carbonate of lime are formed. The salt oc- 
curs as flat transparent crystals, has a cooling taste, and is not very solu- 
ble in water. There is an officinal lozenge made of the substance ; but if it 
is to be used as a lozenge — and that perhaps is the best way of using it — 
it is well to suck the crystals, allowing them to melt gradually in the mouth. 
In this way they melt slowly. Chlorate of potass acts as a refrigerant, a3 
does nitre, and it undoubtedly does much good, used in the fashion we have 
just pointed out, in certain forms of ulceration of the tongue and mouth, espe- 
cially of a syphilitic taint, and due to mercurial impregnation. In all diseases 
of the throat of a malignant nature, where there is usually a tendency to the 
formation of a deep fur, and of this fur to decompose, a mixture of this salt 
with hydrochloric acid is of great value. In most cases, however, we prefer 
sulphurous acid used as spray ; nevertheless both have their uses. The no- 
tions prevalent as to its action on the blood are simply absurd. Ten or twenty 
grains may be given internally for a dose ; but it is best given in the way we 
have indicated — by sucking, or combined with hydrochloric acid. 

Permanganate of potass is made by heating chlorate of potass with peroxide 
of manganese and caustic potass. The product has subsequently to be boiled, 
to convert it into the purple manganate. It occurs in dark-looking needle- 
shaped crystals, readily soluble in water, which takes from them a magnificent 
purple hue. Its officinal preparation is a solution called liquor potassae perman- 
ganatis, one of the most valuable substances employed in medicine, not inter- 
nally perhaps, but by oxidizing and decomposing all the semi-putrid substances 
with which it comes in contact. Hence, as a lotion, it may be applied to foul 
ulcers, gangrenous parts, foul mouths, etc. It is, however, chiefly used as a 
disinfectant for the hand, etc., after touching foul sores or dead bodies before 
touching others. Its strength as an irritant, too, is considerable - ; hence it may 
be used as an injection, well diluted, for gleet, leucorrhoea, etc. It is not 
worth while giving it internally, but diluted, so as to be transparent or nearly 
so, and of a fine bluish-purple hue; it may be used as a wash, gargle, etc., with 
advantage. Ten grains to the ounce is about the proper strength. The' sub- 



POT 642 POT 

stance was introduced by Condy, and a solution of this or of the green man 
ganate is commonly known as Condy 's fluid. 

Bichromate of potass occurs in large red crystals of a tabular form. It is 
mainly employed as a dye stuff, and in the preparation of some drugs, as vale- 
rianate of soda. 

Bromide of potassium is made by adding bromine to caustic potash. It oc- 
curs as white cubical crystals, and owes its activity entirely to the bromine it 
contains. It is given instead of bromine, especially in epileptic and epilepti- 
form seizures, and often with much success. The dose is 20 or 30 grains, 
beginning with five, and going upwards. See Bromine. 

Iodide of potassium, like the former, owes its efficacy to the iodine it con- 
tains, and not to the potass. It is made by mixing iodine and caustic potass. 
It is given where iodine should be given, being less irritating. Its dose varies 
from 2 to 30 grains or more, according to the purpose to be fulfilled. See 
Iodi.ve. 

Sulphuretted potass, or liver of sulphur, is made by heating sulphur and 
carbonate of potass together. Tbe salt has a strong smell of sulphuretted 
hydrogen. It is almost entirely used as a local remedy in skin diseases, para- 
sitic or otherwise. Internally it is readily absorbed, but its influence is not 
quite clear. Baths of it are of great use in chronic skin diseases and chronic 
rheumatism. There is an officinal ointment, which should be prepared just 
before use. If required internally, it is best administered as a natural mineral 
water. 

Ferrocyanide of potassium and ferridcyanide of potassium are only used 
as tests, or in the preparation of other remedies. By themselves they are not 
administered. 

Potato is the name given to the underground stem of the Solanum tubero- 
sum, a plant belonging to the natural order Solanacea?. The native country 
of this plant is South America. It was first grown in tbe British Islands by 
Sir Walter Raleigh, in his garden at Youghal in Ireland. The part of the 
plant used as an article of food is the tuber or underground stem. The potato 
contains seventy-five per cent, of water, ami weight for weight contains less 
alimentary matter than most vegetable productions. It contains, however, 
starch, fibrin e, and albumen, and mineral matters, which render it a very im- 
portant article oi diet. The following is the composition of a pound of 
potatoes : — 

Ozs. Grs. 

Water 12 

Flesh formers 100 

Starch 2 209 

Gum 30 

Fat 15 

Suffar 2 223 

Cellulose 223 

Ashes 64 

16 

Notwithstanding the small quantity of flesh formers, potatoes are known to be 
a most valuable article of diet. They should never be depended on alone, but 
as an addition to a diet with fat or flesh formers they are invaluable. During 
the potato famine in Ireland no substitute was found equal to them, and scurvy 
was the frequent result of their absence from the diet of the poor. 

Potatoes are cooked in various ways, but the best methods of cooking are 
those where the saline matters are pi-evented from being lost in the medium 



POU 643 PRE 

(as water) in which they are cooked. They may be eaten raw as a salad, 
with vinegar, and this has been found especially valuable in cases of scurvy, 
where uncooked vegetable food has not been procured for a length of time. 
The starch is often separated from the potato, and used to adulterate corn- 
flour, arrowroot, and other amylaceous foods. The scrapings of a potato may 
be used as a cold cataplasm with advantage in small burns. The potato con- 
tains a certain quantity of an alkaloid which is dissipated by heat, but it 
possesses no poisonous properties. 

Poultices. When poultices are ordered for the purpose of soothing pain, 
or promoting by their warmth the formation of matter, it is of the utmost im- 
portance that they should be well made and properly applied, and before being 
put on the skin they should be smeared with sweet oil or glycerine, to prevent 
any particle sticking. As regards bread and linseed-meal poultices, no better 
authority can be quoted than Abernethy, who was singularly minute, and 
properly so, in his directions. The bread and-water poultice he directs to be 
made as follows : " Put half a pint of hot water into a pint basin ; add to 
this as much of the crumb of bread as the water will cover ; then place a plate 
over the basin, and let it remain about ten minutes ; stir the bread about in 
the water, or, if necessary, chop it a little with the edge of the knife, and 
drain off the water by holding the knife on the top of the basin, but do not 
press the bread, as is usually done ; then take it out lightly, spread it about 
one-third of an inch thick on some soft linen, and lay it upon the j3art." Lin- 
seed-meal poultices, says the same authority, should be made as follows : 
" Scald your basin by pouring a little hot water into it ; then put a small 
quantity of finely ground linseed-meal into the basin, pour a little hot water 
on it, and stir it round briskly until you have well incorporated them ; add a 
little more meal and a little more water, then stir it again. Do not let any 
lumps remain in the basin, but stir the poultice well, and do not be sparing of 
your trouble. If properly made, it is so well worked together that you might 
throw it up to the ceiling, and it would come down again without falling to 
pieces; it is in fact like a pancake. What you do next is to take as much of 
it out of the basin as you may require, lay it on a piece of soft linen, let it be 
about a quarter of an inch thick, and so wide that it may cover the whole of 
the inflamed part." 

Bran Poultices are frequently required, being useful as fomentations. A 
linen or flannel bag should be made of the size required, and loosely filled with 
bran ; then boiling water should be poured upon it until it is thoroughly moist ; 
next it is to be wrung out in a coarse towel, and applied as directed. 

Yeast Poultices are made by taking one pound of flour, one ounce of yeast, 
boiling them together, laying on linen, and applying. 

Precipitate, White. See Mercury. 

Precordium is the region of the chest which lies in front of the heart; it 
corresponds to the lower sternal and left infra-mammary regions. See 
Chest. 

Pregnancy may be reckoned to include within its meaning all the changes 
which take place in the ovum after its fertilization, whether these relate to 
the embryo or to the mother. In a treatise of this nature it is not possible to 
consider all the bearings of the subject, so we shall confine our observations to 
a few of the most important and practical. To this end we shall consider the 
subject in two of its aspects only, namely, as regards the signs of pregnancy 
and the diseases of pregnancy. 

The signs of pregnancy are derivable from various sources, more or less 



PRE 644 PRE 

accurate, some being of comparatively little value, others being absolutely 
certain. Probably the first thing to excite suspicion that she is pregnant on 
the part of a female is the cessation of the menstrual flow. The time arrives 
when this should make its appearance, and it fails to do so. Other circum- 
stances may have arisen which lead her to suppose that she is pregnant, and 
this confirms the fact. Or, it may be that no such suspicion enters the mind, 
but a second period comes round, and there is still no sign of the ordinary 
flow. By this time other signs have appeared, and to one who is willing to 
be convinced these will probably be quite sufficient to satisfy the mind ; but a 
man convinced against his will is of the same opinion still ; more so of a 
woman — for often you cannot convince her on this subject, or at all events 
she will seem to be unconvinced. But this cessation by itself is far from a 
certain sign. We have already pointed out that such an occurrence is fre- 
quent where a female becomes the subject of ill-health, whatever the nature 
of it may be ; and we have shown especially that such an event is common 
among women who are anseinic and pallid in their complexion, so that by 
itself alone this indication is, comparatively speaking, worthless ; its value is, 
however, much greater in a strong, healthy woman than in a weak and delicate 
one. 

There are, however, many instances where this indication is entirely absent. 
Thus, it not unfrequeutly happens that for a good number of years a married 
woman may never see the flow at all ; for no sooner does one pregnancy ter- 
minate, and the child is reared to the stage appointed by nature, than a new 
one begins. Moreover, in a considerable proportion of cases the flow con- 
tinues for perhaps a month or two after the commencement of pregnancy. 

Another indication of considerable importance is morning sickness, especially 
taken in conjunction with the foregoing. Generally this symptom sets in 
about the fifth or sixth week of pregnancy, so that the omission of the second 
menstrual period and the appearance of this sickness, taken together, m;iy he 
considered fair evidence of the existence ' of pregnancy. This sickness is 
peculiar. It usually commences immediately on getting up, may be severe for 
the time, but usually it does not last long ; in most cases it passes away in 
about half an hour, and the patient is well for the rest of the day. Occasion- 
ally it lasts longer, and may even persist for the whole period from morning 
to morning; when this is the case it becomes dangerous, interfering with 
nutrition, for the patient can take no food, or, if it is taken is immediately 
brought up again. This sickness generally disappears about the third or 
fourth month, hut may persist longer, whilst in many women it does not ap- 
pear at all. This morning sickness is not, however, an invariable sign of 
pregnancy ; notably it may be produced by irritability of the stomach, and 
extra indulgence in food or drink the previous evening ; it may likewise be 
produced by disease or misplacement of the uterus when there is no preg- 
nancy. Its great value is as confirmatory evidence. Sometimes there is in 
pregnant women an extraordinary flow of saliva, but that of course, taken by 
itself, is worthless. 

The changes which take place in the female breast are important. These 
begin about six weeks or two months after the commencement of pregnancy. 
The breasts feel fuller and tenser than usual, seem heavy, and sometimes throb 
and tingle, especially about the nipples. They increase in size and firmness, 
and in their interior may be felt a kind of knotted mass. This is highly im- 
portant and characteristic, as it indicates that the enlargement is due to the 
milk-secreting apparatus, and not to the mass of fleshy tissue alone, which is 



PRE 645 PRE 

common enough from various causes if a woman increases in embonpoint. 
After a time these contain milk. Another characteristic feature in the breasts 
is that round about the nipples they become very dark, the darkness increas- 
ing and extending as pregnancy advances. Round about the nipples, too, 
appear little dark prominences about the size of millet seed. These are 
characteristic; but the breasts may enlarge from other enlargements of the 
uterus than that due to pregnancy, and some women, especially those of dark 
complexion, have naturally a dark ring round about the nipple. Milk, too, 
may appear in the virgin breast, so that none of these signs are by themselves 
conclusive ; like the others, they must be taken in conjunction. Then their 
value is great, especially the enlargement in thin women, and the darkening 
in a fair-complexioned woman. The sign most commonly relied on is the 
most fallacious of all — that is, enlargement of the abdomen. The abdomen 
may be enlarged from a score of causes, so that except there be a stiict and 
accurate investigation by a skilled individual of the cause of the enlargement, 
such an observation may be merely misleading. Once, however, the uterus 
begins fairly to enlarge, there is no great difficulty to the skilled practitioner, 
and up to that time, of course, the enlargement of the abdomen will be but 
slight. 

Between the fourth and fifth month of pregnancy there occurs an in- 
cident which is usually convincing to the woman — that is, quickening. 
This term is given to the mother's perception of the first motions of the foetus. 
It has been likened to various things — to a slight pulsation among others. 
Slight as the motion may be, however, it not unfrequently gives rise to faint- 
ness in the mother ; gradually these movements become stronger, until some- 
times they prove exceedingly troublesome. The first perception of these 
movements is by the female commonly laid down as the half-term of preg- 
nancy, but this is not strictly accurate. Not long after these arrives a period 
when a skilled practitioner is able to diagnose with absolute certainty the 
presence of a foetus in the uterus; this he does by means of the stethoscope. 
By applying this instrument over the abdomen of the female, just between 
the umbilicus and the nearest point of the pelvis, one may hear. the beating 
of the heart of the foetus. This sound, which is called the foetal tic-tac, from 
the resemblance to the sound of a watch, is an absolute sign of pregnancy ; 
nothing can produce it except the heart of a living foetus, and so its detection 
implies the diagnosis of pregnancy. There is, too, no danger of mistaking it 
for anything else, as the only sound likely to be confounded with it would be 
the sound derivable from the mother's circulation ; but this foetal sound is 
double, and the heart beats just about twice as fast as does that of the mother. 

All these are signs, more or less valuable, of pregnancy, and there are 
others which, however, we need not touch upon here. Not, unfrequently, 
however, the pregnancy is concealed ; these signs have either not been ap- 
parent, or have been overlooked, and the first intimation of pregnancy is the 
setting in of labor pains at the end of the ninth month. In no case can a prac- 
titioner say with absolute certainty that a female is pregnant until about the 
fifth month of pregnancy. He can of course pronounce it highly probable, 
but nothing more. Accordingly one should be careful in bringing accusations 
of pregnancy, which it might be difficult to prove or disprove. 

The diseases of pregnancy can hardly be discussed here ; one or two more 
may, however, be alluded to. The salivation spoken of may be excessive, and 
may require remedy ; if so, the usual remedy for salivation may be given ; 
perhaps the best is to give the patient some pieces of alum and chlorate of 



PRE 646 PRE 

potass, telling her to suck these from time to time. This often has the desired 
result. The sickness and vomiting of pregnancy are frequently much more 
serious matters ; they may, indeed, go so far as to endanger the life of the 
female from inanition, for sometimes it becomes impossible for her to keep 
anything in her stomach. Various plans have to be tried if the sickness 
is troublesome. The patient ought to keep the recumbent posture as much as 
possible ; the food should be as light and as easy of digestion as possible ; the 
time should carefully be watched, so as to give it at any moment tlie sickness 
may go, and then a quantity should never be given which will endanger the 
repetition of the vomiting. Still that may not suffice. Ice should therefore 
be given, and sometimes champagne will be kept down when nothing else will. 
All kinds of remedies have been tried, chief among them being prussic acid 
and oxalate of cerium, and sometimes all will prove vain. At the last it may 
be absolutely necessary to bring on premature labor to save the life of the 
mother. Ordinarily the appearance of this premature labor, or abortion as it 
is commonly called, requires to be carefully guarded against. Certain broad 
rules have been laid down already on this subject. See Abortion. 

Albuminuria is an accident which sometimes arises in pregnancy, and when 
it does may prove a most formidable complication. The exact cause of this 
albuminuria is not quite clear ; ordinarily it is set down to pressure of the en- 
larged womb on the renal veins. Frequently it is not discovered until labor 
sets in, when the lirst indication of its presence may be a violent convulsion. 
If these convulsions occur during pregnancy before labor begins it may be 
necessary to empty the womb to save the mother. (See Puerperal Convul- 
sions.) There are many other maladies incident to the state of pregnancy 
which we cannot, however, discuss. There is one, simple enough apparently, 
which frequently gives rise to a good deal of trouble — that is, constipation. 
Confined bowels should be carefully guarded against, and the best antidote is 
an occasional teaspoonful of castor oil the first thing in the morning, if sick- 
ness will permit. 

Premature birth is said to take place when a child is born between the sixth 
and ninth month of foetal life. It may come on of itself in some cases where 
there is a constitutional taint, or from fright, or injury, or habit, and then the 
case is like a labor, only less severe. If a premature birth is induce! for the 
sake of killing the offspring, as in the case of an unmarried person, the 
offense is a criminal one, and renders the guilty parties liable to severe pun- 
ishment. There are, however, some rare cases in which there is such deform- 
ity on the part of the mother that premature birth must take place to save the 
life of mother and child ; but this procedure is only justifiable after careful 
inquiry into the nature of the case, and a consultation of skilled and independ- 
ent medical men. 

Presbyopia is the name given to a defect in the eyesight, produced gen- 
erally in advanced life. See Eye and Vision. 

Preserved Meat. The practice of preserving animal food was observed 
by the nations of antiquity, and the feasts of the Romans were remarkable for 
animal products brought from all parts of the world. The arts of smoking 
pork and salting beef were known to our ancestors in Europe ; it is only in 
modern times that the idea has been conceived of bringing animal food from dis- 
taut parts of the world, so as to meet the demand in the increasing popula- 
tions of Europe for a large supply. We may date the attempt of preserv- 
ing animal food first, for use at a future time, to the Polar expeditions. At 
the International Exhibition (London) in 1851 this subject attracted consid- 






PRO 647 PRO 

erable attention, and at that time meat preserved in tin cases for use in ships 
and for exportation was exhibited. From that time the subject has attracted 
more or less attention. It was not, however, till I860 that any considerable 
portion of meat preserved in tins was sent to Europe. In that year it is 
stated that £320 worth of tinned meat was imported into Europe. In 18G8, 
£45,000 worth was imported ; and in 1872 it is calculated that not less than 
£1,000,000 worth of American, Australian, and other meats was sold in Great 
Britain alone. 

The process by which the meat is prepared is a very simple one, and con- 
sists simply of exposing meat, from which the bone has been separated, in a 
tin case to a heat above that of boiling water. To do this, the tin with the 
meat is placed in a tank containing water, holding in solution some salt, 
which will allow the water to be heated up to 250° or 260° Fahr. The tin is 
exposed to this temperature for some time ; the tin case is covered with a lid 
in which a little hole is made, and when the process is supposed to be com- 
pleted the pinhole is soldered down, and the tin is air-tight. 

Experience has shown that meat preserved in this way can be kept for any 
length of time. The effect of the cooking seems to act in one of two ways. 
According to one theory, the exposure of the meat to heat drives off all the 
free oxygen from the tissues of the meat, which is the active agent in putre- 
faction. According to another theory, all putrefaction is produced by living 
germs in the air, which by the process of steaming are destroyed. 

Besides steaming in tins, many other processes have been adopted for send- 
ing meat to Europe from America and the antipodes, such as dipping it in 
boiling fat, enveloping it in paratfine, covering it with ice, and salting it. 
Ocean steamers are now, however, provided with large refrigerators, by means 
of which meat is landed in England in a perfectly fresh condition. 

The question has arisen whether the meat thus preserved retains its digest- 
ive and nutritive qualities, so as to render it a fit substitute for fresh meat. 
There is no doubt that the " tinned " meat, from its exposure to a high tem- 
perature, possesses qualities different from those of meat cooked at a lower 
temperature, but this has nothing to do with its digestible power or its nour- 
ishing properties. It does not appear from any chemical analysis or experi- 
ment on its use that the tinned differs at all from fresh meat. In prisons in 
England, where it has been tried on a large scale, no difference has been 
observed in the health of prisoners after having taken it for months. In 
workhouses where it has been tried the old people prefer it to the inferior 
fresh meat often served up to them. The same reports come from lunatic 
asylums, ships, and institutions where it is employed. Every now and then a 
case is found in. which the occlusion of air or germs has not been perfectly 
effected, and in which decomposition has set in ; but under no other circum- 
stances has any objection to its use been substantial ed. 

The tinned meat requires little or no cooking. It may be taken cold with 
hot potatoes or any other form of vegetable food. It may be heated and served 
up as a stew, but the ingenuity of an ordinary cook will suggest a hundred ways 
in which it may be placed upon the table. The price of this meat will be seen 
to be much less than fresh meat when it is considered that it contains no bones 
and no water. It is calculated that one pound of this meat in the dieting of a 
family will go as far as two pounds of fresh meat. 

Probang. An instrument formed of a slender piece of whalebone, with a 
piece of ivory or sponge at its extremity, for pushing bodies down the gullet or 
oesophagus into the stomach. 



PRO G48 PRO 

Probe. An instrument for trying the depth and extent of wounds. 

Procidentia is another term for prolapse of the womb. 

Progressive Locomotor Ataxy. A disease which is characterized mainly 
by the peculiar gait the patient assumes when walking, very much resembling 
that of a drunken man. The affection depends upon a grave disease of the 
spinal cord, by which its functions are more or less impaired, and in consequence 
of which the individual loses in a great measure control over his movements. 
In the ordinary movements that we make in locomotion there is a certain har- 
mony of action between the muscles of our extremities. It is quite true that 
we can move an arm or leg of one side quite independently of the other side, 
but it is also true that as soon as we learn to walk we use our muscles in 
a certain order; infants acquire this by experience ; every mother knows how 
awkward their fir;>t motions are. Animals seem to have this faculty very early, 
for most of them can walk the first day of their existence. Now this faculty 
of coordination — this faculty of harmonizing the movements of independent 
parts — is lost in cases of this disease. 

Causes : These at present are not clearly made out. It seems that exposure 
to cold and wet is a very frequent cause: it seems most common in those who 
are engaged in draining, and in those who work for days together in water with 
large leather boots on, as those who are making docks, etc. Such men get hot 
and perspire at their work, while their feet are very cold, if not wet. There 
is no reason to suppose that syphilis has anything to do with this complaint; 
it is much more common in men than in women, and this is probably due 
to the nature of the employment. It comes on, as a rule, in middle life, and 
seldom occurs amongst the young or the aged. As its name implies, it is es- 
sentially chronic in its course, and when once begun it progresses gradually, 
and goes on for many years. 

Symptoms : The three most marked symptoms are so-called rheumatic pains 
in the limbs, chiefly in the legs, a want of harmony of movement, and more 
or less loss of sensibility in the lower extremities. At first the patient feels a 
sense of numbness and tingling in his legs, and he has " flying pains " about 
him ; he is able to work, but does not feel so steady as before. By degrees he 
finds that when walking he loses partial control over his movements ; he can 
walk several miles a day, but finds he is awkward in starting; in time his legs 
move incoherently, and in making a step the foot does not go directly forward, 
but is projected irregularly ; his gait is so awkward that passers-by fancy he 
must have been drinking. If now he is asked to walk with his eyes shut he is 
much worse, and would fall without assistance ; in turning round he is awkward, 
and also in starting ; but once set going, he can walk a long distance without 
fatigue. Yet there is no paralysis ; for if he sit down and bend his leg, he can 
resist well all efforts to straighten it, and this is not the case where paraplegia 
is present. He cannot always be certain of the nature of the ground on which 
he stands, nor, unless he look, can he be always certain whether he is on a 
wooden floor or on a stone pavement. His spirits are usually bad, and at times 
he bursts into tears without any apparent cause. Pie may have a desire to pass 
water frequently, but he has perfect control over his bladder and motions. In 
some cases there is loss of hearing or dimness of vision, in consequence of some 
nerve tracts in the brain becoming involved in the disease, but this is not a 
marked feature. The intellect is unimpaired, and he can read, eat, drink, and 
sleep well. 

Treatment: Very little can be done, if anything, in curing this disorder. 
Various medicines have been tried, but without any marked benefit ; touics, and 



PRO 649 PRO 

especially iron and quinine, seem to do most good by improving the general 
health. The patient should be warmly clothed and live well ; he need not keep 
in the house, but should walk out every day. No local treatment to the spinal 
cord does any good. As these cases generally occur among the poor, they are, 
in, consequence, prevented from obtaining a livelihood, and, being driven to the 
workhouse, are not always able to live on the best of food. They should be 
encouraged to learn some simple occupation which does not involve any exer- 
cise or much manual labor. 

Progressive Muscular Atrophy involves, as its name implies, a gradual 
wasting of the involuntary muscles. It is well known that in cases of lead- 
poisoning wrist-drop is apt to occur from atrophy of some of the muscles of the 
fore-arm. In this affection, however, the atrophy or wasting is much more 
general. As a rule it begins in the arms, and is often most noticeable in the 
upper arm and shoulder, so that the patient is prevented from raising his hand 
to his head. It affects both sides, and extends pretty equally on each side. 

Causes : These, at present, are not understood ; it may occur in children as 
well as in adults ; it has been known to be hereditary in families, so that several 
children of the same parents have been carried off in turn. It is a very rare 
disease, nor is it yet determined whether it depends on an alteration of the ner- 
vous system or of the muscular system, although most authors are in favor of 
the former view. It is a disease which is very chronic ; it goes on gradually 
from bad to worse, until finally the muscles of respiration become involved, 
and death may ensue from suffocation. 

Symptoms : The first symptom generally noticed is a wasting of the muscles 
of the arm or leg, but more commonly the former ; the fingers are used awk- 
wardly in picking up anything ; there is a numbness and tingling in the extrem- 
ities, and occasional twitchings of the muscles of the part. In time the wast- 
ing is more marked, and the loss of power is proportionate to the amount of 
wasting. The patient cannot raise his arm nor flex it properly ; if bent, he 
cannot resist any one trying to unbend it ; he cannot make his hand reach his 
head without assistance. On examining the parts chiefly affected, great wasting 
will be noticed, and the bones can be felt through the emaciated tissues ; when 
the muscles of the shoulders waste, the head droops forward slightly, and the 
patient has a high-shouldered appearance. In a similar way the legs waste, so 
that walking is performed with difficulty, and finally the sufferer has to keep 
his bed. Yet all the while the general health is not much impaired ; he can 
eat, drink, and sleep well ; the mental faculties are not affected, and his chief 
distress is the progressive weakness. But in time other parts get affected ; as 
long as only the extremities are atrophied, loss of power alone ensues, and lo- 
comotion is rendered difficult ; after a while, the muscles of the chest will begin 
to waste, and the patient becomes short of breath. As this goes on, the expan- 
sion of the chest is interfered with, and the sufferer is liable to bronchitis and 
congestion of the lungs ; he has not strength to spit up the. accumulated phlegm 
in his air-passages ; exposure to cold or damp air makes him have a distressing 
cough and aggravates his symptoms. Hence it is always a bad thing for the 
patient to have catarrh or bronchitis, as it generally carries him off suddenly ; 
in very severe cases hardly any expansion of the. chest-walls occurs, and death 
is due to suffocation. 

Treatment : For this disease, when once developed, little good can be ob- 
tained from any drug. Iron, quinine, strychnine, and various tonics have been 
tried, but none of them seem to have any influence in checking the onward 
progress of the disease. Shampooing, electricity, and friction may be tried. 



PRO 650 PRU 

and for a time benefit seems to result. The general health should be kept up 
by a nourishing diet ; the body should be kept warm, and flannel must be worn 
next the chest. All exposure to cold and wet must be avoided, and although 
out-door exercise should be taken when the weather is fine and dry, yet the sub- 
ject of this disease should not go out after sunset nor risk an exposure to the 
night air, as he might in that way catch cold or bring on some lung complica- 
tion. In the later stages the patient has to be propped up in bed, as he is too 
weak to support himself ; in such cases all that can be done is to adopt any 
means that may please or give comfort to him, and so render more easy the in- 
evitable end. 

Prolapse of the Womb is said to occur when that organ descends lower 
than usual ; it may come on after confinements, and is chiefly met with in those 
who stand a great deal, as washerwomen, etc., and in those who get up too 
soon after a labor. Mechanical treatment is best for this condition, and the 
patient should wear a pessary for the purpose. Much discomfort and distress 
is caused by a prulapse ; often there is difficulty in passing water and in defe- 
cation. See Pessaries. 

Prolapsus is a term applied to the falling down or protrusion of any of 
the soft organs of the body, through their natural passages. Thus prolapsus 
ani is the falling down of the rectum through the anus. Prolapsus uteri is the 
protrusion of the womb at the vulva. Prolapsus iridis is applied to the pro- 
trusion of the iris through a wound in the cornea. 

Proof Spirit, or Weak Alcohol, is made by adding three pints of dis- 
tilled water to five pints of rectified spirit. It contains forty-nine per cent, of 
alcohol, and its specific gravity is .920. It is employed in making some of the 
tinctures of the Pharmacopoeia. 

Proptosis is the name given to that peculiar condition of the eyeball in 
Graves's disease. It is often seen in a much milder degree, and may constitute 
a kind of deformity without at all interfering with vision. The cause seems to 
be a form of swelling of the cushion on which the eye rests. 

Proud Flesh is a term applied to the granulations of a wound when heal- 
ing by suppuration. See Inflammation Granulations. 

Prunes or Drit.d Plums are seldom employed by the physician, though 
sometimes used in domestic practice. The smaller and more acid specimens 
ought to be selected if they are to be used at all. These, however, though 
tending to relax the bowels, are of little use. If they do give rise to relaxa- 
tion they generally, too, produce griping, and very likely flatulence. The 
common prunes may be used ad libitum. 

Prurigo is a form of skin disease characterized by the appearance of small 
clear blebs or pimples, which may alter their character su as to become scabs. 
These scabs are, however, more frequently produced by the scratching of the 
sufferers, who tear the skin with their nails till it bleeds, and so these minute 
crusts are formed. The itching which accompanies prurigo is almost intolera- 
ble, and is always aggravated by heat, so that the subjects of it dare hardly ap- 
proach a fire or go to bed. 

This malady is peculiarly prevalent among old people, and one variety of it 
is accordingly characterized as prurigo senilis. The malady is most obstinate, 
sometimes refusing all relief till the patients are weary of their lives. 

Many assert that this malady is invariably due to those horrid insects, body- 
lice, and we are not prepared to deny that in a great number of cases, es- 
pecially in elderly people, this is so. Neither are we, however, prepared to 
deny that some forms of prurigo may arise from nervous irritation, without 






PRU 651 PRQ 

the agency of parasites. In all cases this rule is imperative: let the under 
linen be well searched, especially in the morning, when these parasites are 
torpid. And let not the rank or position of the sufferer stand in the way of 
this. In these days one never knows with whom they are brushing elbows, and 
these vermin may and do get hold of persons in a higher sphere of life in a 
wonderful manner. But it is among the lower orders that one sees prurigo 
and vermin most commonly associated, and in them there is but one remedy. 
They must be stripped, put in a warm bath, and well washed with carbolic 
acid soap, much stronger than that commonly used, and their clothes must all 
be baked ; boiling often does not suffice. The skin is best anointed with 
carbolic acid ointment, or washed with a weak solution of the same. A weak 
solution of corrosive sublimate is frequently of great use in relieving the itch- 
ing, and in destroying the cause of it. If the malady is due to other than para- 
sitic causation, other remedies must be used, such as are employed for what is 
technically known as pruritus, or itching. See Pruritus. 

Pruritus is the name given to the main symptom of the disease prurigo, as 
well as of other skin diseases, that is, itching. It sometimes gives rise to in- 
tolerable torments far worse than actual pain. Pruritus may affect the whole 
body, but much more commonly it affects certain special tracts. Amongst 
these the neighborhood of the organs of generation is a somewhat fre- 
quent site, and to this the term pruritus pudendi has been applied. It may 
be due, especially in children, to the presence of worms, and these should be 
carefully looked for ; but in a considerable number of instances nothing can be 
seen on the skin beyond the effects of scratching. For such itching various 
remedies may be tried, lead and opium lotion being one of the best. Lime- 
water may be also tried, and, if there is any discharge, magnesia. Prussic acid 
is sometimes used as a lotion, but requires great caution. In females it not 
unfrequently depends on uterine disease, and all remedies will prove useless 
until that is alleviated. Great cleanliness is, of course, essential, and stimu- 
lating food and hot fiery drinks must be avoided. In some cases the wet pack 
locally gives more relief than anything else. 

Prussic Acid, also known as Hydrocyanic Acid, is one of the most 
potent poisons known, but used aright it is also a valuable medicine. It is 
made by distilling yellow prussiate of potash (ferrocyanide of potassium) with 
sulphuric acid. This acid so prepared is mixed with a good deal of water ; the 
anhydrous acid may be made by passing sulphuretted hydrogen over cyanide 
of mercury, but it is too powerful a poison to be rashly handled. The ordinary 
acid, which is very dilute, is colorless, and has a peculiar odor and tastes very 
slightly acid, the marks of its acidity passing readily away, it being very vola- 
tile. The ordinary acid contains only two per cent, of the auhydrous acid, and 
that known as Scheele's oidy four ; nevertheless both are powerful poisons. 
There is an officinal preparation in the Pharmacopoeia called acidum hydro- 
ryanicum dilutum. The acid is now much used in the form of cyanide of po- 
tassium. This is largely employed by photographers, and has been the cause 
of several accidents, being almost as dangerous a poison as the acid itself. 

The anhydrous acid is probably the most intense poison known, destroying- 
life with the greatest rapidity, not appearing to affect any one organ, but ap- 
parently arresting the functions of all. If the acid be strong, death may follow 
a dose in a few seconds, but under ordinary circumstances a fatal result, 
though speedy, does not follow with the same rapidity. The final act in de- 
stroying life seems to be paralysis of the heart. i 

As to any antidote, usually death occurs so speedily that there is time for 



PSO 652 PSO 

no remedies ; sometimes ammonia is tried with a view to overcome the pros- 
tration, but as a rule with small avail. If the dose were small, and time per- 
mitted, it would be well to employ the hydrated oxide of iron, as in arsenical 
poisoning. 

Greatly diluted prussic acid applied to the skin diminishes sensibility, and 
so if there is much pain or itching in the part such an application often does 
good. In skin diseases, where there is much itching and the skin is not 
broken, there can be no better application than a very weak solution of cyanide 
of potassium or of hydrocyanic acid. For this purpose thirty grains of cyanide 
of potassium may be added to a pint of water, or half a drachm (fluid) of the 
acid may be added to six ounces of water. This only if the skin is unbroken. 
Moderate doses allay irritability of the stomach, and are frequently used in all 
painful affections of that organ, in ulcer, cancer, and especially neuralgia. 
Sometimes, too, it is employed with benefit in vomiting, but the exact cases in 
which it is beneficial are not quite clear. 

So, too, in some chest affections, prussic acid is used with advantage. A 
certain number of cases of asthma seem connected with disease or irritability 
of the stomach ; in these prussic acid may be tried with advantage. In whoop- 
ing-cough, too, this remedy is often successful in allaying the violence of the 
paroxysm, though not in shortening the duration of the disease. Some rec- 
ommend it in functional or other diseases of the heart, when palpitation is 
most violent. 

The vapor — which consists of ten or fifteen drops of hydrocyanic acid added 
to an ounce or so of water at the ordinary temperature, the vapor being in- 
haled — is an admirable remedy for some forms of irritation of the lung, es- 
pecially such as induce violent cough in consumptive individuals. Indeed, 
save that it is desirable to give it by the mouth when the stomach is concerned, 
this seems the best way of administering it. The dose by the mouth is from 
two to five drops freely diluted. It is apt to lose strength by keeping. 

Psoas Abscess. When the pus formed by the side of the spine in con- 
sequence of various diseases of the bodies of one or more lumbar vertebrae 
gravitates along the muscles of the pelvis and points under the skin at the 
upper and inner parts of the thigh, it forms what is called by surgeons a psoas 
abscess. A soft fluctuating swelling is produced, which increases rather rap- 
idly in size and extends inwards and downwards, reaching in some instances 
as far as the knee. This constitutes the lower portion of a large abscess ex- 
tending as high as the spinal column in the loins, and which, as it passes from 
the abdomen into the thigh under the structure known as Poupart's ligament, 
is constricted to a narrow neck. This affection, like lumbar abscess, is serious 
in consequence of its almost invariable connection with advanced ulcerative 
disease of the spine. When the swelling in the thigh is large and painful, and 
when deep-seated fullness can be made out along the lower part of the abdo- 
men on the corresponding side, and when one finds angular curvature and 
remote symptoms of disease of the spine, there can be very little doubt as to 
the presence of a psoas abscess. But where the abscess is small and the 
symptoms of suppuration extending from the thigh to the spine are not well 
marked, the diagnosis is not so easy, and the psoas abscess may be readily 
mistaken for a rupture or for an aneurism. Very little can be done for the 
treatment of psoas abscess. So long as the swelling does not cause much pain 
and grows slowly it should be left alone. Should, however, the abscess attain 
a large size, and the distended skin become red and inflamed and threaten to 
give way, the surgeon will find it necessary to let out the contained pus, either 



PSO 653 PUE 

by repeated tapping or by making a free incision, under a veil dipped in a mix- 
ture of carbolic acid and olive oil. 

Psoriasis. This is a dry, scaly disease of the skin ; it is chronic in its 
course and characterized by slightly raised red patches covered by white, shin- 
ing, opaque scales ; these scales often come off in great numbers, so that on 
waking in a morning the patient finds his bed full of little branny particles. 
Sometimes the spots are circular, small, and numerous, and scattered over the 
skin ; sometimes they are ring-shaped and the centre is healthy, while the dis- 
ease spreads at the circumference ; sometimes large patches of irregular shape 
occur, and most often they are seen at the knees and elbows ; at other times 
the patches assume a figure-of-eight form. The. edges are always well defined 
and with a tendency to be circular ; when the scales are rubbed off, a dry and 
red surface is left. The name lepra was formerly given to the ring-shaped 
variety of psoriasis, but the term has now fallen into disuse. Psoriasis in all 
its forms runs a very chronic course, lasting not unfrequeutly for many years. 
When cured, it is prone to come back again. Some persons have an attack of 
psoriasis every year ; spring and autumn are the seasons when it most fre- 
quently appears. The red patches of psoriasis are due to inflammation of the 
skin ; the scales are due to excessive formation of epithelium on the inflamed 
surface. The rash is often accompanied by much itching ; it occurs on the 
coarse and dry parts of the skin, and not where the sweat-glands are abundant. . 
The disease is never communicated from one person to another, although a 
tendency to it is certainly hereditary ; it may come on as a consequence of 
syphilis. On the palms of the hands and soles of the feet it m ty be mistaken 
for eczema. The treatment consists in paying attention to the state of the 
stomach, regulating the diet carefully ; arsenic is the best remedy, and it may 
be given in small doses two or three times in the day, but its action must be 
carefully watched. In many cases the local application of tar or pitch will 
suffice for a cure. 

Ptosis is the term applied to paralysis of the upper eyelid, so that it falls 
and covers the eye, the patient being unable to open that eye save by means 
of his fingers. The condition is mainly of importance, as an indication of brain 
mischief, for this more frequently follows haemorrhage, or other damage to the 
cerebrum, than any other symptom. The muscle which raises the eyelid is 
governed by the same nerve which guides the movement of most of the muscles 
of the eyeball. Consequently, drooping of the upper eyelid is very often 
accompanied by squinting, the remaining muscles of the eyeball dragging it 
out of its accustomed situation. 

Ptyalin is the active principle of saliva. See Saliva. 

Ptyalism means an increased and involuntary flow of saliva. It attends 
the action of some medicines, especially the preparations of mercury, also 
iodide of potassium. See Mercury, Iodine. 

Puerperal Convulsions are commonly held to include the convulsions 
which occur both before, during, and after labor. But we must confine our- 
selves mainly to the two kinds first named, sometimes termed the eclampsia 
of the pregnant and puerperal states. The convulsions generally occur quite 
suddenly. The spasms are violent and intensified, that is, of the kind called 
clonic, and they are attended by complete unconsciousness. Most frequently 
the whole body is affected, though sometimes only half of it is so ; and as they 
pass away the consciousness does not perfectly return, but stupor, more or less 
complete, continues. When the convulsions are partial, consciousness may 
not be lost. Such convulsions are most common in the later months of preg- 



PUE 654 PUE 

nancy, and just before labor, and occur more frequently in those in childbed 
for the first time. The fits usually follow each other in rapid succession, and 
each one lasts from half an hour to two hours or more, including the comatose 
period after each. By and by consciousness returns, but there is no knowledge 
of what has occurred in the interval. These convulsions are not unattended 
with danger, and as they not un frequently happen when no previous appear- 
ance of illness has threatened, they are greatly dreaded by pregnant females. 

Nevertheless, they may be, so to speak, predicted, and so far avoided. Their 
cause is now known, at least approximately, and being known can be avoided. 
The convulsions are generally admitted to be due to renal michief, most prob- 
ably setting up albuminuria and uraemia, and subsequently convulsions. What 
the kidney mischief may be is not quite clear. Sometimes beyond the albu- 
minuria, which ordinarily has lasted some time, there may have been little sign, 
though sometimes, of course, it has been known that the woman has been the 
subject of kidney disease before she became pregnant. Curiously enough, 
these last are not the most unfavorable cases, although the kidney mischief 
may be greatly aggravated thereby, and ultimately prove fatal. As far as the 
convulsions are concerned, those are most fatal where no previous mischief 
was known. 

In patients who become the subjects of puerperal convulsions there may be 
signs of kidney disease beforehand, as swelling about the face, and especially 
belo.v the eyes. But something more than this is required to account for the 
convulsions. It has been supposed by some that the pressure of the enlarged 
womb on the veins coming from the kidneys has been enough to give rise to 
the uraemia and the convulsions. Were that so, puerperal convulsions ought 
to be much more common than they are ; but this, too, is peculiar : that very 
often the removal of the foetus is sufficient to cause their arrest, which it would 
not were they due to uraemia entirely. If convulsions come on during preg- 
nancy, labor commonly begins too, and the child is expelled. If not, espe- 
cially towards the end of pregnancy, it is highly desirable to evacuate the 
contents of the uterus, knowing that this often arrests them should the woman 
be attacked at a period at which the child could live. 

If labor has set in, sometimes the rupturing of the membranes and discharge 
of the waters will procure cessation of the convulsions. If they do not cease 
promptly, however, no time is to be lost ; the uterus must be emptied, by turn- 
ing or forceps, as the case may be. and so both lives may be saved. Inhalation 
of chloroform, or a mixture of chloroform and ether, is strongly recommended 
by some. In the olden time there was no such hesitation ; bleeding was had 
recourse to, promptly and to the fullest measure, with, we fear, somewhat un- 
toward results. 

Puerperal Fever. This is a continued and contagious fever occurring 
in connection with childbirth. It comes on within a week or ten days after 
confinement, and must not be mistaken for weed or ephemera, which is a 
harmless kind of milk-fever. Puerperal fever is a very dangerous disorder, 
and it is one far easier to prevent than to cure. In some respects it is allied 
to erysipelas, and those who have been attending such cases have at times 
given puerperal fever to their patients. It is very important that women 
should not go into a large general hospital to be confined, for it has been 
shown over and over again that in that way many go in only to die ; and 
whereas in the surrounding districts no cases may have occurred, yet in a hos- 
pital some are sure to occur, and when once it has broken out it is very diffi- 
cult to <ret rid of it. It is far better for a woman to be confined at home in a 



655 




iFlG. CXI. 




ELQi CXLL 




Flft, CXII1 



PLATE XXII. 



PUB 657 PUL 

dirty alley than to go into the most comfortable ward of a general hospital. 
Nor are special hospitals for women much better in this respect, for the mere 
herding of the women together when in that state is injurious, and if an epi- 
demic of fever happens to break out it is attended with dangerous results. No 
one who has been lately near a case of scarlet fever, or, in fact, any fever, or 
a case of erysipelas, either as doctor or nurse, should go near a woman in her 
confinement, and any one attending a puerperal fever case should not, of course, 
go near another woman in labor. It is only by such strict rules that you can 
prevent the spread of this fatal disorder. 

Symptoms: There is headache, with shivering and rigors; there is a dimi- 
nution of the supply of milk, and the usual discharge lessens in quantity and 
even ceases. The temperature rises; the tongue is dry and coated, and there 
is much thirst and prostration. No spots are, as a rule, observable on the skin, 
but in some cases there may be small petechia?. The bowels are generally 
loose, and the urine is turbid and contains blood or albumen. The mind, at 
first clear, soon becomes clouded, and the mother will take no notice of her 
child; delirium of a low, muttering character comes on, and death takes place 
generally from exhaustion or syncope. 

Treatment: Very little can be done when once the fever is well developed. 
The woman will, of course, be in bed in a cool, well-ventilated room, but with- 
out draughts. The diet must be light and nourishing, and consist of milk, 
beef-tea, eggs, and stimulants as required for each case. The bed-hangings 
must be removed, and also any carpet, etc. ; these should be heated in an oven, 
so as to become disinfected. Conchy's fluid should be used freely, or chloride 
of lime may be placed in saucers about the room. The patient's strength 
must be supported as well as possible until the crisis is passed ; the treatment 
will be the same as that described under typhus. See Typhus Fevkr. 

Puerperal Mania is a form of insanity which comes on after a confine- 
ment, and may sometimes cause the patient to commit suicide. It is most 
common in unmarried women, and it is probably dependent on the mental 
distress and anxiety they undergo in concealing their state. Most cases had 
better be removed to an asylum, as, amongst the poor especially, proper nurs- 
ing cannot be obtained in these cases. The mania comes on within a week or 
ten days after the labor ; the milk ceases, and there is generally an aversion 
for their offspring. They talk very wildly, and often use bad language. They 
may often hurt themselves unless watched. Under proper treatment they gen- 
erally recover. No lowering measures must be adopted : a nourishing diet, 
rest, a quiet room, and moderate stimulation are the best for this disorder. 
See Insanity. 

Pulse. If the finger be placed upon an artery, such as that at the wrist, 
what is known as the pulse may be felt ; this is because the elastic artery 
dilates with each beat of the heart at regular intervals ; the pulse does not 
quite correspond to the beat of the heart in time, but occurs just after it, and 
the farther the artery is from the heart the longer is the interval. It follows 
that the pulse will be quick or slow, regular or irregular, according to the 
action of the heart at the time, and therefore it is useful as a guide in many 
diseases. Further, the wall of the arteiy may lose its elasticity in old age, or 
in some cases of fibrous or atheromatous degeneration, and then it becomes 
more rigid, and it is harder work for the heart to send the blood through such 
vessels ; or, as in some cases of fever, etc., the elastic walls may lose their tone 
and become relaxed, so that the blood flows faster through such vessels, and 
the capillaries in front become fuller of blood : this change takes place chiefly 



PUP 658 PUR 

th rough the influence of the nervous system. The average rate of the pulse 
in a healthy man is about 75 beats in a minute. 

Pupil. This is the name given to the central aperture in the iris of the 
eye, by which light can enter and act upon the retina. The pupil dilates in 
the dark, and contracts by a strong light. In man it is circular ; in the cat it 
is oval ; in most animals the iris is made up of muscular fibres. Belladonna 
dilates the pupil, opium contracts it ; in most cases of debility the pupil is 
large, while in nervous people ic is generally small. See Eye. 

Purgatives are remedies whose special function it is to cause an unloading 
of the alimentary canal. The group contains very various members, some 
gentle, some violent, in their action ; some acting mainly by increasing the 
motion of the bowel, some again by increasing its secretion. Some act on one 
part, some on another : thus aloes seem to act almost entirely on the great 
gut, castor oil little, if at all, on it. Laxatives are commonly included in the 
best ; but purgatives, strictly speaking, have a wider action. Rhubarb, senna, 
aloes, and jalap are comprehended among ordinary simple purgatives. More 
powerful purgatives, also called cathartics, are colocynth, scammony, castor 
oil, and podophyllin. Some seem to increase the liquid flow from the bowels. 
Most saline substances are in this group, such as tartrate and bitartrate of 
potass, Rochelle salts, phosphate of soda, Glauber's salts (sulphate of soda), 
Epsom salts (sulphate of magnesia), etc. 

Many of these are combined with advantage ; thus, jalap and cream of 
tartar, scammony and the same, rhubarb and magnesia, senna and sulphate of 
magnesia, are all frequently given together, the one acting as an adjunct to the 
other's efficacy. 

But as many purgatives, especially the more violent, gripe severely, or 
otherwise give rise to unpleasant effects, it is common to add to them some 
substance to prevent griping. These adjuncts are either hot substances, like 
ginger and red pepper, or aromatic oils, like peppermint, etc. ; or they may 
be sedatives, like belladonna, hyoscyamus, etc. 

A few purgatives act specially on the liver, and are called cholagogues ; 
chief among these are the preparations of mercury, podophyllum, and perhaps 
taraxacum. For particulars with regard to each, see under the appropriate 
heading. 

Purpura is characterized by an eruption of spots called petechia?, or 
patches called ecchymoses, which are caused by haemorrhage into the skin, 
varying in tint from bright red to violet. The small spots are round, the 
larger more irregular in shape ; they do not disappear when the finger is 
pressed upon them. For the first few hours of their appearance the spots are 
of a pale pink, and slightly raised ; they then become level and deepen in 
color, finally becoming orange-colored and yellowish as they fade away ; while 
the old ones disappear, fresh ones keep coming. In some severe cases the 
haemorrhage takes place not only into the skin, but from the nose and aliment- 
ary canal ; blood may also appear in the faaces and urine. In mild cases 
there is little or no disturbance of the general health ; in severe cases there 
may be febrile symptoms, lassitude, and pains in the limbs. It occurs in those 
who live well, and it is not produced, like scurvy, from want of vegetable 
food ; its cause is not known. Tannin and gallic acid, iron and turpentine, 
have been given in this disease, and generally with good effect. Petechial spots 
may occur in the course of typhus fever and some other diseases, but these 
must not be confounded with purpura. 

Purpuric Fever is a term used to designate those fevers in which the 



PUS 659 PY^B 

eruption assumes a deep purple color, and which does not disappear on press- 
ure ; it used to be a synonym for typhus fever, but it also may be used in 
cases of malignant scarlet fever or small-pox when the rash is petechial ; such 
cases are nearly always rapidly fatal, and marked by great prostration and 
bleeding from the organs. See Malignant Diseases. 

Pus is a term applied to the fluid contained in abscesses, and discharged 
from the surfaces of ulcers and granulating wounds. Healthy pus is of a 
white or pale yellow color, of creamy consistence, free from smell, and chem- 
ically neutral, being neither acid nor alkaline. Its usual specific gravity is 
about 1.030. If left standing for some time in a high vessel, it separates into 
a thin upper layer of transparent fluid and a thick and opaque yellow deposit. 
The fluid layer is composed of water, albumen, salts, chiefly chloride of sodium, 
fatty acids, and extractive matter. The deposit is almost entirely composed 
of pus-corpuscles or globules, which are minute, spherical vesicles measuring 
from l-5000th to l-2000th of an inch in diameter. Within these globules are 
contained three or four small dark bodies, called nuclei, and a number of very 
minute granules. If a drop of acetic acid be added to a specimen of pus placed 
under the microscope, the granules will be seen to disappear and the nuclei to 
become more distinct. If water be added instead of acetic acid, the globules 
swell and become less opaque. These bodies are identical with bodies exist- 
ing in the blood which are called white corpuscles, in contradistinction to the 
more numerous and darker bodies known as the red blood-corpuscles. There 
is also a close resemblance between pus-globules and the corpuscular bodies 
existing in chyle and lymph. In foul and unhealthy ulcers the discharge does 
not consist of inodorous pus, but of a thin fetid and dirty fluid, called ichor or 
ichorous pus. When mixed with blood, pus is said to be sanguineous pus, or 
muco-purulent discharge. It is a mixture of healthy pus and of an increased 
secretion from a mucous membrane. This fluid is observed especially in dis- 
eases of the air-passages and of the lining membrane of the bladder. 

Pustules are prominences formed on the surface of the skin in some dis- 
eases ; the epithelium of the skin is raised, and beneath is some pus or matter. 
It is found in cases of small-pox, ecthyma, impetigo, and in some kinds of acne. 
When pricked, the matter exudes, and the pustule may dry up and heal, form- 
ing a scab, which falls off in a few days. 

Putrid Fever is a term formerly used for cases of typhus fever ; it is now 
occasionally used to designate very bad forms of scarlet or typhus fever or 
small-pox, when those diseases have assumed a malignant form, and are accom- 
panied by purple spots on the body which do not disappear on pressure. 

Pyaemia. This is a disease with well-marked constitutional and local 
symptoms which is supposed to be due to the introduction into the system of 
pus or the constituents of pus. It is closely allied to septicaemia, puerperal 
fever, and erysipelas, and is often connected with inflammation of one or more 
veins. Some few cases of this disease have been reported in which the pa- 
tients were quite free at the time of the attack from wound or sore ; but usu- 
ally the pyaemic symptoms follow a severe injury or a surgical operation, or 
occur in the course of some chronic suppurative affection. Pyaemia often re- 
sults from compound fractures and operations on the bones, especially amputa- 
tions, and is one if not the chief of the causes of death in the surgical wards of 
large city hospitals. The constitutional or general symptoms of pyaemia re- 
semble those of typhoid fever : the local symptoms consist in the formation of 
abscesses in the liver, lungs, and joints, and occasionally in haenaorrhagic and 
pustular affections of the skin. The following is the usual history of a case of 



PYE 660 PYR 

pyaemia following a severe compound fracture : About the seventh or tenth 
day after the injury the patient has a severe attack of shivering, which is fol- 
lowed by intense fever, headache, and perhaps vomiting. The pulse then 
becomes frequent, and the bodily temperature increases from 99° to 103° or 
104°. These symptoms persist, and the patient becomes restless and at times 
delirious. The attacks of shivering are frequently renewed, and in the inter- 
vals there is profuse perspiration. The tongue is dry and brown, and there is 
a peculiar sallow or tawny appearance of the skin over the whole body. The 
patient becomes much emaciated, very prostrate, and finally sinks from ex- 
treme exhaustion on about the fifteenth or twentieth day after the injury. The 
local symptoms presented in connection with this typhoid condition are painful 
swelling of one or more joints, pain in the region of the loin, shortness of 
breath, cough and persistent expectoration, irregular patches of a bright red 
color scattered over the skin, especially near the joints, small pustules on the 
skin somewhat resembling those of small-pox. The first symptom indicates 
suppuration within the affected joints ; and the chest symptoms, inflammation 
of the pleurae and lower portion of the lungs, with formation of small pulmo- 
nary abscesses. Suppuration in the liver is indicated by pain and swelling on 
the right side of the abdomen, and by jaundice. 

The following are the predisposing causes of this disease : exhaustion from 
a long previous illness, as dysentery or fever, and from deprivation of food ; 
organic disease of kidneys ; profuse haemorrhage during or after an operation ; 
unhealthy employment and residence in foul and badly ventilated quarters; 
chronic alcoholism and intemperance both in eating and drinking. The most 
frequent predisposing causes are impure air, such as is contained in over- 
crowded surgical wards of a large hospital, and neglect of the patient's wounds 
leading to the accumulation of decomposing and putrid material about the raw 
surfaces. The duration of an attack of pyaemia varies much in different cases. 
Death may occur on the third or fourth day, or the symptoms may continue 
for a month or six weeks, and then terminate fatally. In acute pyaemia death 
most commonly takes place between the seventh and tenth days. Cases are 
sometimes met with in which the pyaemic symptoms are slight, and are pro- 
longed for a period of three or four months, or even longer. To this form 
has been given the name of chronic pyaemia. Pyaemia is a very grave affec- 
tion, and when acute and associated with frequently repeated chills and mis- 
chief in the lungs is in almost all, if not all, cases rapidly fatal. Indeed, re- 
covery from any form of pyaemia is a very rare occurrence. 

The treatment of pyaemia, like that of other acute and exhausting diseases 
of a typhoid character, usually consists in the free administration of alcoholic 
stimulants and concentrated fluid nutriment. Quinine in large doses seems in 
some cases to do good. Strict attention should be paid to the nursing of the 
patient, who is generally quite helpless. The room should be well ventilated, 
and freed of carpet and all but indispensable articles of furniture. Some dis- 
infectant solution should frequently be sprinkled over the floor, and care be 
taken to remove and disinfect at once soiled sheets and bed-clothing, and to 
burn the dressings at every change. 

Pyelitis is a technical term applied to a disease of the kidney, in which 
there is a formation of pus in that organ or in the ureter. 

Pylorus is the name given to the end of the stomach which is directed to 
the right side. See Stomach. 

Pyrexia is a technical term for fever, or the febrile condition ; it is present 
whenever the temperature of the body is above 99° Fahr. ; it is generally as- 



PYR 661 QUI 

sociated with headache, furred tongue, quick pulse, hot skin, and high-colored 
urine, with a feeling of fatigue and lassitude. Besides being met with in what 
are ordinarily called fevers, pyrexia is found in all cases of inflammation, in 
acute rheumatism, catarrh, etc. 

Pyroligneous Acid. See Acetic Acid. 

Pyrosis, also known as Water Brash, has been by some employed to sig- 
nify heart-burn, with or without eructations of sour burning fluid. The term 
gastralgia is, however, commonly employed to signify heart-burn pure and sim- 
ple; pyrosis, the acid eructations which commonly accompany it. As to the 
causation of pyrosis, see Indigestion. Its remedies must be considered with 
reference to the various sources of its production. In a goodly number of cases 
it is due to fermentation of the food ; if so, sulphurous acid will be found to 
give relief. In some cases an alkaline stimulant, like aromatic spirit of am- 
monia, is the best thing for momentary relief. 

Pythogenic Fever is a term synonymous with typhoid fever ; it is not, 
however, a word in common use. See Typhoid Fever. 



Q. 



Quartan Ague is said to occur when the fever comes on every third day, 
as is described in the article on Intermittent Fever. 

Quassia is the wood of a tree growing in the West Indies, termed Picrcena f 
rxcelsa. It arrives in logs or billets, is grayish-brown externally, and light 
yellow internally. The wood is tough, but not very heavy, and is usually sold 
as chips. Sometimes drinking-vessels, carved out of the wood, are sold. These 
are filled with water at night, and allowed to stand till morning, when the 
contents are consumed. The quassia wood is intensely bitter, and yields its 
bitterness very readily to water. Its preparations are an extract, a tincture, 
and an infusion. Of these, the infusion is mainly used, chiefly as a vehicle, 
for which it commends itself, being one of the very few bitters which contain 
no tannin, and so does not blacken with iron. Quassia is a pure bitter, but 
not an agreeable one. It is used sometimes in indigestion, but columba has 
there mostly superseded it. In indigestion, with loss of power and irritability 
of the stomach, it may well be given along with either an acid or an alkali, 
according to the period of digestion. Sometimes, but rarely, it has been used 
as an antiperiodic ; in this way it seems to be devoid of efficacy. It is prob- 
ably most useful combined with a preparation of iron and an acid in recovery 
from prostrating illness. 

Quicksilver. See Mercury. 

Quinine is the most important constituent of cinchona bark, and has now, 
to a very great extent, superseded the crude substance as a remedy. Pure 
quinine is not employed in medicine, being quite insoluble in water ; but the 
sulphate takes its place. There are other alkaloids contained in these barks, 
especially cinchonine, and the relative proportions of these vary in certain' 
kinds, cinchonine being more abundant than quinine. The bark known as 
calisaya bark is that which contains most quinine. This is taken coarsely 
powdered, and moistened with very dilute hydrochloric acid ; this acid is after- 
wards separated by percolation, and carries with it the alkaloid. These are 
precipitated by means of caustic soda and well washed. Afterwards the al- 
kaloid is dissolved by means of sulphuric acid and allowed to crystallize. 
Thus prepared, sulphate of quinine is snow-white and crystalline, the crystals 



QUI 662 QUI 

being feathery. It possesses the curious property of fluorescence, that is, cer- 
tain rays of light falling in a solution of quinine, though themselves invisible, 
cause the solution to yield light. The salt is neutral, and requires an acid to 
dissolve it in water if a solution of any strength is to be made. The effects 
of quinine are manifold. Applied to the white corpuscles of the blood, and 
all bodies resembling them, it arrests their motion, and apparently kills them ; 
it also, within certain limits, arrests putrefaction even more powerfully than 
creasote. On the digestive tract quinine acts as do most other bitters ; it gives 
rise to an increased flow of mucus, and to a small extent also that of the gastric 
juice Especially will it be serviceable to arrest the putrefactive changes in 
food which has been retained in the stomach without being digested, and so 
gives ri>e to flatulence, acidity, etc. Quinine, after being swallowed, passes 
into the blood, and in great measure is evacuated by the kidneys, almost un- 
changed. 

•The effect of quinine on the sense of hearing is peculiar. If taken in large 
doses, it speedily gives rise to noises in the head, singing in the ears, and 
sometimes deafness ; sight, too. may become dim, or even blindness for a time 
ensue ; headache is also produced, frontal in site and severe in character ; 
generally the pain is of a dull, heavy kind, the face is flushed and hot, and the 
eyes are suffused. These effects of large doses of quinine go by the name of 
cinchonism. Moreover, in large doses, quinine has the power of markedly re- 
ducing temperature ; for this reason it has been largely given in acute rheuma- 
tism, pyaemia, and some forms of fever. Sometimes quinine in these cases has 
been given in enormous doses, twenty grains, frequently repeated, being not 
uncommon. It is true that in these cases the temperature has sometimes been 
reduced, but the patient has died all the same. The most important use of 
quinine seems to be in malarious fevers, remittent or intermittent. The best 
plan of giving the remedy in these diseases seems to be to wait for a remission, 
then to give a full dose, at least five or ten grains, and keep up the effect, by 
an hourly administration of the remedy thereafter ; two grains will generally 
suffice as a dose for this purpose, but to arrest the paroxysm it is best to give 
a much larger quantity. Certain forms of neuralgia, of a distinctly remittent 
type, are best treated by quinine. A large dose should be given just before 
the expected attack : five or ten grains should suffice. Even ordinary neu- 
ralgias are frequently benefited by doses of quinine given during an intermis- 
sion. Quinine is commonly prescribed in most forms of convalescence from 
acute disease. It is then ordinarily given in a dose of one or two grains dis- 
solved in water or orange wine by a few drops of dilute sulphuric acid. In 
this way it is of undoubted service. 

Quinsy is a common and troublesome affection, consisting of inflammation 
of the tonsils and adjacent parts of the fauces or back part of the mouth. It 
may occur at any age, but it is most common in young people ; and when 
once any one has been subject to it, is very likely to recur on exposure to cold, 
so that some have an attack every year. Although painful at the time, no 
serious results may be anticipated, as it is a disease which is very amenable to 
treatment. 

Symptoms : The patient feels out of sorts after exposure to wet or cold ; he 
has a stiff and painful feeling in the throat ; the tongue becomes furred and 
white ; the appetite is bad ; there is often headache and pains in the limbs ; 
the temperature rises rapidly, and all the symptoms of a fever come on. The 
tonsils enlarge, so that the act of swallowing is made with difficulty, and the 
tonsils may be so large as almost to meet in the middle line, and quite prevent 



QUO 663 RAI 

any solid food being taken; at the same time there is swelling outside, just 
below the ear, which is painful on pressure. The enlarged tonsils may be- 
come full of pus, and when they burst ihey discharge much matter, and give 
at once much relief. The febrile symptoms last four or five days, and then 
pretty quickly subside ; in most cases the inflammation goes away without the 
formation of any matter ; generally, also, one side is more affected than the 
other. 

Treatment: The patient should at once go to bed, or at least keep in a room 
with a moist and warm atmosphere ; any attempt to go out in the air only in- 
creases the malady, and makes the throat more sore than before. No solid 
food can be taken, and therefore beef-tea, hot milk, and soups must be given, 
and the thinner the fluid the more easily is it swallowed. Port wine is very 
valuable, and three or four glasses should be taken every day, and will be 
found to give great relief. Steam should be frequently inhaled by placing the 
mouth over a jug full of boiling water, but not over the mouth of a kettle, as 
the patient's mouth may be scalded. Gargles are of no use, as they do not go 
far enough back, and the effort of gargling is distressing to the patient. A 
hot bran or linseed-meal poultice should be placed round the throat at night, 
while during the day hot flannels should be worn. Sponging the outside of 
the throat with hot water will give great relief ; the inside of the throat may 
be sponged with some astringent lotion, as tannic acid or iron and glycerine, 
by which it may be kept constantly moist. A mixture containing chlorate of 
potass and bark is most useful in this affection, and it should be continued for 
some time until convalescence is established. Puncturing the tonsils with a 
small and narrow knife is very useful, even if it does not cause matter to es- 
cape. In some cases a leech or two behind or below the ear is useful, but 
blisters do no good. People who are liable to quinsy should be very careful 
to avoid, as far as possible, foggy and damp weather, as the disease is then 
very liable to recur. This affection might at first be mistaken for scarlet 
fever ; but the fever lasts for a shorter time, and there is no rash, nor is it fol- 
lowed by dropsy or swelling of the glands. In diphtheria there is less fever, 
but much more prostration, while a membrane forms over the nostrils and a 
fatal result often happens. See Sore Throat. 

Quotidian Ague is said to occur when the fever comes on every day, al- 
though it may not come on exactly at the same hour. See .Intermittent 
Fever. 

R. 

Rabies. See Hydrophobia. 

Radius is a name given to one of the bones of the fore-arm. 

Railway Injuries. The ill effects following injuries met with in railway 
accidents are of a somewhat peculiar nature, irrespectively of such forms of 
accidents as are mentioned elsewhere, such as fractures and dislocations. 
These injuries consist of concussions of the spine and spinal cord, and from 
the frequent absence of outward signs, and the obscurity of the early symp- 
toms, are of a very insidious character, and their diagnosis is of the utmost 
importance to a medical man, as they so frequently are the sources of medico- 
legal inquiry. A well-known author, speaking of this class of injury, says : 
" In no ordinary accident can the shock be so great as in those that occur on 
railways. The rapidity of the movement, the momentum of the person in- 
jured, the suddenness of its arrest, the helplessness of the sufferers, and the 



RAI 664 RAI 

natural perturbation of mind that must disturb the bravest are all circum- 
stances that of necessity greatly increase the severity of the resulting injury 
to the nervous system, and that justly cause these cases to be considered as 
somewhat exceptional from ordinary accidents. This has actually led some 
surgeons to designate that peculiar affection of the spine that is met with in 
these cases as the Railway Spine." Injuries of the spine and spinal cord have 
been already treated of generally, and it is hardly to the purpose to reconsider 
them specially in reference to the subject in hand, and we shall therefore pass 
on to such matters as relate to those cases where the fact of injury sustained 
on a railway has been the cause of litigation. Concussion of the spine from 
a direct and severe injury to the back may terminate, according to the same 
authority, in four ways : (1.) In complete recovery, after a longer or shorter 
time. (2.) In incomplete recovery. (3.) In permanent disease of the spinal 
cord and its membranes. (4.) In death. It is a very remarkable circum- 
stance that, although the patient has apparently sustained in many cases a very ' 
trifling injury, the result is widely disproportionate, the reason of this being 
that the symptoms indicative of concussion of the spine, and of the subsequent 
irritation and inflammation of the cord and its membranes, are so slowly pro- 
gressive. A patient is often quite unaware that anything serious has hap- 
pened, feeling perhaps only violently jolted, and a little giddy or confused. 
After a while, however, when he has reached home, the effects of his appar- 
ently simple injury begin to declare themselves. u A revulsion of feeling 
takes place ; he bursts into tears and becomes unusually talkative, and is ex- 
cited ; lie cannot sleep ov if he does, he wakes up suddenly with a vague sense 
of alarm. The next day he complains of feeling shaken or bruised all over, 
as if he had been beaten or had violently strained himself by exertion of an 
unusual kind. This stiff, strained feeling chiefly affects the muscles of the 
back and loins, sometimes extending to those of the shoulders and thighs. 
After a time, which varies much in different cases, from a day or two to a 
week or more, he finds that he is unfit for exertion and unable to attend to 
business." Such is generally the early history of a case of railway concussion. 
Sometimes serious symptoms begin to develop immediately after the receipt of 
the injury, in other cases not till long afterwards ; most marked and distinct 
changes are perceptible in the countenance, and in the state of the memory ; 
the thoughts become confused, all business aptitude is lost, the temper becomes 
irritable, the sleep disturbed, restless, and broken ; there are often loud and 
incessant noises in the head, the vision is frequently affected in various ways, 
the hearing, taste, smell, and the sense of touch become perverted ; the sense 
of speech is rarely affected, and usually the attitude of those afflicted is pe- 
culiar. There is a loss of freedom in the efforts of motion, or movement, and 
the individual appears afraid to make such efforts ; the gait, again, is very 
characteristic ; he walks unsteadily, and in a straddling manner ; the power of 
walking is very limited, and he is unable to ride; the nervous power of the 
limbs will be found to be affected ; sensation and motion, or both, may be im- 
paired. Coldness of one of the extremities, owing to loss of nervous power 
and defective nutrition, is often noticed. The prognosis in these cases is very 
unfavorable, and patients have never been known to recover, completely and 
entirely, so as to be in the same state of health as before the accident. 

With regard to the treatment of concussion of the spine brought on by such 
injuries, the first thing obviously is complete rest, and the patient should be 
compelled to lie down on a couch, ami the mind must be kept as much as 
possible at rest also ; ice-bags over the injured part oi' the spine ; internally the 



RAI 665 REC 

bichloride of mercury in quinine or bark ; mix vomica, strychnine, and iron are 
all of great value in certain cases. Salt-water douches to the spine, and gal- 
vani>m are recommended in some instances. The great thing to be done is 
to endeavor to improve the general health, and " prevent the development, if 
possible, of secondary diseases, such as phthisis, dependent on malnutrition, 
and a generally broken state of the health." 

Rain. When, by the condensation of the aqueous vapor which forms the 
clouds, the. individual vesicles unite, so as to become larger and heavier, they 
form regular drops, which come down as rain. The amount of rain which 
falls, in any given place is measured by a rain gauge or pluviometer. This 
consists of a cylindrical vessel, with a funnel-shaped lid, at the bottom of which 
is a small hole, through which the rain falls. A glass tube by the side of and 
in communication with the bottom of the vessel is marked with a scale, so as 
to show the quantity of rain which has fallen. When rain falls through moist 
air, the drops will, from their temperature, condense the vapor and increase in 
volume ; when, on the other hand, they traverse dry air, they tend to evaporate 
and lose in bulk. As a rule, most rain falls in hot climates, as there evapora- 
tion is most abundant. An inch depth of rain on a square yard represents a 
fall of 46.74 pounds, or 4.67 gallons of water. On an acre it corresponds to 
22,622 gallons, or rather more thau 100 tons. This subject is further treated 
of in the article on Meteorology. 

Rales. A term used to describe certain sounds in the chest produced in 
the act of respiration by the passage of air over or through mucus. 

Ramollissement is a technical term for softening of the brain. See 
Cerebral Softening. 

Ranula. A tumor situated below the tongue, bluish in color, translucent 
and cystic in character. It sometimes attains such a size as to displace the 
tongue and impede its movements, causing serious inconvenience in mastica- 
tion, deglutition, and articulation. It may be caused either by obstruction of a 
salivary duct, or by the occlusion and dilatation of a mucous cyst, or dilatation 
of a bursa mucosa said to exist on the outer surface of the genio-hyoglossus 
muscle ; or" it may be a new growth of itself, a myxomatous cyst. It may be 
healed by simple incision, or by cutting out a portion and evacuating the con- 
tents, and to prevent premature closing a strip of lint should be introduced, 
or frequently the introduction of a seton suffices. In the case of cysts contain- 
ing a thick, putty-like material, the cyst wall must be dissected out entire. 
The injection of iodine is sometimes followed with good results. The con- 
tents of the cyst are gummy or albuminous in character, containing simple 
round mucous globules as their only structural element. Occasionally phos- 
phatic concretions are met with. 

Rattle. This is a term applied to a noise in the. throat caused by the air 
passing through the mucus in the air-passages ; it often precedes death. 

Receptaculum Chyli is the name given to a small chamber or cavity 
lying in the abdomen in front of the aorta, which receives the chyle from the 
lacteals of the intestine, and from various lymphatics ; the fluid then passes up 
the -thoracic duct, and enters the blood near the neck. 

Rectified Spirit. When any fluid which has undergone vinous fermenta- 
tion, as wine beer, etc., is subject to distillation, the volatile alcohol will pass 
over into the receiver, mixed with some water, and to this mixture the name 
of rectified spirit is given. This fluid is in reality alcohol, with 16 per cent, 
of water ; its sp. gr. is .838 ; it burns with a blue flame, without smoke, pro- 
ducing carbonic acid and water. From this fluid, by removing the water by 



REC 666 EEC 

carbonate of potash, absolute alcohol maybe obtained; by adding water until 
the sp. gr. of the fluid is .920 proof spirit is formed. See Puoof Spirit. 

Rectum. The rectum (or straight gut) is the lower portion of the large 
intestine, about eight inches in length, and largest in capacity just above the 
anus. It commences opposite the left sacro-iliac articulation, and descends 
obliquely towards the middle line as far as the lower end of the sacrum, then 
it bends towards the periiueum, and, turning downwards, terminates in the 
anus. The chief diseases to which the rectum is liable are : — 

Abscess. Some young, weakly persons are subject to the formation of ab- 
scess in the areolar tissue, outside the rectum, and sometimes the collection of 
matter is situated at a considerable depth, as is shown by the tenseness and 
pain at the verge, with considerable difficulty in passing motions or making 
water ; the abscesses usually " point " at the margin of the anus, and should b< j 
opened at once, in order to prevent the formation of fistula. As the general 
health is very low in a constitution in which such collection of matter forms, 
the greatest attention must be paid to its improvement, and this state of things 
is not unfrequently associated with phthisis. 

Fistula. By the term fistula is meant a sinuous passage by the side of the 
rectum, the result of abscess, opening at the nates, sometimes not having any 
communication with the gut (Blind External Fistula), sometimes communicat- 
ing with it, without, however, having any external orifice (Blind Internal Fis- 
tula). In some cases the internal and external apertures communicate, in 
which case the fistula is termed complete. These fistuloe are prevented from 
healing by the passage of feculent matters along them, and by the continuous 
state of motion of the part, caused by the action of the sphincter ani muscle, 
and, moreover, from their inability to contract. Of all the forms above men- 
tioned the complete is the most common and the most annoying, owing to the 
great pain and irritation it causes, and on account of the almost constant pass- 
ing of fa?cal mucus or flatus along it. The internal opening is usually about 
an inch and a half from the anus, and is to be felt as a small papilla, always 
within reach of the finger. Fistula is frequently co-existent with phthisis, 
probably due to tubercular inflammation of the rectum. The treatment of 
anal fistula is comparatively simple, and it consists in freely laying open the 
track or tracks, and dividing the sphincter ani, allowing it to heal up from be- 
low. Before the operation the bowels must be well evacuated. In the case 
of either blind external or blind internal fistulas they must be reduced to the 
complete form, that is, an external and internal opening must be made, by 
passing a probe throughout the tract. After the operation a good opiate is to be 
administered, to allay pain, and to prevent the action of the bowels. At the 
end of the third or fourth day a slight aperient should be given, and care 
taken subsequently to prevent the too early closing of the wound. The oper- 
ation should not be undertaken in advanced cases of pulmonary phthisis, as the 
wound in all probability will not heal up, and the pulmonary symptoms will 
be aggravated from the fact of closing up the outlet of the purulent and other 
discharges. However, from the great irritation or pain with which such a 
condition is sometimes attended, as an obvious means of relief the operation is 
justifiable. 

Fissure. Fissures are small chaps or cracks, forming just inside the rectum 
in the mucous membrane, and usually situated at the posterior part. The 
affection is almost invariably connected with dyspepsia. The pain is most ex- 
cruciating on passing a motion, or on any attempt to make an examination, 
the patient shrinking away, even at the mere approach of the finger. A slight 



REC 667 EEC 

operation, that of dividing the fissured track with a bistoury, is all that is nec- 
essary, and subsequent attention to diet and the general health. 

Haemorrhoids (Piles). Haemorrhoids maybe described as being an enlarge- 
ment of the vessels of the rectum, forming tumors, whether attended with the 
discharge of blood or not. They may be classed as of two kinds : external and 
internal. External piles consist of a collection of varicose veins and of hy- 
pertrophied skin and cellular tissue, forming tense, round, purple swellings 
protruding from the anus, varying much' in size ; sometimes only as large as a 
pea, at other times almost as large as the fist. When they do not bleed they 
are termed blind piles. Internal piles are probably more frequent, and are 
productive of much more distress than the preceding ; they exist inside the 
sphincter, and are rarely " blind." They consist of three kinds or forms : (1) 
spongy vascular growth ; (2) a knot of haemorrhoidal veins ; (3) pendulous 
tumors, composed of fibro-areolar tissue. Piles rarely occur before the period 
of puberty, more commonly in females than males ; the predisposing causes are 
habitual constipation, pregnancy, any tumor causing pressure upon the veins 
of the rectum, torpid state of liver, and sedentary occupation with luxurious 
living. The exciting causes are purging, and exposure to wet and cold, over- 
riding, rowing, etc. The treatment of external piles consists in palliation or 
in radical measures. The daily action of the bowels must be procured, and if 
the piles be inflamed, gentle purgatives, avoidance of straining at stool, and 
hot fomentations. If indolent, stimulant and astringent applications are nec- 
essary, such as tannin, galls, etc. Attention to the state of the liver is most 
important. In the case of small, tense piles, incision and the evacuation of 
the clotted blood they contain will prove a cure. Sometimes the piles must be 
snipped off, or in severe cases undergo the radical cure of ligature, clamp, 
or cautery. 

Treatment of internal piles. The palliative treatment is the same as in 
the previous form of piles, and haemorrhage may be restrained by the internal 
use of gallic acid or turpentine. The pile should be carefully returned after 
each motion, pushed up with the finger, a bougie, or a tallow candle, and a 
suppository administered, of which tannin and cocoa butter is the best form. 
The radical cure is best performed by ligature, the piles being constricted, or 
strangulated and allowed to slough off. A full dose of morphia should be 
given after the operation, and attention be paid to the state of the bladder ; 
should retention of urine be threatened, hot fomentations should be ap- 
plied to the belly, and henbane administered, or the catheter may be re- 
quired. The smell of the portions undergoing separation by sloughing is 
best subdued by a solution of chlorinated soda, or Condy's fluid. It should be 
borne in mind that bleeding piles must not be interfered with without due cau- 
tion in elderly persons having heart disease, or tendency of blood to the head, 
and that the system must be duly prepared if an operation is determined on. 

Prolapsus. By prolapsus is meant the protrusion of the bowel at the anus. 
It may occur at any age, although complete prolapse is met with at the ex- 
tremes of age. It is caused by a want of tone of the sphincter, constipation 
or straining, ascarides, stricture, or stone in the bladder. Jn children the 
bowel, after being replaced, should be prevented from falling again by apply- 
ing a broad pad of lint, and drawing the buttocks firmly together with a broad 
strip of adhesive plaster, and children should be made to pass motions lying 
down. Bark, steel, quinine, and cod-liver oil to be given, and the parts 
douched with cold water after each motion. In all cases, care must be taken 
to prevent constipation, and astringent injections, such as alum, rhatany, or 



REC 668 RED 

perch loride of iron, with suppositories of tannic acid and cocoa butter, are very 
useful. Medical treatment tailing, operative proceedings should be resorted to. 

Stricture. .Stricture or contraction of the walls "of the rectum is dependent 
upon organic or malignant disease, or in some cases there is a spasmodic strict- 
ure, which, however, is a concomitant of some preexisting condition, such as 
piles or ulceration of the mucous coat. Stricture is rarely beyond the reach 
of the finger, and the leading symptom of its existence is the fact of the mo- 
tions, if solid, passing as pellets or in small pieces, and if fluid, being ejected 
as by a squirt. The treatment consists in keeping the bowels gently open, and 
in the careful use of a bougie as directed by a medical attendant. In severe 
cases operation is necessary. The stricture produced by malignant disease 
(scirrhous cancer, generally) is of course only to be treated by palliation. See 
Cancer. 

Irritable rectum : Pruritus. Itching of the anus is a very common and 
troublesome affection, generally connected with some irregular state of the 
lining mucous membrane of the rectum, as for instance ascarides, but very 
often its cause may be urethral stricture (see Stricture), stone in the blad- 
der, and in elderly men enlargement of the prostate, or the existence of piles, 
and it is occasionally due to pediculi. The treatment most successful is the 
internal administration of tar in form of pill, arsenic, or, confection of pepper; 
locally, tobacco-water enema, a mild mercurial ointment, such as calomel and 
glycerine, cold bathing and plenty of exercise, and avoidance of spirits 
coffee, and highly seasoned food. 

Bleeding from rectum. Sec HEMORRHAGE. 

Foreign bodies in rectum. See Foreign Bodies. 

Recurrent Tumors. This is a term used when a tumor returns after 
removal. See TUMORS. 

Red Gum, or Strophulus, is a simple form of skin eruption which oc- 
curs in infants. It may come very soon after birth, and generally within the 
first year of life ; it occurs in those which have a delicate skin, and are of 
a scrofulous habit. This eruption is much allied to eczema, nor is it uncom- 
mon to find red gum on the body and eczema on the head. The disorder is a 
very harmless one, and may be brought out by any local irritation, as worms, 
improper diet, teething, etc. The rash is. best marked on the back, where it 
appears in profusion as a number of miuute red papules, attended by a trifling 
itching; sometimes the rash may come on all over the body. It is a disease 
of no practical importance, and may be treated by giving a very simple diet, 
consisting of milk or milk and lime-water, without thickening the food at all. 
A little rhubarb and magnesia so as to act as a gentle purgative should be 
given. Bathing the skin with tepid water is very useful, and if persisted in 
zinc ointment should be applied to the affected part. 

Red Poppy, Pa-paver rhceas. although used in medicine, can hardly be 
spoken of as a substance of medicinal importance. The petals, which are 
well known, are of a bright red color, becoming dull red on drying. These 
petals are gradually added to boiling water, and the whole allowed to macerate 
for about' twelve hours. After this the liquid is strained off' and mixed with 
sugar, the whole forming a preparation known as syrup of red poppies. This 
preparation must not be confounded with the syrup of poppies, which is much 
more active. The syrup of red poppies is only used for its bright color, which 
makes the medicines with which it is mixed look agreeable, if they do not 
taste so. 

Reduction of Dislocation. See Dislocation. 



EEF , 669 EEL 

Refrigerants are what we commonly call cooling medicines. They in- 
clude saline and acid substances, some of them powerful, some of them weak. 
Refrigerants are at least of two kinds : some have actually the power to dimin- 
ish temperature, some seem only to allay thirst. Those which can diminish 
temperature are saline substances, given whilst dissolving. Some of these, as 
is well known, possess a power of diminishing temperature sufficient to freeze 
water. Others again, like acid fruits, seem only to possess refrigerant powers 
by allaying thirst, for a dry parched mouth is one of the most prominent indi- 
cations of fever, and this being relieved there is often a belief that the bodily 
temperature is actually lessened. Of the salts which possess the power of 
diminishing temperature when dissolving, saltpetre may be taken as a type, 
though there are many others which are never given internally. The juice of 
grapes, oranges and lemons, with the acids they yield, — namely, tartaric and 
citric, — are also useful, mainly, as already pointed out, in relieving thirst and 
moistening the parched mouth. 

Relapsing Fever, or Famine Fever, is a contagious disease which is 
chiefly met with in the form of an epidemic in periods of scarcity and famine. 
It is characterized by a very sudden attack of shivering or rigors ; a quick, 
full pulse ; white, moist tongue, afterwards becoming yellow or brown ; pain 
at the pit of the stomach and vomiting ; an enlarged liver and spleen ; con- 
stipation of the bowels ; hot and dry skin ; no marked rash on the skin ; high- 
colored urine and pain in the limbs, with severe headache ; restlessness and 
often delirium ; then comes an abrupt cessation of the symptoms, on or about 
the seventh day, generally accompanied by copious perspiration. The febrile 
symptoms are then absent completely for a few days, the tongue becomes clean, 
the appetite returns, and the patient can often get up and walk about. Then 
comes the relapse, on or about the fourteenth day from the commencement of 
the fever, running a course similar to the first attack, but shorter in duration, 
and generally terminating about the third or fourth day of the relapse ; recov- 
ery generally ensues then, but there may be a second, third, or even a fourth 
or fifth relapse in some cases. 

History: Hippocrates described an epidemic of this sort two thousand years 
ago in the island of Thacus, off the coast of Thrace, and numerous outbreaks 
have occurred since, although by many people it has been confounded with 
typhus ; and it is a fact to be remembered that the two fevers may often be 
prevalent at the same time. An epidemic occurred in London in 1729, in Ire- 
land in 1739, in Newcastle in 1777, and in many parts of England in 1801. 
During the first sixteen years of this century there were occasional occurrences 
of this fever in Ireland, and in 1817-19 there was a severe epidemic of it. 
Yet the mortality was but small. Thus in the Dublin hospitals "28,514 cases 
of this fever were admitted from September, 1817, to November, 1818, inclu- 
sive, and of these only 1242 died, or 1 in 23. The next epidemic was in 
1826, which was also associated with typhus fever. From 1828 to 1842 re- 
lapsing fever disappeared from England ; it then again appeared in Scotland, 
and to a less extent in England. After the epidemic of 1843 a few cases 
were observed, both in Ireland and Britain, until the end of 1846 ; in 1847- 
48 another epidemic appeared, also accompanied by typhus fever. The years 
1846 and 1847 were marked by severe famine, not Only in England but in 
some parts of the Continent, and chiefly in the Prussian province of Upper 
Silesia, and in some other parts of Germany. In 1851 several cases appeared 
in London, but almost wholly among the Irish, many of whom had only been 
iu Ljndon a short time, and were very badly off. In 1869 another epidemic 



REL 



670 



REL 



broke out in London, and a great many fell ill, but the mortality was very 
small ; it commenced amongst some Polish Jews, and then rapidly spread over 
the metropolis. This fever has always been more prevalent in Ireland than 
in other parts of Great Britain, and whan it has prevailed in England the 
Irish have suffered more than the English and Scotch. Of the cases admitted 
in the London Fever Hospital, over a series of years, it was found that 1 in 
every 386 of the Irish inhabitants in London were affected ; 1 in 8351 of for- 
eigners ; 1 in every 15,200 of the Scotch, and 1 in every 16,465 English in- 
habitants. 

Causes: Age seems to have very little influence in this disorder; it attacks 
alike young and old, while typhus affects older people; the difference may be 
seen in this table : — 



Under 10 vears of sige there were 

"15' " '« . . . 

From 15 to 25 years of age . . 

" 25 years and upwards . . 

30 " " "... 

" 40 " " "... 

50 " "... 

" 60 " " "... 



Per cent, of Per cent, of 

Typhus Cases. Relapsing Cases. 



5.78 


8.23 


16.30 


22.65 


30.12 


38.44 


53.58 


38.90 


43.66 


30.43 


26.47 


17.62 


11.92 


6.63 


4.68 


1.60 



In relapsing fever, as in typhus, females of an advanced age are more liable 
to be affected than males. 

Out of a total of 441 cases at the London Fever Hospital, 233 were males, 208 females. 

Of eases below 25 years of age 155 " 112 " 

Of cases above 25 years of age 76 " 94 " 

Sex has very little influence in predisposing to this disease; of 4917 col- 
lected cases, 2541 were males, while 2376 were females. The season of the 
year exerts very little influence on this disease ; typhoid fever is most preva- 
lent in the autumn, and typhus fever during and towards the end of winter. 



Seasons. 


London 
Fever Hospital. 


Edinburgh 
Royal Infirmary. 


Glasgow 
Royal Infirmary. 




90 
120 
123 

108 


253 

545 

1,551 

1,595 


672 


Summer 

Autumn 


687 
542 
432 







Thus it will be seen that in London and Edinburgh autumn and winter 
seemed the seasons most affected by the fever, but in Glasgow most cases oc- 
curred in the spring and summer. No occupation seems to have a predispos- 
ing influence, but it is always most common among those who are idle and 
vagrants, and have a precarious living. Overcrowding and destitution favor 
the propagation of relapsing fever ; those who are exposed to cold and wet, 
to intemperance, mental and bodily fatigue, depression of. spirits, etc., are 
thereby rendered more liable than others to catch the fever. Relapsing fever 
is certainly contagious ; actual contact is not necessary, for the poison may be 



REM 671 REM 

conveyed through the air from one person to another. Starvation and destitu- 
tion are the two conditions which most of all tend to produce the disease ; from 
the records of the London Fever Hospital since 1847, 430 or 97.5 per cent, 
of the patients admitted were paid for hy the parish authorities, and were 
totally destitute ; all were very poor, and not a single patient had been a ser- 
vant in a private family. A large proportion of them had been litei'ally starv- 
ing for some time previous. The disease can hardly be mistaken for any 
other. It is chiefly known by its sudden onset ; the severity of its symptoms 
during the first week ; the absence of a rash and the sudden cessation of all 
symptoms, followed in a few days by a second or even third relapse. Although 
most cases recover with only one or two relapses, yet they are left for some 
time in a very weak condition, and are liable to bronchitis and a peculiar form 
of ophthalmia. The mortality from this fever is but slight, not being more 
than one in twenty-one cases ; in the last epidemic in London it was far less 
than that ; it seems to have been much less fatal in London than in Scotland 
or Ireland ; of 439 cases treated in the London Fever Hospital, from 1848 to 
1857, only nine died, or 2.05 per cent. Most of the fatal cases die suddenly 
from syncope, or failure of the heart's action, or from suppression of the urine 
followed by coma. 

Treatment: Bleeding used to be generally adopted, but all are now agreed 
that it should never be used in these cases ; of 364 cases which were bled, one 
in 18.2 died; of 190 cases not bled, only one in 47.5 died; this is conclusive 
as to the danger of such a proceeding. Mercury is a drug which has no effect 
in checking the fever. Quinine seems to have very little influence in prevent- 
ing a relapse. The best treatment to be adopted is that which consists in 
placing the patient in a large, well-ventilated room, in promoting cleanliness, 
and in giving milk and other nourishing diet, such as has been described in 
the article on Fevers. At the commencement of the attack the bowels should 
be opened, if required, by a purgative ; the skin should be frequently sponger! 
with tepid water, but only one part of the body should be exposed at a time, 
so as not to cause a chill to the surface. The vital powers must be kept up 
by milk, beef-tea, egg and milk, etc. Stimulants are not often wanted, but 
must be given with care when there is much prostration and failure of the 
heart's action. If there is any suppression of the urine, the bowels must be 
freely opened, the patient put into a hot bath, and dry cupping applied to the 
loins. During convalescence tonics must be given, and the mineral acids with 
quinine are the best for this purpose. For some time after the fever has 
ceased the patient requires a liberal and generous diet before he will suffi- 
ciently regain his strength. 

Remittent Fever is a malarious fever, characterized by irregular l-epeated 
exacerbations, the remissions being less distinct in proportion to the intensity 
of the fever. It is accompanied by functional disturbance of the liver, and 
frequently by yellowness of skin. There is a slight cold stage, which does 
not recur with every exacerbation ; an intense hot stage, with violent headache 
and gastric irritation ; and a slight sweating stage, which may be wanting. 
This disease is also known as jungle fever, bilious fever, bilious remittent, 
endemic fever, marsh remittent, and as gastric malarious remittent. In the 
article on Intermittent Fever the effect of malarious influences on the human 
system was described, and it was mentioned that whereas in temperate cli- 
mates intermittent fever of a mild character was met with, yet the nearer 
we approached the tropics the fever assumed a greater severity, while in the 
tropics themselves the intermissions were less distinct, and the cases ran into 



REM 672 REM 

the remittent form of fever; so that there seems to be an intimate connection 
between these two forms of disease. 

History : Remittent fever is the gravest form of fever which arises from 
miasmatic or malarious influences, and it is most prevalent and fatal when 
high temperature and malaria act together. It exists in a severe form on the 
western shores of Africa, and in the course of its great rivers. In India it is 
most common and fatal in the delta of the Ganges, in the jungles at the base 
of mountain ranges, and at certain periods of the year in some uncultivated and 
jungly plains. It is met with also in North and South America, and more 
especially near the Gulf of Mexico and in the West India Islands. In inter- 
mittent fevers there is an absence of fever between the attacks, but in remit- 
tent fever, while the urgent symptoms abate in intensity, there is not any 
absence of fever, and the more severe the case the less marked are the remis- 
sions. 

Symptoms : The earliest symptom that comes on is oppression and discom- 
fort at the pit of the stomach. The cold stage is not so well marked nor so 
long in duration as in ague; sometimes no rigors or shivering can be noticed, 
but merely a slight feeling of chilliness, alternating with flushes of heat. The 
patient feels cold, but his temperature is at this time higher than usual, and 
may be above 100° Fahr., rising, as the hot stage advances, to 106° or 107° 
Fahr. When the hot stage comes on there is generally vomiting, and this 
continues throughout, causing much distress ; the tongue becomes furred and 
dry, and' there is a feeling of fullness and oppression in the pit of the stomach, 
the pulse rising to 100 or even 120. The countenance is flushed, the eyes suf- 
fused, and the patient complains of violent headache and pains in the limbs 
and bones ; there is much restlessness and prostration. 

After the above symptoms have lasted from six to twelve hours they begin 
to abate ; a slight moisture may be perceived on the brow and neck, and then 
over the body; the pulse and temperature go down ; the headache lessens; 
the vomiting ceases, and some sleep may be obtained. This period of remis- 
sion is not always observable in very severe cases. After an interval of from 
two to eight or ten hours the fever returns, and all the distressing symptoms 
are gone through again, to be followed soon by a second remission. The 
vomited matters at first consist of any food that may be in the stomach, and 
then a large quantity of watery fluid is brought up ; then bile becomes mixed 
with the vomited matters, giving them a greenish-yellow color, which may go 
on to be brown or even black from the presence of blood. 

The headache, at first throbbing, soon becomes a constant pain, with a feel- 
ing of tension across the forehead. Delirium of a violent form is rare, but 
there is often confusion of thought, and in some fatal cases a low, muttering 
delirium precedes the state of coma, which ends in death. Sometimes petechial 
spots appear on the skin, and blood is found also in the vomit and in the 
stools. A slight degree of jaundice is common in many cases. The spleen is 
not often found enlarged. 

The duration of the fever may be from five to fourteen days, but the length 
of time is much influenced by treatment. The fever may terminate in re- 
covery, or may pass into an intermittent form, or death may ensue. Death 
rarely, if ever, occurs before the eighth day, and the patient sinks partly from 
exhaustion and partly from the action of the poison on the system. Sometimes 
an attack may come on in a few hours after exposure to the malarious in- 
fluence, but generally it takes a week or ten days before the disease develops 
itself. For the causes of this fever further information may be obtained by 



REN 673 RES 

reading the article on Intermittent Fever. Few could make any mistake in 
recognizing the difference between an intermittent and a remittent fever. 
Yellow fever is unknown in India ; when it occurs elsewhere it may be re- 
membered that in that complaint the fever is continuous, and there are no re- 
missions. Most cases of remittent fever recover, if properly treated ; the case 
is more favorable as the remissions become more marked, but less favorable 
when there is great prostration and exhaustion. 

Treatment : Bleeding must never be used. Place the patient in bed, and 
secure careful ventilation of the room. Iced water, soda water, or lemonade 
may be given to check the thirst and vomiting ; an ice-bag may be applied to 
the head, and great relief may be afforded by packing the patient in a wet 
sheet, changing it when it becomes too warm, but in some cases it does not 
suit, and then bathing the surface with tepid water will do good. On the first 
sign of remission, from fifteen to twenty grains of quinine should be given, and 
this may be done though the tongue be foul and the headache continue. A 
free action of the bowels may be gained by giving a purgative at the onset, or 
by an enema. In the second remission another large dose of quinine should 
be given, and so on until cinchonism is produced. Mercury ought never to be 
given, and its use may prove very serious to the patient. Turpentine stupes 
and hot fomentations will relieve the pain at the pit of the stomach. During 
convalescence quinine and other tonics should be given, until the patient's 
health is reestablished. Change of climate is then very desirable. See 
Intermittent Fever. 

Renal Disease. See Kidney. 

Respiration is the process by which the air enters and emerges from the 
lungs, and in doing so causes the aeration of the blood, and converts the black 
venous blood into the scarlet arterial blood. 

Respiration consists of two acts, inspiration and expiration, and as a rule 
an individual breathes fifteen times in a minute. The lungs always contain 
air, and no expiratory effort, however forced, can empty them ; the amount of 
this air which cannot be got rid of is called residual air, and is on the average 
from 75 to 100 cubic inches. About as much more in addition to this remains 
in the chest after an ordinary expiration, and is called supplemental air. In 
ordinary breathing, from 20 to 30 cubic inches of air pass in and out of the 
chest ; this is called tidal air ; thus, at the end of an ordinary inspiration, 
about 230 cubic inches of air are contained in the lungs ; in addition, by taking 
a very deep inspiration, another 100 cubic inches, called complemental air, 
may be added. Of the 230 cubic inches contained in the lungs at the end 
of an ordinary inspiration, about one-seventh goes out at every expiration, 
and is taken in again at the next inspiration, and so on ; thus it will be 
seen that it is important that the air in a room should be constantly renewed, 
or else a person would be breathing over again his expired air. Now this ex- 
pired air is less pure than the inspired air, because it is deprived of some of its 
oxygen by the action of the blood, and it has received in return carbonic acid 
and moisture ; the more oxygen there is in the air of a room the better it is for 
health, for if carbonic acid accumulates it produces headache, lethargy, and 
in large quantities a fatal result. (See Carbonic Acid Poisoning.) About 
350 cubic feet of air pass through the lungs of an ordinary man in a day ; in 
passing through the lungs, the air would lose from 4 to 6 per cent, of its vol- 
ume of oxygen, and gain 4 to 5 per cent, of carbonic acid. During twenty- 
four hours there will be consumed about 10,000 grains of oxygen, while 12,000 
grains of carbonic acid will be produced, corresponding to 3300 grains of car- 
43 



RES 674 RHA 

bon. During this time about 5000 grains or 9 oz. of water will be exhaled 
by the lungs. In twenty-four hours an ordinary man would vitiate 1750 cubic 
feet of pure air to the extent of 1 per cent., or 17,500 feet of pure air to the 
extent of 1 in 1000. Taking the amount of carbonic acid in the atmosphere 
at 3 parts, and in expired air at 470 parts, in 10,000, the body would require a 
supply per diem of more than 23,000 cubic feet of ordinary air, in order that 
the surrounding atmosphere might not contain more than 1 per 1000 of car- 
bonic acid; and more than this proportion is injurious; every one ought, 
therefore, to have at least 800 cubic feet of well-ventilated space. In the 
article on the Lungs a description is given of their structure, and of the 
various changes which the air and blood undergo. The mechanism of respira- 
tion need not be fully described here. During inspiration the diaphragm de- 
scends, and the depth of the chest from above downwards is thereby increased ; 
at the same time the ribs move upwards and outwards, so as to increase the 
cavity of the chest from side to side and from front to back. Thus the chest- 
walls expand in three directions during inspiration, and -at the same time the 
lungs follow the expansion and become inflated with air. During expiration, 
the lungs, being elastic, retract, and the reverse movement of the diaphragm 
and chest-walls takes place. Anything which interferes with the due expan- 
sion of the chest, as tight lacing, etc., is therefore very injurious ; any deform- 
ity of the chest, a habit of stooping, a curved spine, a pigeon-breast, etc., all 
diminish the breathing area of the lungs. As a rule, the wider a man is 
round the chest, the better is his state of health and capability of exertion. 
Exercise, gymnastics, drilling, rowing, etc., are all excellent means of expand- 
ing the chest and promoting good respiration. When a man runs he gets out 
of breath because the circulation of the blood is increased, and he requires more 
air in a given time to aerate it. In all schools or institutions where children 
are crowded together, great pains should be taken to see that there is due ven- 
tilation and pure air; for this reason, too, it is very essential to have parks 
and open places for the poor in large towns, as it is often their only chance of 
getting wholesome air. (See Lungs.) For methods of artificial respiration, 
see Drowning. 

Respirator. An instrument worn over the mouth by those who wish to 
avoid exposure to the night air in cases of consumption, winter-cough, etc. In 
this way warmer air is conveyed into the lungs, and this prevents any irrita- 
tion of the windpipe and also prevents a cough. 

Retention of Urine occurs in hysteria, and in some forms of paralysis, 
in some cases of drunkenness, after a confinement, etc. It is readily known 
by the patient not passing any water. The simple treatment required is to 
pass a catheter and draw the water off. 

Retina. A delicate membrane within the eye, chiefly made up of nerve 
fibres, which receive the impression of light from the external world. (See 
Vision and Eye.) It is liable to be affected in Bright's disease, in affections 
of the brain, and from external injury, when there is more or less loss of sight. 

Retro-pharyngeal Abscess is said to occur when the abscess forms at 
the back part of the pharynx. 

Rhatany, technically known as Krameria, is the root of a plant (Krameria 
triandra) growing in Chili. As imported there is a short root-stock, whence 
spring long red rootlets, which, were it not for the color, would look something 
like a rat's tail — whence, it is said, the name. The powdered root is also 
red. This has no smell, but has a sweetish taste, afterwards very astrin- 
gent. This is due to the quantity of tannin which it contains, and to which it 



RHE 675 RHE 

mainly owes its properties. Its preparations are an extract, a tincture, and an 
infusion. These may be given whenever it is necessary to use tannin, but in 
practice rarely are so. Sometimes they are given for diarrhoea or dysentery, 
but rarely. The main use of the root is as an ingredient in tooth-powders. 
For this it is very useful ; the powder, being astringent, acts well on spongy 
gums, and at the same time, mixed with chalk and a little alkali, promotes the 
removal of tartar from the teeth. 

Rheumatism is one of those enigmatical disorders about which we know 
much and know little. We know what conditions give rise to it, or are most 
likely to do so, and we also know too well what its consequences may be ; 
but as to the immediate causation of the symptoms we are ignorant. Besides, 
under the same title there are undoubtedly grouped diseases in many respects 
differing the one from the other ; all are known as rheumatism, yet among 
them are some of the most serious maladies to which flesh is heir, and yet 
again others of the slightest. The type of what we call rheumatism is acute 
rheumatism, also called rheumatic fever. This malady is characterized by a 
high temperature, profuse sour sweats, and swelling and reddening of some 
of the larger joints of the body, most frequently the knee and ankle joints. 
These swollen joints are intensely painful, but as a rule the mischief passes 
away of its own accord. The great risk in a case of rheumatic fever is the 
danger of heart complication. Often in the course of the disease the pericar- 
dium, or the lining membrane of the heart itself, the endocardium, becomes 
inflamed. The pericarditis may not give rise to any very dangerous perma- 
nent mischief, but the inflammation of the other does. The portion of the 
endocardium most frequently attacked is that covering the valves, so that these 
become inflamed and thickened ; by and by, as time wears on, they contract, 
and are rendered incompetent efficiently to fullfil their fuuction of flood-gates, 
whence arise in time all the ills due to heart disease. Most cases of heart 
disease do, in point of fact, date their onset from a rheumatic attack. Rheu- 
matic fever most frequently arises from cold and damp, especially if the indi- 
vidual has suffered from any cause of depression, as fatigue, improper food, or 
the like. It begins with restlessness and fever, with white or creamy tongue, 
and deranged bowels, constipated or relaxed. Presently the joints begin to 
ache, the pain increases till there is great swelling and tenderness all over one 
or more of the large joints of the body ; the hip-joint is not, however, very 
often affected. There is by this time in most cases a very high temperature, 
102° or 103° Fahr., but it gradually increases, and in many cases becomes ex- 
cessive ; this, indeed, constitutes one of the great dangers of the disease. Ex- 
cessive bodily heat is apt to develop itself, and when the temperature rises 
above 105° Fahr. there is always more or less danger to the patient, and every 
degree of increase adds to it in far more than geometrical progression, for by 
the time it reaches 108° recovery is as nearly as possible hopeless, and at 
109° may be said to be quite so. In those cases where a high temperature 
develops itself, the sweat, which is ordinarily very profuse and of a strong acid 
odor, disappears, and its reappearance may be said to be the first sign of real 
amendment. The pain and tenderness in the joints, too, are very great. The 
patient can hardly bear the weight of the bed-clothes, still less can he bear the 
swollen limbs touched ; he himself dare not move, and even dreads the move- 
ments of others. The pulse is quick and of fair volume, and except the heart 
be affected it is regular. The thirst is extreme, whilst the tongue is coated 
with a thick white fur, which speedily renders the scanty saliva acid. The 
urine is high colored and full of urates — that is to say, it deposits on cooling 



RHE 676 RHE 

a thick brick-dust like sediment, which is re-dissolved on heating. It is difficult, 
too, to say when the patient has fairly seen the worst, for joint after joint may 
be affected, and even when the patient seems fairly on the road to recovery 
he may suffer a relapse. The great feature of the disease is the tendency to 
implicate the heart. Curiously enough, the right or venous side of the heart is 
never affected, only the left, or arterial, and the pericardium, which is supplied 
with arterial blood. Sometimes the heart affection precedes the joint mischief, 
but this is not the rule. This process of heart implication has been described 
as metastasis. Now metastasis implies a change of site, but there is no change 
of site in rheumatism. It is true the heart becomes affected, but the joints do 
not improve on that account. The heart attack is as much a portion of the 
history of the disease as are the swollen joints. Another curious complication 
is chorea. These irregular and uncontrollable movements make their appear- 
ance generally with the heart complication,. or shortly after. They ordinarily 
persist long after the rheumatic affection has ceased, and may even become 
permanent: they are most frequent in young people. As in the rheumatic af- 
fection of the heart it is common to find fungi on the valves, deposited either 
by the blood, or formed on the valves by inflammatory changes — Usually the 
former — these may be broken up by the blood current, and conveyed to some 
remote situation, as the brain, there to set up fresh mischief. 

Now as to the cause of rheumatic fever. We shall not long dwell on such 
an unprofitable subject. It was long ago suggested that it was due to the 
presence of lactic acid in the blood, and that theory has been more or less up- 
held to the present time. It is worthless to speculate whether this is true or 
no ; some, certainly, of the experiments carried out to support this view have 
been of the crudest possible description, altogether unworthy of attention. 
The excessive acidity of all the secretions has perhaps aided the lactic acid 
view, and has given rise to a mode of treatment which is, with due modifica- 
tions, perhaps the best — that is, the treatment by alkalies. To this end the 
bicarbonate of potass is given, either by itself, or effervescing with citric acid, 
in good large doses, thirty grains or so, every four hours, continuing it till the 
pain begins to abate, and the urine is rendered alkaline. This plan is a good 
one, undoubtedly, if employed not rashly but with due vigilance, but there are 
doubts that in certain cases it has been over much employed, and has done 
harm. This, on the whole, is the plan we recommend. The joints ought at 
the same time to be wrapped in cotton wool, but in some cases great good is 
derived by applying warm alkaline lotions next the skin, and placing cotton 
wool over that. Then, too, the perspiration must be provided for — some- 
thing must receive it, and if linen is next the skin this soon becomes cold and 
unpleasant with the patient's profuse sweating. Woolen cloths should there- 
fore be placed next the skin, but should not be allowed to remain too long, or 
they act as a kind of poultice, giving rise to what are called sudamina on the 
surface ; hence there used to be a saying that the cure for rheumatism was six 
weeks in blankets. In the olden time of course bleeding was largely em- 
ployed, and there can be no doubt but that its use was disastrous, for in those 
days the test of the necessity for bleeding was the condition of the blood itself, 
and rheumatic blood of all others affords the buffed and cupped appearance 
which was supposed to indicate the necessity for further blood-letting. A 
favorite plan of treatment, begun of late years, has been blistering. Large 
cantharides blisters have been placed round the limbs close to the affected 
joints, and allowed to remain there some hours ; after these have been re- 
moved large poultices are to be applied to favor the flow of fluid. It would 



677 





Fig. cxiv 



Fig. cxv. 





FIG. CX VI. 



Fig. cxviii. 





Fig. cxvii. 



Fiq. cxix 




Fig. cxx. 



Fig. cxxi. 




Fig. exxn. 



I fi r^^-T ^N 



Fig. cxxiti. 



PLATE XXIII. 



RHB 679 RHE 

be better, however, to apply the blistering fluid with the poultices over that 
from the beginning, especially as this process is far less painful than the other. 
Dr. Herbert Davies, who introduced this plan, gave no medicine, but allowed 
the blisters to suffice for everything. There can, however, we think, be no 
doubt that the addition of effervescing alkaline draughts is an improvement ; 
this plan is mainly to be commended for the relief it gives to the pain in the 
joints. Many men like to give large doses of quinine. Now it is well known 
that quinine does materially reduce temperature, and it will do so in rheuma- 
tism as in other maladies, but the disease is not thereby remedied ; it pursues 
its course as before, and when the real time comes to use quinine with advan- 
tage, it has lost, by frequent repetition in large doses, its special virtues. By 
all means give quinine, but not till the pain has passed away, and the tempera- 
ture is nearly natural. In a disease like rheumatic fever, where pain is one 
of the most prominent symptoms, it may readily be supposed that opium has 
been employed; nevertheless, for some reason or another, it is not usually 
had recourse to, there being an idea that its exhibition, though useful for the 
time being, would tend to prolong rather than shorten the fever. This belief 
had its origin in the notion that the disease was due to some materies morbi 
which had to be eliminated, a view which is most probably not the true one. 
At all events, the current of opinion seems to set against the use of opium, 
and in favor of other sedatives. Nitrate of potass has been used and com- 
mended by some authorities ; it has been given both internally and externally 
— given ab libitum, dissolved in water, internally to slake thirst, externally to 
cool the joints. Lemon juice is another remedy which has not, like the last, 
received universal acceptation ; it may, however, be useful on account of the 
citric acid and potass which it contains. The diet during the brunt of the 
malady should be light ; slops are generally given, beef-tea and the like. 
By and by, when the patient becomes stronger, fish may be given, but meat 
must be reserved until a later period ; too early use of it may bring on a 
fresh attack. The patient should have plenty of drink supplied to him by the 
nurse, he himself not being allowed to move. Lemonade, made of lemons 
and water with sugar, is best, or soda or potass water may be given ; wine 
must, as a rule, be forbidden; so must, above, all things, beer. In convales- 
cence, quinine or bark and ammonia, afterwards iron and cod-liver oil, are to 
be prescribed. 

Chronic Rheumatism is quite a different affection from rheumatic fever, 
since acute rheumatism may pass into the chronic stage, but most frequently 
the one is quite independent of the other. Most old people, especially if they 
have led a life of exposure and fatigue, are more or less affected with rheu- 
matism, sometimes so far as completely to cripple them. The constitutional 
disturbance is slight, but the pain is sometimes great, both night and day, so 
as to wear out the patient by continual harassing. Some cases of this form 
of rheumatism do not suit well with heat, the pain being worst at night in 
bed ; but most of these cases are better for heat, and friction especially. If 
the patient has any syphilitic taint, as is sometimes the case in the worst in- 
stances, the pain at night may be terribly harassing. Some special forms of 
chronic rheumatism have acquired distinctive names. Thus there is a rheu- 
matic affection of the loins we call lumbago. This is almost always aggravated 
by movements. Stiff neck, such as occurs after exposure to a cold draught of 
air, is another sample of chronic or sub-acute rheumatism, attacking a special 
part. Myalgia is the name given to pain in the muscles not due to rheuma- 
tism, and to be distinguished therefrom. Myalgia is not unfrequently found 



RHE 680 RHI 

localized in the side, and there a kind of rheumatic pain is also ordinarily 
located. It is of importance to distinguish the one from the other, as the 
treatment of the two is different. Chronic rheumatism must not be treated by 
rote ; each case must be dealt with on its own merits. We must try to im- 
prove the general health, and to procure the patient sound rest by sedatives if 
necessary. Multitudes of remedies have been tried, and some do better than 
others if the cures are properly selected. In most of them, iodide of potassium, 
and bark and cod-liver oil, are the most important remedies. If there is a 
gouty taint colchicum may be given, and some strongly recommend Actcea 
racemosa ; in most instances bicarbonate of potass is useless. Here local treat- 
ment is of great value, especially the local application of hot mineral waters, 
as douches and otherwise. The sulphur waters of many of our American 
springs are good in certain cases. Hot alkaline waters are, however, as a 
rule, preferable. Iodine paint to the affected joints sometimes does good, but 
not so much as hot alkaline lotions. Sulphur does good to many. Patients 
should wear flannel, and be careful in their diet. Beer, porter, and full-bodied 
wines should be prohibited. 

Rheumatic Gout, as the malady is commonly called, is a most anomalous 
disease. It certainly has nothing to do with gout and nothing to do with 
rheumatism. The affection consists in an inflammation of the joints, chronic 
in character, and in some respects resembling gout, in others rheumatism, but 
in all essential respects totally distinct. The affection is a most troublesome 
one, and not unfrequently cripples the patient, whilst defying the practitioner's 
art. It is said that more women suffer from this affection than men, but that 
is doubtful. There is often no constitutional predisposition, hereditary or 
otherwise, except some cause of general weakness. Rheumatic gout — or 
rheumatoid arthritis, as it is also called — seizes on various joints, sometimes 
the large, sometimes the small ; but the hip, shoulder, knees, elbows, wrists, 
ankles, and hands are its favorite sites. Often it occurs in females at the turn 
of life or about puberty. When acute, the disease comes on abruptly, some- 
thing like rheumatic fever ; but more frequently it steals on gradually, the 
bowels being out of sorts, and the urine loaded and scanty ; the joints hecome 
stiff and painful, and are more or less swollen. This gives rise to lameness, 
and the joints may be felt to crackle as they move, something like a door on 
ungreased hinges. As the disease advances, the stiffness grows greater and 
greater, whilst round about the joint are formed great masses of imperfect 
bone, whilst the cartilages covering the joints become absorbed ; the joints are 
thus greatly deformed. The functions of the constitution are badly performed, 
there is constant indigestion, the rest is disturbed, and the patient becomes 
painfully sensitive to the weather. No heart complication ever results from 
rheumatic gout. 

The treatment is very unsatisfactory. The best thing, we believe, short of 
a visit to a foreign spa, is rest and cod-liver oil. The bowels must be kept 
open by saline aperients, and sulphur waters generally suit well. Arsenical 
baths have been very highly commended, as have a hundred other substances. 
Iodide of potassium internally, and alkaline lotions applied so as to act like poul- 
tices externally, sometimes do good, but must not be continued too long for 
fear of impairing the constitution. So, too, any fixed appliance to the limb or 
joint may bring on fixation of the joint, an irreparable mischief. 

Rheumatoid Arthritis. See Rheumatism. 

Rhinoplastic Operation. This is a name given to an operation whereby 
a piece of skin can be takeu from a healthy portion of the body and adjusted 



RHI 681 RHU 

to a surface where the skin has been destroyed by injury or disease. By this 
method surgeons have been enabled to form anew nose bj r removing a flap of 
skin from the healthy forehead. In cases of severe burn on the arm, skin has 
been taken from the surface of the abdomen, and much deformity of the burnt 
surface has been saved. Great skill is, however, required to bring about a suc- 
cessful result. 

Rhinoscope. This is an instrument consisting of a small oval or circular 
mirror fixed on a handle about six inches in length ; when introduced into the 
mouth it should be passed into the back part of the fauces, with the mirror 
looking upwards at an angle of about forty-five degrees. The observer, sit- 
ting in front of the patient, wears on his forehead a large circular mirror, which 
reflects a strong light into the mouth from an adjacent lamp, in the same way 
as is described in the article on the Laryngoscope. In this way the back part 
of the nostrils may be carefully examined. 

Rhoncus, a medical term, by which is meant a sound distinguishable in 
the lungs when the air-passages are contracted by disease. The English of 
this word would be rattle, the French rule, but some physicians use the Latin 
rhoncus. 

Rhubarb, as employed in medicine, consists of the roots of sevei'al plants, 
the species of which is not very accurately known, growing in Central Asia. 
The root, as imported, is always more or less perfectly deprived of its bark. 
The rhubarb makes its way from this district in two directions — one by way 
of Russia, the other by way of China. The Russian, commordy called Turkey 
rhubarb, occurs in irregular-shaped pieces, the rind of which has been re- 
moved. Its surface is smooth and yellow, its texture compact, its fracture un- 
even and gritty, marbled red and gray. The powder is bi'ight yellow and its 
smell rather pleasant, but the taste is bitter and disagreeable. These pieces 
usually have a hole drilled in them for slinging on a cord. 

The East Indian variety has the bark imperfectly removed, so that the sur- 
face is rounded instead of being angular. It is red and veined externally, not 
covered with a yellow powder, like the Russian. The root is altogether more 
woody than the Russian variety, and the powder redder. 

Other specimens are in use, but are of inferior quality. Some are brought 
from India, and some are cultivated in England. 

The peculiar purgative principle has never been separated from rhubarb, 
but it contains a beautiful crystalline substance, chrysophanic acid. This oc- 
curs in needles of a golden lustre, not very readily soluble in water, but read- 
ily in alkalies. Oxalate of lime is found abundantly in some specimens, and 
gives the gritty character in Russian rhubarb. The best specimens of rhubarb 
are the grittiest, and so the quantity of oxalate of lime, though in itself having 
nothing to do with its purgative action, have come to be a kind of test of the 
quality of the rhubarb. 

The preparations of rhubarb are an extract, infusion, syrup, tincture, and 
wine, with a compound pill and a compound powder. The compound pill, 
which is the pill in most general use as a laxative, contains rhubarb, aloes, 
myrrh, hard soap, and oil of peppermint. It is a most useful preparation. 
The compound powder, perhaps better known as Gregory's powder, consists 
of rhubarb, magnesia, and ginger. It is a great and deserved favorite in the 
nursery, and is used with benefit by older individuals. 

Rhubarb, when taken into the mouth, turns the saliva yellow, and the urine 
it turns reddish-yellow, if alkaline, purple-red. In small doses it acts as a kind 
of tonic to the stomach and bowels ; in larger doses it is purgative, but it is apt 



RHU 682 RIC 

to be followed by constipation, seeing that it exercises a kind of astringent ef- 
fect, subsequent to its purgative action. On this account rhubarb, especially 
in the form of wine or tincture, is often prescribed in the early stage of diar- 
rhoea, in order that it may carry off any irritant substances giving rise to the 
diarrhoea, and subsequently arrest the too violent action of the irritated bowel. 
Combined with alkalies, rhubarb is of infinite value in many forms of indiges- 
tion, depending especially on an irritable condition of the bowel. Habitual 
flatulence and distension are thus in many cases relieved. Females, who are 
most subject to this, perhaps from sedentary habits, further reap the benefit of 
its action in habitually constipated bowels. 

To children, rhubarb is commonly given as Gregory's powder, or along with 
a little gray powder. In either form it is exceedingly beneficial, as it also is 
along with a little bicarbonate of soda. Children are apt to eat things which 
disagree with them, giving rise to diarrhoea and the like. In such instances 
Gregory's powder in an invaluable remedy. 

A very good remedy for certain forms of indigestion, especially among fe- 
males, is rhubarb and ginger tea. The two together are infused, and a wine- 
glassful of the infusion taken every morning. Another very good plan is to 
chew the two together, swallowing the saliva. Ten grains suffice for this. 
This plan is highly commended for pills. The purgative dose of rhubarb is 
twenty or thirty grains. 

Rhus Toxicodendron. Sumach, is not officinal, but is used a good deal in 
medicine, especially by homoeopaths. The leaves of the plant, also known as 
the poison sumach, are employed. These contain a peculiar resin, very acrid 
in character, insomuch that the juice blisters the part to which it is applied. 
If given in any quantity internally, it creates much irritation of stomach. It 
is said to acton the spinal cord something like strychnine, and has accordingly 
been given in paralysis. The results are, however, not quite positive. The 
powdered leaves may be given in one-grain doses. 

Ribs are the bones which help to form the chest ; they are twelve in num- 
ber on each side ; behind, they join the spine, while in front they are contin- 
ued by cartilage to the breast-bone or sternum. The ribs are very liable to 
fracture from external injury. 

Rice, a plant belonging to the natural order of grasses. The common rice 
of domestic use is Oryza sntiva, and is a native of the East Indies. It is the 
principal article of diet of the Hindoos, Chinese, and other Oriental nations. 
It is cultivated in other parts of the world, and is produced in abundance in 
the marshy grounds of North and South Carolina. Although this grain is 
largely consumed by the inhabitants of the world, it contains less flesh forming 
matter than any other. It can only be the substantive article of diet of an in- 
dolent and feeble people. When eaten in this country it should only be as an 
adjunct to other kinds of food. It cannot he healthily used as a substitute for 
potatoes or other flesh vegetables for any length of time. In cases of relaxa- 
tion of the bowels in children or grown people it is a useful article of food. 
The Chinese and Mongolians distil a strong fiery spirit from rice, called " ar- 
rack." Some people mix the spirit called toddy, obtained from the cocoanut 
tree, with the arracl; and thus increase its potency and improve its flavor. 

Rickets. This is the name given to a constitutional disease characterized 
by an unhealthy state of the system, which precedes for several weeks or 
months a peculiar disease of the bones, and of some others organs of the body ; 
there is curvature of the bones of the arms and legs and enlargement of their 
extremities. 



RIC 683 RIO 

Causes: Some maintain that this disease is hereditary, while others are op- 
posed to that view. There seem to be, however, predisposing causes on the 
part of the parents or the nurse which have an unfavorable effect on the healthy 
development of the child. The state of the mother's health seems to affect 
the child more than that of the father ; there is no evidence to show that syph- 
ilis has any influence in producing a rickety child. Where the mother is pale 
and anasinic, and where without any actual disease there is a state of general 
debility, and in cases where a family has been brought forth in rapid succes- 
sion, the children are liable to become rickety. As a rule the elder children 
are often healthy, while those born later are the subjects of this disease. If 
one child be born which becomes rickety, it is generally the case that all the 
succeeding offspring will be rickety also. This has been explained thus : 
" Among the poor, the parents are generally worse fed, worse clothed, and 
worse lodged the greater the number of their children — for the man's wages 
remaining stationary, the calls on his means are increased. And among the 
rich and poor alike, the larger the number of children, the more has the 
mother's constitutional strength been overtaxed, and the more likely is she to 
have lost in general power." Deficient or improper diet, impure air constantly 
breathed, want of cleanliness and sunlight, cold, moisture, and deficient cloth- 
ing, seem to be the conditions which are generally found to procede the devel- 
opment of rickets ; of these causes, improper food is by far the most common. 
The children of the poor are fed badly, in many cases, from their birth. 
Brown sugar and butter, castor oil and gruel, are given them in the first few 
days of their existence, when their stomachs are far too tender to put up with 
such noxious things ; when awake, they are kept constantly at the mother's 
breast, and no time is allowed for the stomach to digest the food. Too often 
the food is thickened with corn flour, sweetened with coarse sugar, and mixed 
with bread or biscuits within a month after birth, while if constipation follow 
this mode of feeding, the unfortunate child is dosed with castor oil. When it 
gets a little older and has existed four or five months, it is fed with the same 
food that the parents have : herrings, a piece of fried bacon, cheese, potatoes, 
cakes, and even beer are allowed to be swallowed by a child, when the delicate 
stomach should have nothing else but its mother's milk. So true is it that 
women know how to bear children, but not how to rear them. Nor is the 
child weaned when ten months old, but the mother goes on suckling it with 
the idea that she may retard the next pregnancy. And the succeeding off- 
spring are brought up in a similar way when the mother's health has been im- 
paired, and they suffer, therefore, to a greater degree. For the proper feeding 
of an infant, see Diet. 

Symptoms : No child is born rickety ; the impairment of the general health 
usually begins between the fourth and twelfth month. Most commonly the 
rickety condition is not noticed until the child begins to walk, or is affected by 
his first teething. 

Of 343 collected cases 98 appeared in the first year 

" 176 second year. 

"35 third year. 

" 19 " fourth year. 

" 10 " fifth year. 

5 " sixth year. 

Of these 147 were males and 196 were females. At first the most ordinary 
symptoms are those which indicate irritation of the intestinal canal ; there may 
be diarrhoea alternately with constipation, enlargement of the abdomen, and 



RIC 684 RIC 

more or less emaciation. The child is dull and languid, peevish and fretful ; 
the appetite is bad and the sleep disturbed at night. If it tries to walk it is 
" taken off its legs ; " it is thirsty and will drink plenty of water ; it has pain 
in the bones ; a pale face and flabby skin ; the hair on the head is thin, and 
blue veins marble the surface by their prominence ; the fontanelle remains 
open. In the next stage there are three symptoms to be chiefly noticed : (1.) 
A profuse perspiration of the head, neck and upper part of chest. This sweat- 
ing is worse at night ; beads of sweat may be noticed on the head, while the 
lower part of the body is dry and hot. (2.) There is a desire to kick the 
clothes off on the part of the child, as if with a wish to be cool ; so that the 
little patient lies with its naked legs on the counterpane. (3.) There is gen- 
eral tenderness, so that the child cries when it is moved about. The urine is 
thick and deposits a pale sediment of phosphates on cooling. The next set of 
phenomena are those connected with the deformity of the skeleton. With the 
increasing paleness and flabbiness of the skin, the wrists and ankles enlarge 
and the ends of the ribs are knuckled. The long bones of the extremities and 
chiefly those of the legs begin to yield, not being strong enough to bear the 
weight of the child. The deformity is very great in some cases, and such 
children are called knock-kneed or bow-legged. The spine is curved forwards ; 
the head falls backwards and the face looks upwards ; lateral curvature of the 
spine is not so common, and with this curvature there is generally the deform- 
ity known as pigeon-breast. 

The back is flattened, there is a hollow under the arm-pit, the ribs are 
pressed in, and the breast-bone or sternum is more prominent than usual. At 
each inspiration the softened ribs are sucked in, and the space for the lungs 
and heart is much encroached upon. In this way also the bones of the arms 
become distorted, and the more so if the child tries to support itself by its arms 
and hands. The forehead is square and projecting. The head is generally 
unusually large and the top flattened. The process of teething is generally 
delayed, and those that are through decay and soon fall out. The bones 
forming the pelvis are sometimes distorted, and add to the general mischief. 
Such children are generally of an inferior intellect, although sometimes thought 
by their mothers to be very precocious ; this seems due to the fact that such 
patients are more in the society of their elders, and have an old-fashioned way 
about them, because they cannot play with other children. After this the 
child may gradually get worse ; the emaciation goes on, the abdomen is more 
tumid, the softening of the bones and the deformity increase, and generally 
disease of the liver, kidneys, or spleen comes on. Death may occur from 
bronchitis or congestion of the lungs, or from diarrhoea, or from waxy degen- 
eration of different internal organs, or from general dropsy. Children affected 
with rickets are liable to attacks of spasmodic croup (Laryngismus Stridu- 
lus), convulsions, and chronic hydrocephalus. So death may end a life which 
to the unfortunate child has been one of unabated misery. Yet many cases do 
recover and grow up to adult life, but the deformity remains, and they are 
never so healthy as other people. The favorable symptoms will be an increase 
in weight, an animated expression, and less pain in the limb ; the pulse is less 
frequent, and the stools not so pale; the urine will return to its natural color, 
and the appetite is more natural. The growth of the limbs then goes on with 
great rapidity, and the muscles acquire a powerful development. Many of the 
dwarfs are examples of recovery from rickets ; they may possess plenty of 
strength in spite of their deformity ; they are generally irritable and sulky, 
keeping aloof from their fellow-creatures in consequence of their misfortune 



RIG 685 ROS 

being the subject of derision and mockery by their more fortunate brethren. 
The sooner the disease comes on after birth, the more likely is it to be fatal ; 
as a rule, if the disease be not far advanced, and if the deformity have not 
much affected the spine and chest, a favorable result may be looked for. 

Treatment : Improvement of the general health is the first thing to be sought 
after. The child should be placed in a warm and dry atmosphere, with due 
ventilation and pure air. The diet is most important, and should be given ac- 
cording to the rules laid down in the article on Diet, adapting it, of course, 
to the different ages of the patients. On a fine day, the child should be 
wrapped up warm and carried out into the open air. The child should sleep 
alone ; the bed-clothes should be kept dry and clean. A warm salt-water bath 
should be given every morning if the child can bear it. All lowering remedies, 
as mercury and bleeding, must be carefully avoided. Steel wine or the syrup 
of the phosphate of iron, either alone, or in conjunction with cod-liver oil, is 
a very valuable remedy. Change of air and a visit to the sea-side may bring 
about excellent results, if the parents can afford it. Lime-water may be mixed 
with the milk if the latter curdle on the stomach. Cod-liver oil should be 
taken after a meal, and with orange wine or as an emulsion. Raw meat, 
pounded in a mortar, is a good thing, but milk must form the principal article 
of food. See Diet. 

Rigidity of the Body (rigor mortis) comes on naturally a few hours after 
death, and may last two or three days. Hence bodies should be laid out as 
soon as possible after the fatal event has occurred. 

Rigors, or Shivering, come on after exposure to cold, in the commence- 
ment of an ague fit and at the onset of many fevers ; during this period the 
temperature of the body is always raised. 

Ringworm is a skin eruption caused by the presence of a vegetable para- 
site. The rash is most common in children, and may occur on any part of the 
body, but chiefly on the scalp and arms and upper part of the chest. It is 
readily transmitted from one child to another, and thus it often spreads in a 
school amongst a great many. The cure for it is simple, and consists in 
washing the part with some solution which will kill the parasite. For this 
purpose sulphurous acid, acetic acid, or iodine paint may be applied with great 
success. For the nature of this disease, and also its treatment, see Epiphyta. 

Rochelle Salt is now technically known as tartarated soda ; that is, cream 
of tartar neutralized by bicarbonate of soda. However known, the substance 
is valuable ; too little used, perhaps. It exists as crystals, neutral in reaction 
and readily dissolved in water. The taste is something like common salt, but 
not so bitter. It is most frequently administered effervescing as a seidlitz 
powder. Each of these powders contains two drachms of this salt, with a suffi- 
ciency of bicarbonate of soda in the blue paper to cause effervescence when 
mixed in water with the contents of the white paper (tartaric acid). For some 
people such a quantity of salt is quite sufficient to open the bowels, easily and 
freely ; others require more. This can easily be managed by telling the chemist 
to add a drachm or two drachms of the Rochelle salt according as it is required 
to the blue paper of a seidlitz powder. The effervescing material requires no 
addition. 

Rodent Ulcer, or Noli me Tangere. See Lupus. 

Rose Petals and Rose Hips, the product of the Rosa gallica and canina, 
are introduced into the Pharmacopoeia in the form of confection, as a basis for 
pills. There is also an acid infusion of red-rose petals containing sulphuric 
acid, which is useful as an astringent, or as a vehicle for more powerful reme- 



ROS 686 ROU 

dies. In themselves rose petals are slightly astringent, but by themselves are 
seldom used as such. Most commonly these preparations serve as agreeable 
vehicles for more powerful remedies. 

Rosemary is used only in the form of oil. This oil is distilled in this 
country from the flowering tops of the Rosmarinus officinalis, which mainly 
grows in Southern Europe. The oil has the fragrance of the plant. It is color- 
less and soluble in spirit. The spirit is the only officinal preparation, but the 
oil itself is most frequently used. 

It is a powerful stimulant, and may be given in hysteria and nervousness in 
females ; some forms of headache are greatly improved by it. It is also used 
as a rubefacient. The oil is contained in soap liniment and compound tincture 
of lavender. The oil may be given in doses of a drop or two on sugar, or the 
spirit may be added to various kinds of medicines as a stimulant and aromatic. 

Roseola, or Rose-rash, sometimes also known as false measles, in a good 
many respects resembles the eruption of measles, but is not infectious nor con- 
tagious, and there is no watering at the eyes and nostrils, and no cough. The 
skin is mottled, of a rose-color, the patches being of no great size and of irreg- 
ular shape ; sometimes the eruption appears as a cross of small, slightly raised 
rose-colored spots. At first the eruption is bright red, hut gradually it fades, 
and finally disappears. The constitutional symptoms arc slight. The rash 
fades in from three to six days. Sometimes the throat is affected slightly, as 
in scarlatina, which has led some to believe that the malady consists of a mix- 
ture of scarlatina and measles, but of that there is no proof whatever. 

Various maladies give rise to a roseola ; the most important of these is 
syphilis. Usually syphilitic roseola is the earliest of the constitutional symp- 
toms ; it commonly makes its appearance within six weeks of the primary 
attack, but it may be so slight as to give rise to no inconvenience, and so fre- 
quently escapes observation. 

Syphilitic roseola ordinarily consists of a number of rose-colored spots, com- 
pletely isolated and even with the surface, but sometimes they are fused 
together so as to give rise to patches which are above the surface, and so merge 
imperceptibly into the papules which commonly follow in order of secondary 
symptoms. At the same time the fauces present a rim of redness correspond- 
ing to the external rash. Belladonna sometimes produces a roseolar rash, but 
not very often. In infancy, stomachic derangement or dentition often gives 
rise to such an eruption, and it occasionally precedes the eruption of small-pox. 

Little treatment is necessary. The bowels had better be opened by a saline 
purgative, and the diet restricted; after that a few doses of any alterative 
tonic will suffice to restore wonted health. 

Rosin. The hardened exudation of pine-trees, of which there are three 
kinds in commerce — black, white, and yellow. It is used in pharmacy only 
to give consistence to plasters. 

Round Worms. These are parasites which at times infest the alimentary 
canal of human beings. Generally only one is met with at a time, and it may 
be either vomited up, or more often it is passed in a motion. Pain in the 
stomach, flatulence, nausea, grinding of the teeth, and an irregular appetite are 
the chief symptoms. Santonin is the best remedy, and of this substance five 
grains may be taken with as much of compound jalap powder, in the case of a 
child, but more may be given of the latter substance for an adult. The term 
Ascaris himbricoides or lumbricus is the technical name given to this parasite ; 
it very much resembles in size and shape the ordinary earth-worm. See En- 
tozoa. and Parasites. 



RUB 687 RUP 

Rubefacients are irritant substances, which, when applied to the skin, give 
rise to heat, redness, and other signs of slight local inflammation. After re- 
moval it may or may not happen that the cuticle peels off. If applied for a 
longer period, the cuticle is raised, and blood or serum forms underneath ; that 
is, we find a blister. A great number of substances are included in the list of 
rubefacients, but not many are used, on account of the intractable character of 
most. About the simplest is the compound camphor liniment ; and weak am- 
monia, in the favorite form of hartshorn and oil (freshly prepared) is also use- 
ful. The best is perhaps a mustard poultice, or Rigollot's mustard leaves ; 
volatile oil of mustard and oil of turpentine are more powerful, and require 
some skill in application. Corrosive sublimate and iodine are still more irri- 
tant ; they may be made to give rise to severe inflammation. Rubefacients 
are especially useful for getting rid of slight local pains or dissipating slight 
local inflammation. 

Rubeola is the Latin name for measles. See Measles. 

Rue is chiefly employed in the form of oil, which is distilled from the 
leaves and unripe fruit of the Ruta graveolens, a plant which grows through- 
out Europe. This oil is greenish-yellow in color. It has a very disagreeable 
odor and an acrid taste : it turns brown by keeping. 

Rue, or its oil, is a powerful stimulant to the part to which it is applied, 
and hence it has been given as a stimulant in flatulence. In hysterical affec- 
tions, especially where the menstrual functions have been in abeyance, it is 
sometimes given with benefit. In these it may be employed as an enema. It 
is not, however, largely used. Tt has falsely obtained a reputation as an abor- 
tive. The oil may be used as a local rubefacient, but is seldom employed for 
this purpose: the dose of it internally is from two to three drops. 

Rum is a spirit distilled from fermented sugar and molasses. Its peculiar 
odor depends on butyric ether, and a flavor given by the addition of pine-apples. 
It is often used, mixed with honey and milk, for colds and hoarsenesses. See 
DisxrLLED Spirits. 

Rumination is the term applied to the action in a section of the animal 
kingdom of devouring the food rapidly, and then casting it up to chew at lei- 
sure. The action is familiar in many domestic animals, and is called " chewing 
the cud." Sometimes a similar kind of process in miniature is seen in man as 
the consequence of disease. Ordinarily, if the food be chewed slowly and 
swallowed leisurely, it is speedily attacked by the gastric juice, and as speedily 
dissolved, but if bolted and indigestion follow, it may return into the mouth in 
a condition which admits of being chewed and swallowed again. It is a sign, 
therefore, of an abnormal condition, and sometimes of serious disease. 

Rupia is the term given to the latest and most disagreeable form of syph- 
ilitic eruption. These eruptions ordinarily go through various stages, begin- 
ning with roseola, passing into papules or little hard masses, which scale off, 
and leave no mark. Next they seem to have a yellowish top and ulcerate, and 
finally they appear as blebs, which, disappearing, leave a kind of dark-greenish 
crust on the surface of a wound. This wound of the surface ulcerates and 
forms pus ; this is added to the crust, which goes on growing from the ulcerating 
surface beneath until it acquires a considerable height. In this state it looks 
exactly like the shell-fish called a limpet, which consists of one shell only, 
and adheres to the rock by the surface of the animal. This shell is pointed so 
as to resemble the kind of hats old women, called witches, are supposed to 
wear in plays and the like, and this appearance closely corresponds to the 
eruption of which we. now speak. The crust goes on growing to a consider- 



RUP 688 SAF 

able size, and may then break off, leaving a raw, unhealthy, ulcerating surface. 
From this surface a new and larger scab is formed, and so the process goes on 
except it be restrained. 

Now, in dealing with those sores we must not temporize ; if not got rid of 
they may spread further and further, and even one leaves behind an indelible 
white sunk cicatrix which is unmistakable. It is therefore of prime importance 
to get rid of them early, especially if, as they often do, they affect the face. 
Local measures are essential, but before doing any good these hard and un- 
sightly crusts must be got rid of. That may be done, but not effectually, by 
poulticing ; the process is tedious and unsatisfactory, so something better should 
be employed. Solution of potass and glycerine mixed and applied to the crusts, 
the whole being kept moist by a supply of the same material on lint, will 
speedily cause them to soften and fall off. When they have thus fallen off and 
left the ulcerating surface bare, these had better be destroyed, and the best 
thing for so doing is a strong solution of corrosive sublimate. This kept ap- 
plied to it for a time will ordinarily suffice to make the part take on healthy 
action, after which citrine ointment is the best dressing. Cod-liver oil and 
iodide of potassia with mercury should be given at the same time. 

Rupture is a word commonly applied to cases of hernia. (See Hernia.) 
Rupture of the loin, stomach, or spleen may occur in cases where the person is 
run over, and fatal results ensue. Rupture of the heart and aorta now and then 
comes on after long-standing disease, but of course sudden death supervenes. 

Rupture of the bladder may be due to an accident, while very rarely rup- 
ture of the womb may come on during a difficult labor, where there is deformity 
of the pelvis. 

Rye. A grass much grown in this country, but chiefly in Germany, Rus- 
sia, and Norway. Its botanical name is Secale cereale. It yields a very nutri- 
tious flour, and when made into bread assumes a dark appearance ; hence it is 
called " black bread." Although rye contains more starch and sugar than 
barley it is not used for fermentation, on account of the rapidity with which it 
passes into an acid condition. Rye bread is sour to the taste on this account. 
The grain is subject to a disease which gives it a spined or horned appearance. 
This is the result of a fungus, which is injurious when eaten, but under the 
name of ergot of rye is valuable medicinally in uterine cases. See Ergot. 

S. 

Sabadilla, also known as cevadilla, is the dried fruit of the Asagrcea offici- 
nalis of Mexico. From it is obtained the alkaloid veratria. The fruit is light 
brown in color, about half an inch long, and contains a few seeds. These 
seeds are blackish, brown, and shining. They have an intensely bitter taste, 
which is also acid. The seeds are only used as a source of veratria, not being 
themselves employed. 

Saffron is the stigma of the flower of Crocus sativus, growing in Green- 
land and Asia Minor, but cultivated in Southern Europe. This portion is 
orange-red in color, and when dried as collected constitutes hay-saffron. 
Sometimes it is packed and pressed into a parcel ; this constitutes cake-saffron. 
Saffron readily yields its coloring matter, so that when moistened and pressed 
against a piece of paper it stains it of an orange color. This coloring matter 
is readily soluble in water and in alcohol ; sulphuric acid turns it from orange- 
red to blue. It is hence called polycroite. The only preparation of saffron is 



SAG 689 SAL 

a tincture, which is little used in medicine, save for its coloring properties. 
Saffron is contained, however, in decoction of aloes, aloes and myrrh pills, 
compound tincture of cinchona, ammoniated tincture of opium, and tincture of 
rhubarb. It is somewhat surprising that it is included in so many prepara- 
tions, for it is almost useless, and is very expensive. It has indeed some rep- 
utation abroad for favoring the menstrual flow, but in this country such a 
belief hardly prevails. It is very often adulterated, the so-called cake-saffron 
frequently containing no saffron at all, but only petals of marigold, or more 
probably safflowers. 

Sagapenum is a gum resin like galbanum in some respects. It is sup- 
posed to be the product of some umbelliferous plant, but its exact source is 
unknown. It is imported from the Levant in tears or masses. In many re- 
spects it resembles assafostkla, and was used in the same way chiefly in the old 
compound galbanum pills. It is no longer officinal. 

Sage. A well-known herb, botanically Salvia officinalis. It is in every 
garden, and is used in cookery, and as a domestic remedy for sore throat, as a 
gargle, with honey, alum, or any astringent. As a wash for ulcers about the 
mouth or lips it is safe and pleasant, and often very efficacious. 

Sago is a form of starch obtained from several kinds of plants. That which 
is most commonly used is the product of the sago palm (Sagus loevis), which 
grows in the islands of the Indian Archipelago. The sago is obtained from 
the cellular tissue in the interior of the trunk of the tree. It is a good and 
pleasant article of diet for the invalid. 

Sal Ammoniac, also known as hydrochlorate of ammonia or chloride of 
ammonia, is a salt all whose virtues are not yet exactly known. This we do 
know, that it does good in some forms of headache, almost magically. It is 
also of value in some forms of liver disease, and as a stimulant of the men- 
strual flow when that is in abeyance. It does not partake much of the prop- 
erties of ammonia. Its taste is disagreeable, and it has to be given in large 
doses. Some recommend beer as the best vehicle. The dose is twenty or 
thirty grains. 

Sal Volatile is really the carbonate of ammonia, but the name is most 
frequently given to its preparation, the aromatic spirit of ammonia. This 
spirit contains carbonate of ammonia, strong solution of ammonia, volatile oil 
of nutmeg, oil of lemon, spirit, and water. It is an agreeable and useful stim- 
ulant where it is desirable that the effects should not continue too long. It is 
of especial value in the depression which follows the use of alcohol in excess, 
or indeed in any form of temporary prostration from which it is necessary 
to rouse the patient. It is also of great value in the bronchitis of the aged. 

Salads. Although many things eaten as salads contain other constituents 
besides mineral matters, their value in diet is mainly due to these. It seems 
necessary, in order to preserve health, that the human body should frequently 
partake of the various constituents which compose it, and which naturally 
waste away with daily use. Thus fat, fibre, starch, and other things are daily 
partaken of, and it is not less necessary that mineral salts, which preserve the 
body in health, should also enter into food. All fresh vegetables and fruit 
contain these salts in large quantities, but in boiling and cooking in any way 
they are dissolved and thrown away, so that it is only by eating some form of 
uncooked food that we can obtain them. Salads are very desirable on this 
account, and it is very wise to allow all people in health, whether children or 
adults, to partake of fresh uncooked fruit or salads every day. Lettuces, 
water-cresses, endive, celery, beet root, radishes, asparagus, sorrel, and even 



SAL 690 SAL 

dandelion, are valuable and pleasant as ingredients in a salad, and many other 
plants might be eaten with advantage were it not for prejudice. 

Salicine is an active principle of a bitter nature extracted from willow 
bark. The bark is stripped from the common willow and allowed to dry. It 
is very tough, and has a somewhat aromatic odor and a very better taste. 
The salicine when pure exists in white, scaly crystals, and is soluble in water 
and alcohol. This is reddened by sulphuric acid, and is converted into an 
odoriferous principle similar to that obtainable from meadow-sweet. Salicine 
has been chiefly commended as an antiperiodic in intermittent fevers where 
quinine was not to be had. Undoubtedly it has some activity in this way, but 
nothing to compare with that of quinine. It is to be given in doses of from 
twelve to twenty grains, and in that quantity may be of use in certain cases 
when quinine does not suit. It has never come into general use, and is not 
likelv to do so, though comparatively cheap. 

Salicylic Acid. A product from carbolic acid. It .is the best disinfecting 
agent known ; is without odor, tastleless, not poisonous, and absolutely pre- 
vents putrefaction. It is much used as a remedy in some forms of rheumatism. 

Saliva. This is the ordinary secretion which is met with in the mouth, 
and proceeds chiefly from the parotid, submaxillary, and sublingual glands, 
aided by the small glands in the mucous membrane lining the mouth. These 
glands are very active when stimulated, and pour a large quantity of fluid into 
the mouth, and this is chiefly so during the process of mastication. The saliva 
is a thin, watery fluid, and contains a small quantity of animal matter called 
ptyalin. This peculiar compound has the power of converting starchy foods into 
sugar, and this is important because the former body is insoluble in the stom- 
ach, while the latter is very soluble. Ptyalin will not act upon fatty or proteid 
compounds. (See Diet.) An extreme flow of saliva, called salivation or 
ptyalism, occurs in some cases where mercury is taken internally ; many 
woods, as betel-wood, etc., also have this property of exciting an increased flow 
when chewed. 

Salivation. This term is applied to a condition in which there is in- 
creased flow of saliva with swelling of the mucous membrane of the mouth. In 
most cases it is caused by the action of mercury, but it has been found that many 
other agents may have the same effect. Iodide of potassium, antimony, cro- 
ton oil, castor oil, opium, and foxglove have been known to produce the milder 
symptoms of salivation. An increased flow of saliva without swelling or ulcer- 
ation of the gums and cheeks may be produced by irritation of the mucous 
membrane of the mouth and alimentary canal, and by menial influences. 

The mercurial salivation commences with tenderness of the gums and inner 
surfaces of the cheeks, and pain when the teeth are brought sharply together. 
The patient experiences a metallic taste. The secretion of saliva is so much 
increased that it accumulates in the mouth, and necessitates frequent spitting, 
and during the night flows from the mouth and saturates the pillow. The daily 
amount of saliva, which in health is about ten ounces, increases to four or six 
pints. The tongue then swells, and the mucous membrane of the gums and 
cheeks becomes red and inflamed, and finally ulcerates. The breath has a very 
offensive and peculiar odor. In bad cases the ulceration extends, and by 
destroying the tissue of the gums exposes the bone of the upper and lower jaws. 
These symptoms are usually associated with those of gastric and intestinal irri- 
tation, aud of nervous debility and excitement ; with the exception of the 
metallic taste in the mouth, none of the above symptoms are peculiar to mer- 
curial salivation, and a similar condition may be presented in cases of salivation 



SAL 691 SAL 

due to constitutional causes. Cancrum oris, a gangrenous affection of the 
mouth which is occasionally met with in children suffering from measles, is 
often attributed by the parents to the effects of mercury, supposed to have been 
administered for the treatment of the febrile disorder. Cases of severe saliva- 
tion produced by the medicinal use of mercury are at the present extremely 
rare, as the effects of mercury are seldom allowed to proceed beyond slight 
redness and tenderness of the gums. In cases where intense salivation has 
been produced by the administration of large quantities of mercury, other 
symptoms of mercurial poisoning are generally present ; of these the most 
prominent are pallor, trembling, an eczematoiis eruption over the surface of 
the body, and general debility. In some peculiarly constituted patients mercury 
may produce all the latter symptoms, and not give rise to salivation or any 
affection of the mouth. The property of producing salivation is common to all 
the preparations of mercury used in medicine, the most active being calomel 
and blue pill. Mercury when introduced into the system in other ways than 
through the mouth and stomach, as by inunction, fumigation, and hypodermic 
injection, does not fail after a certain time to produce similar symptoms of sal- 
ivation. In the treatment of local affections, especially venereal sores and 
cutaneous eruptions, the first appearance of the symptoms of mercurial saliva- 
tion is generally presented by a decided improvement in these affections, the 
indurated bases of the sores have commenced to soften, and the rash on the 
skin is less distinct. Salivation may be produced either by a very large and 
poisonous dose of mercury, or by frequently repeated small doses. In some 
cases there is a long interval between the end of the course of mercury and the 
first appearance of symptoms of salivation, mercury being a cumulative poisou 
which may be stored up in the body slowly and gradually until it is in sufficient 
force to give rise to salivation and other affections. Some individuals are ex- 
tremely sensitive to the action of mercury, and become salivated after very 
small doses of calomel or blue pill. A case has been recorded in which two 
grains of calomel caused salivation, sloughing and ulceration of the throat, 
necrosis of the lower jaw, and death. Other individuals, on the contrary, are 
so constituted that they can resist for a long time the action of large and fre- 
quently repeated doses of mercury, or even remain quite invulnerable. A pa- 
tient who has been subjected to two or more courses of mercurial treatment 
becomes much less susceptible on each occasion to the action of the medicinal 
agent, and is less liable to be salivated by the last than by any previous course. 
The early occurrence of salivation during a mercurial course is much favored 
by a want of attention to the cleanliness of the mouth, and by bad teeth and 
soreness of the gums. Catching cold and even a slight exposure to cold and 
wet will often cause early salivation. 

During a course of mercury great attention should be paid to the state of 
the mouth. The teeth should be frequently brushed, and the patient, in order 
to harden the mucous membrane of the gums and cheeks, should wash out the 
mouth occasionally with some astringent gargle and suck small pieces of alum. 
In cases of mercurial salivation the cause should at once be removed. The 
swollen and ulcerated mucous membrane of the mouth should then be fre- 
quently washed with a solution of chloride of lime, or of alum, or with brandy 
and water. 

Salt is a chloride of sodium, and exerts an extraordinary influence on 
animal as well as vegetable life. All marine animals seem to have their ex- 
istence determined by this substance. It enters into the composition of the 
human body, and all over the world man uses it, when it can be obtained, as 



SAL 692 SAN 

an addition to his food. Salt exists in large quantities in the bowels of the 
earth. It is obtained in the form of rock salt and in brine springs, and when 
purified is sold as " bay salt" and "fine salt." Salt prevents the decomposi- 
tion of animal and vegetable substances. It is used extensively for preserving 
meat in conjunction with saltpetre (nitrate of potash). Bay salt is often em- 
ployed to make artificial sea-water baths, and the stimulating effect of the salt 
in the water is frequently beneficial to those who cannot obtain sea-bathing. 

Saltpetre. See Nitre. 

Sambucus. The botanical name of the elder-tree, or dwarf elder, is Sam- 
bucus ebulus, whilst that of the black or common elder is Sambucus nigra. 
The berries are often made into wine ; and from the flowers is distilled a pleas- 
ant, fragrant wash for the skin, called elder-flower water. 

Sanatoria, as the name is commonly applied, are stations in India and 
other unhealthy countries, especially in the tropics, to which those who are not 
natives may retire for the benefit of their health without encountering the ex- 
pense and loss of time of a voyage home. These sanatoria are all situated at a 
considerable elevation, so that their temperature is low compared with that of 
the plains, and these sites are so chosen as to be as healthy as possible. It 
would be quite impossible to lay down any general rules with regard to the 
selection of such sites, that being indeed a work of such importance as to de- 
mand the attention of a skilled officer. In selecting a health station, such mat- 
ters as daily average temperature and rainfall are mere trifles ; and, besides, 
averages in such matters are assumed things ; it is extremes you want to know. 
The direction of prevalent winds is of even greater importance. The vicinity 
of swamps, especially if the wind regularly blows over them, is also to be in- 
quired into. Finally, when a spot has been selected, the soil must be consid- 
ered, the capacity of the place for drainage, and a hundred other things. In 
the case of most sanatoria, malaria has most to be looked after, and as this 
seems not unfrequently to be developed immediately after exposing the soil and 
felling vegetation, a good large space should be cleared before anything else is 
done. In India the most important sanatoria are hill stations, especially in the 
Neilgherries and the Himalayas ; but there are also some important stations 
farther west. The plan of keeping European troops at such stations seems 
likely to come more into fashion, in which these would become true sanitaria, 
that is, places for keeping healthy, instead of sanatoria, places for regaining 
health. The meanings of the two are quite distinct, though the words are 
commonly confounded. 

Sandal Wood is the product of a tree growing in India and Ceylon, and 
also in the South Sea Islands. It occurs in billets of a dark-brown color ex- 
ternally ; internally the rings are well marked. The powder is blood red, and 
has a slightly astringent taste. It is mainly used for the coloring matter, which 
may be extracted by alcohol or ether and by alkaline solutions. It is sandal 
wood which gives the red color to the compound tincture of lavender and to 
Fowler's solution of arsenic. An oil of sandal wood has recently come into 
use as a remedy for gonorrhoea. Fifteen or twenty drops are usually given for 
a dose ; but a good many people it does not suit ; many cases are not benefited 
by it. In all instances it gives rise to a good deal of pain. Often it is very 
effectual. 

Sanguineous Apoplexy is said to occur when there is a rupture of a 
blood-vessel in the brain. See Apoplexy. 

Sanitary Regulations. The following simple rules have been drawn up 
from the sanitary papers of Dr. Lankester. They are intended to guide people 



SAN 693 SAN 

in case of an epidemic breaking out in any town or village. It is only by tho 
local authorities actively investigating the cause of an outbreak, and then iso- 
lating the cases as far as possible, that one can hope to check those ravages 
which disease makes at times over an infected area. 

The following regulations, or some similar ones, should be printed in large 
type, and be posted on the walls in public places, and also be distributed 
amongst the people : — 

When Small-pox is prevalent. 

(1.) When this highly contagious and fatal disease is prevalent in a district, 
the inhabitants should be made aware of the danger to which they are exposed, 
and the best means of preventing the attack of the disease, and of stopping it 
where it has already broken out. 

(2.) In the first place, it cannot be too widely known that vaccination is one 
of the best means for preventing an attack of small-pox. 

(3.) All persons should be re-vaccinated after twelve years of age. 

(4.) When small-pox prevails in a family or in a neighborhood, every per- 
son should be immediately re-vaccinated under the direction of a legally quali- 
fied medical practitioner. 

(5.) When it has been ascertained that an individual has got small-pox, every- 
thing should be done to separate the person attacked from those around. Where 
it is deemed desirable to remove persons thus affected to a small-pox hospital, 
information can be obtained, and the means of conveying patients ascertained, 
by applying to the officers of the district. 

(6.) Where persons are found to be laboring under the disease, a medical 
man should be sent for immediately. 

(7.) The following directions should in all cases be carried into effect : The 
room should be cleared of all needless woolen or other draperies which might 
possibly serve to harbor the poison. A basin, charged with chloride or car- 
bolate of lime, or some other convenient disinfectant, should be kept constantly 
on the bed for the patient to spit into. A large vessel, containing water im- 
pregnated with chloride of lime or with Condy's fluid, should always stand in 
the room for the reception of all bed and body linen immediately on its re- 
moval from the person of the patient. Pocket handkerchiefs should not be 
used, and small pieces of rag employed instead for wiping the mouth and nose. 
Each piece, after being once used, should be at once burnt. As of necessity 
the hands of nurses become frequently soiled by the secretions, a good supply 
of towels and two basins, one containing water with Condy's fluid or chlo- 
rides, and another plain soap and water, should be always at hand for the im- 
mediate removal of the taint. All glasses, cups, or other vessels, used by or 
about the patient should be scrupulously cleaned before being used by others. 
The discharges from the bowels and kidneys should be received on their very 
issue from the body into vessels charged with disinfectants, and immediately 
conveyed away. No person should be allowed to enter the room except those 
who are attending upon the sick. Persons attending the sick should be scru- 
pulous in cleaning their hands and disinfecting their clothes before they go 
out of the sick-room, or communicate with those who have not the disease. 

(8.) When persons have the small-pox, whether they recover or die, the 
room in which they have been ill should be disinfected. The floor should 
be washed with chloride of lime and water, or with carbolic acid and water. 
The paper should be removed by moistening with carbolic acid and water, or 
with Condy's fluid and water. The room should then be fumigated by burn- 



SAN 694 SAN 

ing sulphur iu an iron dish, the fireplace and the crevices iu windows and 
doors being closed by putting paper over them. The room should be exposed 
to the sulphur vapor for five or six hours ; or the room may be fumigated in 
the same way with chlorine vapor, which is procured by pouring oil of vitriol 
(sulphuric acid) on common salt and black oxide of manganese. 

(9.) After the room has been fumigated, it should be lime-washed, and the 
doors and windows kept open for a week or a fortnight. 

When Typhoid Fever is prevalent. 

This fever is also called drain fever, from its constant association with bad 
and imperfect drainage in houses ; it is also called gastric or enteric fever, 
from its chief seat being in the stomach and bowels. At one time it was con- 
founded with typhus fever, but it differs from that disease in its causes, his- 
tory, and results ; hence the term typhoid (like typhus) was at first given to 
it. It is also called in some parts of the countiy low fever, from the great 
exhaustion and weakness whicli attends it. 

The means by which this disease may be prevented from spreading are very 
simple, and depend upon the fact that the poison by which it spreads is almost 
entirely contained in the discharges from the bowels. Dr. W. Budd gives the 
following excellent directions for preventing the spread of this disease. He 
says the discharges from the bowels infect — 

(1.) The air of the sick room. 

(2.) The bed and body linen of the patient. 

(3.) The privy and the cesspool, or the drains proceedings from them. 

From the privy or the drain the poison often soaks into the well, and infects 
the drinking water. This last, when it happens, is, of all forms of fever-poi- 
soning, the most deadly. In these various ways the infection proceeding from 
the bowel-discharges often spreads the fever far and wide. The one great 
thing to aim at, therefore, is to disinfect these discharges on their very escape 
from the body and before they are carried from the sick-room. This may be 
perfectly done by the use of disinfectants. One of the best is made of green 
copperas. This substance, which is used by all shoemakers, is very cheap, and 
may be had everywhere. A pound and a half of green copperas to a gallon 
of water is the proper strength. A teacupful of this liquid put into the night- 
pan every time before it is used by the patient renders the bowel-discharge 
perfectly harmless. To disinfect the bed and body linen, and bedding gener- 
ally, chloride of lime or MacDougall's powder is more convenient. These pow- 
ders should be sprinkled, by means of a common dredger, on soiled spots on 
the linen, and about the room, to purify the air. All articles of bed and body 
linen should be plunged, immediately on their removal from the bed, into a 
bucket of water containing a tablespoonful of chloride of lime or MacDougall's 
powder, and should be boiled before being washed. The privy, or closet, and 
all drains communicating with it, should b^ flushed twice daily with the green 
copperas liquid or carbolic acid, diluted with water. In the event of death the 
body should be placed, as soon as possible, into a coffin, surrounded with char- 
coal, sprinkled with disinfectants. Early burial is, on all accounts, desirable. 
In towns, and wherever the fever is already prevalent, the last rule should be 
put in force for all houses ; the drains of all houses should be flushed daily 
with disinfectants, whether there be fever in them or not. As the hands of 
those attending on the sick often become unavoidably soiled by the discharges 
from the bowels, they should be frequently washed. The sick-room should be 
kept well ventilated, day and night. The greatest possible care should be 



SAN 695 SAN 

taken with regard to the drinking water. Where there is the slightest risk of 
its having become tainted with fever-poison, water should be obtained from a 
pure source, or should at least be boiled before being drunk. Immediately 
after the illness is over, whether ending in death or recovery, the dresses worn 
by the nurses should be washed or destroyed, and the bed and room occupied 
by the sick should be thoroughly disinfected. These are most important rules. 
Where they are neglected the fever may become a deadly sco'urge. Where 
they are strictly carried out, it seldom spreads beyond the person first at- 
tacked. A yard of thin wide gutta percha or a mackintosh sheet placed under 
the blanket, under the breech of the patient, is a great additional safeguard by 
effectually preventing the discharge from soaking into the bed. 

When Scarlet Fever is prevalent. 

Scarlet fever is a highly contagious disease, and spreads from one person 
to another, and is thus propagated in families, towns, and districts. It is 
therefore highly desirable that every one should understand the nature of this 
disease, and the means of preventing its spreading. It is always attended 
with a scarlet eruption on the skin, and is mostly accompanied by a sore 
throat. Whenever children have sore throat or an eruption on the skin, they 
should be separated from the rest of the family until a doctor has seen them, 
or these symptoms have disappeared. 

There is every reason to believe that, during the progress of this disease, 
not only the eruption of the skin, but everything that is thrown off from the 
body of the infected person, is heavily laden with the germs or seeds which 
are capable of propagating the disease in another person. The discharges 
from the nose and throat are especially virulent. There is also reason to be- 
lieve that the discharges from the bowels are the same. The kidneys are fre- 
quently dangerously diseased in scarlet fever, and the secretion from these or- 
gans is also highly contagious ; the power of spreading the poison by means 
of these secretions is not confined to their immediately leaving the body, but 
continues long after. It is on this account that when these secretions have 
found their way to the cesspool and sewer they may still give off poison to 
the surrounding air, and persons breathing it may become infected. Taking 
these things into consideration, it will be seen that it is necessary, if possible, 
to destroy and annihilate this poison before it leaves the room where the per- 
son is whose body has produced it. The following directions, drawn up by 
Dr. W. Budd, should in all cases be carried into effect : — 

(1.) The room should be cleared of all needless woolen or other draperies 
which might possibly serve to harbor the poison. 

(2.) A basin charged with chloride or carbolate of lime, or some other con- 
venient disinfectant, should be kept constantly on the bed for the patient to 
spit into. 

(3.) A large vessel containing water impregnated with chlorides or with 
Condy's fluid should always stand in the room for the reception of all bed and 
body linen immediately on its removal from the person of the patient. 

(4.) Pocket-handkerchiefs should not be used, and small pieces of rag em- 
ployed instead, for wiping the mouth and nose. Each piece, after being once 
used, should be immediately burnt, 

(5.) As the hands of nurses of necessity become frequently soiled by the 
secretions, a good supply of towels and two basins — one containing water with 
Condy's fluid or chlorides, and another plain soap and water — should be al- 
ways at hand for the immediate removal of the taint. 



SAN 696 SAN 

(6.) All "lasses, cups, or other vessels used by or about the patient should 
be scrupulously cleaned before being used by others. 

(7.) The discharges from the bowels and kidneys should be received on 
their very issue from the body into vessels charged with disinfectants. 

By these measures the greater part of the germs which are thrown off by 
the internal surfaces may be robbed of their power to propagate the disease. 
The poisonous germs that are thrown off from the skin require a somewhat 
different treatment. The plan recommended by Dr. Budd for the purpose of 
preventing the poison from the skin being disseminated through the air is to 
put oil all over the skin. This practice is to commence on the fourth day 
ai'ter the appearance of the eruption, and to be continued every day until the 
patient is well enough to take a warm bath, in which the whole person is well 
washed with disinfecting soap and warm water. These baths should be ad- 
ministered every other day, for four times, when the disinfection of the skin 
may be regarded as complete. This proceeding should not, however, be 
adopted without consulting the medical man who is in attendance on the pa- 
tient. Speaking of the plans above recommended, Dr. Budd says, " The suc- 
cess of this method in my own hands has been very remarkable. For a period 
of nearly twenty years, during which I have employed it in a very wide field, 
I have never known the disease spread in a single instance beyond the sick- 
room, and in a very few instances within it. Time after time I have treated 
this fever in houses crowded from attic to basement with children and others, 
who have, nevertheless, escaped infection. The two elements in the method 
are, separation on the one hand, and disinfection on the other." 

Summary of Facts in Favor of Vaccination and the Vaccination Laws. 

(1.) Persons who have once had the small-pox are not liable to take it a 
second time. In the last century, inoculation of small-pox was practiced, be- 
cause it was known that small-pox thus communicated was usually milder than 
when caught naturally. 

(2.) Cow-pox is a modified form of small-pox, and it has been clearly proved 
that those who have had it are very much less liable to take small-pox than 
others, and are as effectually protected as those who have already had small-pox. 

(3.) Cow-pox is communicated by vaccination. Jenner discovered that per- 
sons who had caught cow-pox from the cow escaped small-pox, and thus was 
led to advise vaccination. 

(4.) Forty-five millions of the people of Europe died from small-pox in the 
hundred years preceding the introduction of vaccination at the beginning of 
this century ; whilst not more than two millions have died from this disease 
during the seventy years in which vaccination has been practiced. In London, 
before the introduction of vaccination, every tenth death that occurred was due 
to small-pox ; now only one death in every eighty-Jive is due to this disease. 
Even greater difference has been observed in other towns and cities of Europe, 
as in Triest, where the deaths from small-pox have been seventy-five times 
less since than before vaccination ; in Moravia twenty-one times less; in Silesia 
twenty-nine times less ; in Westphalia twenty-five times less ; and in Berlin 
nineteen times less. Where vaccination has been stringently enforced, death 
from small-pox has been still more diminished. In Ireland, where this disease 
was once a scourge, it has now become almost unknown, and a similar good 
result has been obtained in many districts in India. When smallpox has 
been rife among the inhabitants of a city or district, it has been repeatedly ob- 
served that the unvaccinated have perished, and the vaccinated survived or 



SAN 697 SAR 

altogether escaped. Very carefully kept records in hundreds of places in 
Europe and elsewhere have proved this. Out of thirty vaccinated nurses con- 
stantly employed at the Small- Pox Hospital, not one ever contracted the small- 
pox ; of the patients admitted to this hospital, from 1836 to 1851, thirty-seven 
in the hundred of those unvaccinated died, whilst only six in the hundred who 
had been vaccinated (well or badly) died. 

(5.) In England there is a larger proportion of unvaccinated persons than 
in any other country of Europe, and consequently a greater number of deaths 
from small-pox are shown, by the public registration, to occur. 

(6.) Whilst small-pox kills so great a proportion of the unvaccinated whom 
it attacks, the inoculation of cow-pox, that is, vaccination, seldom or never 
produces any consequences of an injurious nature. The authenticated fatal 
cases of erysipelas so produced are not more numerous than those which follow 
the prick of a pin. There is no proof that those who have been vaccinated 
suffer from scrofula or any similar disease as a consequence of vaccination 
alone. According to the Registrar-General's returns these diseases have di- 
minished in frequency since the introduction of vaccination. That which fol- 
lows after a thing is not necessarily caused by it. It is a matter of necessity 
that persons who have been vaccinated should have diseases after this opera- 
tion as well as before it, but these cannot rightly be attributed to vaccination. 

(7.) Although very rarely the eruptions of other diseases have through the 
carelessness of medical practitioners been mistaken for cow-pox, yet it would 
be as reasonable to ask for the abolition of railways because of railway acci- 
dents as to demand the abolition of vaccination on account of such accidental 
occurrence. 

(8.) The great means whereby small-pox may be wholly exterminated is 
universal vaccination. 

(9.) Small-pox is one of the greatest curses of man, whilst vaccination is 
one of his greatest blessings. 

Santonin is a crystalline substance, neutral in reaction, obtainable from the 
unexpanded flower-heads of certain species of artemisia. The flower-heads, 
which can, at first sight, hardly be distinguished from seeds, have a strong 
odor and bitter taste. To obtain santonin, these are bruised and boiled for a 
time with water and lime. To this fluid hydrochloric acid is added till the 
whole becomes curd, when it is set aside for the santonin to subside. The 
precipitate is well washed and otherwise purified till it is brilliantly white and 
crystalline. It must be kept away from the light. The crystals have but little 
taste aud no smell, insoluble in cold water, but soluble and subliming with a 
moderate heat. These brilliantly white crystals become yellow by exposure 
to light. Nitric acid converts it into succinic acid. 

Santonin, if given in any quantity, colors the field of vision yellow, so that 
the patient sees everything of that color. Sometimes green takes its place. 
The substance is a capital remedy for worms, and being nearly tasteless is 
easily taken by children. It is useless against flat worms, but is valuable as a 
remedy for round worms, especially of the larger kinds. The dose is from 
two to five grains. It is best given in a little sugar or honey. 

Sarsaparilla is a remedy which has been extolled to the skies, and has 
sunk into complete neglect Lauded at one time, it has been despised at 
another, both probably unjustly. The plant which yields it is a species of 
smilax, chiefly growing in Central America and the West Indies. The part 
employed isthe under-ground stem or rhizome, whence numerous long rootlets 

sometimes called the chump. The root 



SAS 698 SAV 

when cat across is seen to have a central core and an outer covering, between 
which, in some varieties, lies a quantity of starchy matter. According to the 
presence of this, the varieties are classified as mealy and non-mealy. 

In the non-mealy variety, the cortex is deeply colored, and contains a few 
starch grains. This is the character of the sarsaparillas known as Jamaica, 
Lima, and even Vera Cruz. It is the Jamaica sarsaparilla which is officinal. 
This commonly occurs in bundles about a foot and a half long, the roots being 
folded and not thicker than a goose quill. They are of a reddish-brown color. 

Mealy sarsaparilla contains much starch between the inter-covering and 
woody core, so that the roots break much more readily, and with a starchy 
fracture. Sometimes they seem swollen at intervals, and have hence obtained 
the name of gouty. The mealy varieties of sarsaparilla include the Honduras, 
the Brazilian, and the gouty Vera Cruz. These, though used, are not officinal. 

The preparations of sarsaparilla are a simple and compound decoction and 
a liquid extract. The compound decoction contains Jamaica sarsaparilla, 
guaiacum wood turnings, fresh licorice root, and mezereon. This prepara- 
tion is that most frequently used, in doses of from two ounces to a pint. 
Sarsaparilla contains, besides the ordinary root constituents, an oil and a prin- 
ciple called smilacin. It has never been very carefully investigated. 

All kinds of properties have been attributed to sarsaparilla, diaphoretic, 
diuretic, tonic, and alterative, but it has been mainly used as an anti-syphilitic. 
It was early introduced as a remedy in this complaint, and in the form of what 
was called the Lisbon diet drink was largely used for a long time. Gradually 
it fell out of use, and is now seldom employed in that complaint. It is, how- 
ever, said by some that it fell out of use because it was improperly employed ; 
then only small quantities were given, and that in small quantities it is useless. 
It seems, according to some reputable authorities, to do much good in the skin 
eruptions of syphilis, if given in doses of not less than half a pint or pint of 
the decoction daily. 

It has been also used in some skin diseases, especially those of a scrofulous 
origin, as a sudorific where the skin is dry and tending to disease, and in 
chronic rheumatism and gout. In all of these maladies, however, it has been 
customary to use the sarsaparilla merely as an adjunct to powerful remedies; 
or, when other good has resulted, it has not been always quite clear that the 
benefit was traceable to the sarsaparilla. If used at all, it should be used 
abundantly, and in the form of freshly prepared decoctions, simple or com- 
pound. 

Sassafras is the dried root of the sassafras tree, growing in the United 
States and Canada. It is most frequently met with as chips, which have a 
peculiar, pleasant odor, and a warm, sweet, aromatic taste. It is contained in 
the compound decoction of sarsaparilla. Its action is stimulant, and is supposed 
to be specially useful in chronic rheumatism and skin diseases. It is never 
given by itself. Sometimes its oil is used. 

Savin consists of the fresh and dried tops of Juniperus sabina, which is a 
native of England. From it is distilled an oil, colorless or pale yellow, having 
the odor of the tops. The tops themselves are covered with minute leaves, 
pressed to the stem and arranged in four rows. They are dark green, and 
have a disagreeable odor and taste. The oil which is contained in the tops 
gives them activity, along with some resin. From the tops are prepared a 
tincture and an ointment. 

Savin acts as an irritant wherever applied, externally or internally, and is 
reputed to have special power over the womb, and so is given to promote the 



SCA 699 SCA 

menstrual flow. Tlie ointment is mainly used to keep a blistei'ed surface raw, 
when it is deemed desirable to do this. It has been frequently given to pro- 
cure abortion, and as the substance is highly irritant this practice is attended 
with great danger. Its use is to be avoided in pregnancy as dangeixms and 
liable to be misinterpreted. The ordinary dose of the powder is four or five 
grains, and of the tincture twenty drops to half a drachm. 

Scabies. See Itch, Ectozoa. 

Scald-head, a common name for porrigo and eczema. 

Scalds. See Burns. 

Scalp. The scalp consists of those integuments which cover the cranium 
or vault of the skull. They are very firm and dense. The scalp is covered 
with a delicate cuticle or scarf-skin, and immediately beneath this is a thick 
cutis or true skin ; beneath the cutis is a layer of fat and cellular tissue, con- 
taining the bulbs of the hairs. This cellular layer adheres very intimately to 
the subjacent tendinous layer, which is the tendon of the occipito-frontalis 
muscle ; between this tendinous expansion and the bone is a delicate cellular 
layer. The scalp is largely supplied with blood-vessels and nerves. 
' Affections of Scalp. Tumors. The most frequently met with are the en- 
cysted, also called wens. See Wens. 

Fatty tumors are sometimes met with, but are rare, and they seldom grow to 
any great size ; the treatment consists in excising them. 

Erectile tumors, that is, masses composed of a congeries of dilated vessels, 
mostly veins ; these are best treated by the ligature. 

Malignant tumors are met with in the scalp, but they as frequently as not 
originate in the bone. Medullary is the most usual form ; a malignant form 
of ulceration is not uncommon, frequently commencing with a degenerate wen ; 
the only treatment in either instance is early and free removal, provided the 
glands are not implicated. 

Injuries of Scalp. Bruises. Owing to its exposed condition, the scalp is 
naturally very liable to external injury, and, owing to its aforestated vascular- 
ity, the results may be very serious. The ordinary result is the formation of a 
tumor full of blood, the result of extravasation, and the condition is to be 
treated on general principles. If, for instance, the swelling be over some large 
artery, such as the occipital or temporal, steady and firm pressure must be main- 
tained between the tumor and the heart ; the application of cold and pressure 
will check further extravasation. Acute inflammation not unfrequently follows 
these injuries, and if suppuration occurs free incisions must be made. Consti- 
tutional treatment must be attended to, and rest, antiphlogistics, and perhaps 
depletion. Absorption may be accelerated, after all inflammatory symptoms 
have passed off, by keeping the part wet with a solution of muriate of ammonia, 
or tincture of arnica. It may be mentioned that a blow upon the bach of the 
head may produce a black eye, owing to the extravasation of blood under the 
tendon of the occipito-frontalis, and its subsequent gravitation forwards. 

Incised Wounds. In incised wounds of the scalp, no matter how severe, 
the treatment will consist in carefully cleansing both surfaces of the wound, 
and having the parts carefully adjusted and maintained in position by strips of 
plaster, compresses, and bandages. It is well not to put any sutures in ; two or 
three wisps of the hair growing on the opposed edges of the wounds, tied across, 
make an excellent method of obtaining union, and act as a suture without the 
penetration. If the scalp wound becomes " puffy," the adhering lips of the 
wound must be separated to let out the inclosed fluid, and a warm poultice and 
hot fomentations must be applied. Tonics and ammonia should be adminis- 



SCA 700 SCA 

tered at an early period of any symptom of erysipelatous puffiness, and if the 
patient has been in the habit of taking brandy, wine, or spirits he should be 
still allowed them in moderation. Several convenient forms of bandages for 
keeping the dressings on, in scalp wounds or after operation, may be here 
described. 

(1.) The couvre-chef, or handkerchief, so folded as to retain a dressing : 
" the handkerchief having been folded into a triangular shape, the centre of 
the base is placed on the centre of the forehead, the body of the handkerchief 
covering the head, and the apex or corner hanging down the neck. The two 
long ends, previously lying on the cheeks, are crossed beneath the occiput, 
covering the apex or corner, and are brought forward and tied on the forehead. 
The handkerchief is then smoothed by pulling the apex or corner, which is 
turned over the crossed ends and secured." 

(2.) "A double-headed roller can be applied so as to cover the head, and 
make equable pressure on every point (capitellum). The centre of the roller 
is placed low down on the forehead, and the two heads carried back, and made 
to cross low down beneath the occiput. One head is then brought over the 
vertex, while the other is carried round horizontally to lap its extremity ; and 
this turned up over the horizontal one is carried back to the occiput, slightly 
overlapping the former vertical band. At the occiput the heads are again 
crossed (the hands being shifted), and a third turn is made on the other side 
of the vertical band, while a third horizontal round secures it as before, and 
this is continued until the whole head has been uniformly invested." 

(3.) " The four-tailed bandage, of use in retaining dressings on any particu- 
lar part of the head. A piece of cloth is to be split at either end, and the 
central unsplit portion placed on the dressing. The two posterior ends are to 
be secured below the chin ; the two anterior ends overlapping these cross at 
the occiput, and are also to be secured below the chin." 

See Fractures op Skull, Concussion, Compression. 

Scammony is a gum resin exuding from the top of the root when the stem 
of the living plant ( Convolvulus Scamrnonia) has been removed. The root 
itself is also now officinal, as well as the resin contained in scammony, which is 
its active principle. The plant grows in Asia Minor, and is chiefly imported 
from Smyrna. The root somewhat resembles a carrot. It may be three 
inches in diameter at the top. It is brown without and white within, and is 
possessed of a peculiar odor. The gum resin, the well-known scammony, is 
blackish -green in color, and occurs in irregular masses, covered with its own 
powder, but breaks with a shining fracture. From the gum which it contains 
this substance forms a lather if wetted and rubbed. If spirit be added the 
resin is dissolved up, leaving the gum behind. This resin is brownish and 
brittle. If prepared from the root, instead of the gum resin, it is fragrant. 
Scammony used to be much adulterated, especially with starch and chalk. The 
resin forms no emulsion with water, as does scammony itself. Its composition 
is very similar to that of jalap. The preparations of these substances are con- 
fection of scammony, containing scammony, ginger, oil of caraway, oil of 
1 cloves, syrup, and honey. The compound powder of scammony contains 
scammony, jalap, and ginger. Of scammony resin is made a scammony mix- 
ture, by rubbing up the resin with unskimmed milk. This resin is also con- 
tained in compound extract of colocynth, and scammony itself occurs in the 
compound colocynth pill, and the colocynth and hydrocyanus pill. Scammony 
and its resin are powerful purgatives, producing much watery discharge, and 
if not guarded griping much. They are seldom given by themselves, but are 



'01 




Fig. cxxv. 



Fig. cxxvi. 





Fig. cxxrx. 



Fig. cxxviir. 




Fig. cxxx. 



PLATE XXIV. 



SCA 703 SCA 

usually added to other and less violent laxatives. Usually, too, it is customary 
to give along with them some aromatic and stimulant, or some sedative sub- 
stance to guard against griping. It is sometimes used in dropsies, especially 
among children, and the compound powder is often used to get rid of worms. 
The close of scammony itself is about five grains, of the resin three, and of 
the compound powder ten grains. The confection may be given in doses of 
twenty grains. 

Scar. See Cicatrix. 

Scarf-skin, or the Epidermis, is the upper layer of the skin; small 
scales are always being shed, but it is abundantly cast off after scarlet fever 
and some other febrile disorders ; also in cases of psoriasis, etc. 

Scarification is a term used in surgery when the cuticle or external skin 
requires to be cut or lanced through only. Sometimes in case of dropsy it is 
necessary to do this in order to allow the fluid to escape, and in cases of chil- 
dren's gums, where the tooth presses against the external. skin, and is ready to 
burst through, scarification will relieve the irritation and cause no pain. 

Scarlet Fever is an acute febrile disease, producing a scarlet rash upon 
the skin, attended by a sore throat, and often swelling of various glands, and 
sometimes followed by dropsy. 

History : The earliest record bears date A. D. 1556, but since numerous epi- 
demics have occurred in various countries. It is more common in childhood 
than in adult life, and one attack confers great, if not complete, immunity 
from another. This disease gives rise to a great deal of mortality, and chiefly 
in those below ten years of age. 

Contagion is the main if not the only cause of scarlet fever : measles and 
whooping-cough are more contagious ; typhus fever and diphtheria less c6n- 
tagious.. The poison may be retained in clothes for a year or more, and then 
give rise to the fever. Both sexes are equally liable to an attack ; between 
eighteen months and five years is the most common period to have the fever ; 
no season has much influence upon it, but in this country it is, perhaps, most 
common between September and November. Many people confuse the terms 
scarlatina and scarlet fever, and imagine the former is a milder and less dan- 
gerous affection ; this is a great mistake, for scarlatina is only the Latin name 
for scarlet fever, and not a different form ; the term is too often adopted when 
there is some doubt as to the nature of the case, and then it is used to conceal 
ignorance. Scarlet fever may be very mild, or malignant, or latent. The 
period of incubation is generally about a week, but may be only twenty-four 
hours. 

(1.) Mild Scarlet Fever. The onset is sudden; there is a sore throat, with 
tenderness at the angles of the lower jaw and stiffness at the back of the 
neck; vomiting is very common, and chiefly so in children; shivering and 
rigors come on, and occasionally convulsions in young children. The tempera- 
ture rapidly rises, and will go up to 104° or 105° ; the pulse is very quick ; 
the tongue is covered with a thin white fur ; there is thirst and loss of appe- 
tite. This stage lasts from twelve to thirty hours, and then a rash comes out ; 
sometimes the earlier symptoms are so slight that the rash is the first thing 
noticed. The rash consists of small scarlet dots, almost running together, so 
as to give a flush all over the skin ; the color disappears on pressure, but rap- 
idly reappears when the pressure is removed. It generally appears at first on 
the sides of the neck and upper part of the chest, and in the bends of the 
joints : it then spreads downwards, and is found to come out last on the legs ; 
it begins to fade on the fourth or fifth day, and is generally quite gone within 



SCA 704 SCA 

a week. The sore throat is always present to a degree ; there is redness and 
swelling of the tonsils and soft palate, so that it is very painful to swallow, 
while the glands beneath the jaw also swell and are painful. The tempera- 
ture is generally higher than in measles, and much higher than in diphtheria. 
but it rarely exceeds 105° ; the fall of the temperature is usually on the sixth 
or seventh day, but it may be earlier or it may be prolonged. In no fever is 
the pulse quicker than in this disordor, and it may be 140 or 160 in a minute. 
Moderate delirium and headache are often present in these cases. After the 
rash has gone the epidermis is dry and harsh, and about the ninth or tenth 
day it begins to peel, and is sometimes cast off in large flakes, and this desqua- 
mation, or peeling, may last a few days or occupy several weeks. 

(2.) Malignant Scarlet Fever is characterized by an increased severity of 
the above symptoms; there is great prostration, delirium, and sleeplessness; 
the rash does not always come out well : the face may be livid, and stupor and 
coma come on, and end in death ; the throat is ulcerated, and there is much 
difficulty in swallowing. 

(3.) Latent Scarlet Fever is when the disease is so mild that until the se- 
quelae appear one is not aware of having had scarlet fever. There is no rela- 
tion between the abundance of the rash and the danger to the patient. How- 
ever mild the disease may be, the sequela? may come on with great severity ; 
one is just as liable to catch the fever from a mild case as from a severe one. 

Sequela : After the fever has passed there may follow a train of symptoms 
which are very inconstant in their character, and of much danger to the pa- 
tient. The throat may continue to be affected, and the glands outside may be 
inflamed and swell, so that the child's head seems encased in a " collar of 
brawn ; " often these glands suppurate, and a large ulcerated surface is then 
seen. Deafness may come on, and a discharge from the ear. Bronchitis and 
pneumonia are not so common as in measles. Sometimes convalescence is re- 
tarded by abscesses forming in various parts of the body : at other times there 
is a painful affection of the joints, which much resembles rheumatic* fever. 
Renal dropsy is also one of the most usual sequelae, but its frequency varies in 
different epidemics ; the face and loose parts of the skin are very pale and 
puffy, and this is best seen under the eyes and on the insteps ; the urine is 
scanty and dark from containing blood ; there is often headache, loss of appe- 
tite, and perhaps convulsions ; this complication often comes on two or three 
weeks after the first appearance of the rash. See Bright's Disease and 
Hematuria. 

Treatment : Most cases recover in a week, except those which are malignant, 
and those where the woman is at the same time pregnant ; the latter condition 
much increases the danger, and hence women should then be extremely care- 
ful not to go near a case of scarlet fever. The mild cases must be nursed 
simply, and there is no remedy which will cut short an attack. The patient 
must be put to bed and have a milk diet, in the same way as has been fully 
described in the article on Fever and Measles, and need not therefore be 
repeated here. Hot flannels, or cotton wool, or spongio-piline should be 
wrapped round the throat, and steam may be inhaled into the mouth. Some- 
times a compress of linen steeped in cold water and applied to the throat gives 
great relief. When dropsy comes on it shows the kidneys are affected, and 
the patient must be put to bed again, if he has been up previously. A hot 
bath and purgatives must be given to remedy this state of things. Exposure 
to cold too soon after an attack of scarlet fever is often a cause of the dropsy, 
and so care should be taken to keep the child in the house for at least three 



SCI 705 SCI 

weeks after the rash and until the peeling has finished. In this way also the 
child is less liable to give it to others. Malignant cases may be knocked down 
at once and die within forty-eight hours ; ammonia and brandy must be given 
when the state is one of great prostration. Gargles are not of much use to 
the throat ; brushing the fauces over with tannin and glycerine, or with a solu- 
tion of nitrate of silver, is the best remedy. In cases of discharge from the 
ear this must be syringed with warm water three or four times a day, and a 
little cotton wool should then be pushed in. During convalescence tonics 
should be administered, and for this purpose iron and quinine are the best rem- 
edies. The reader is referred to the article on Sanitary Regulations for an 
account of the disinfecting measures to be used. 

Sciatica is not a single disease, but a group of diseases of various kinds, 
but all affecting nearly the same region. That region is the lower portion of 
the hip and thigh, along which the sciatic nerve runs, whence the name. True 
sciatica is a neuralgic affection, but numerous other maladies, especially of a 
rheumatic origin, have been mistaken for it. The sciatica rarely occurs in 
youth, and rarely begins in old age ; most frequently it commences between 
forty and fifty. One kind of sciatica — of the truly nervous kind — is associ- 
ated, especially in females, with hysteria, or other signs of a nervous tempera- 
ment. Frequently these suffer from neuralgia in other situations. The sci- 
atica which occurs in older persons very often follows on cold, damp, and fa- 
tigue. It is especially troublesome in men who have broken down under their 
exertions, and show signs of premature age. Sciatica occurring in these indi- 
viduals is exceedingly intractable, and there are very frequently spots in the 
neighborhood of the great nerve that are exquisitely tender to the touch. In 
this form of paralysis, too, the motion of the extremity is interfered with. 
There is loss of power and motion, or any attempt at it gives rise to great pain. 
Besides loss of motor power there may be loss of sensation of the ordinary 
kind. There may be greater sensibility to mere touch, but the power of dis- 
criminating possessed by the skin is diminished. As the nerve which supplies 
the lower "extremity is concerned in this affection, not only is the motor power 
impaired and the sensory functions interfered with, but there is often a loss of 
governing power, so that any stimulus which ordinarily would have little ef- 
fect whilst the central governing power had full control over the extremities, 
may give rise to spasmodic contractions or cramps of the muscles of the af- 
fected extremities. 

Another group of cases, where there is marked pain in the sciatic nerve, 
seems due to inflammatory or other changes in its sheath subsequent to rheu- 
matism or syphilis. These cases belong to a totally different category from 
the former, and the treatment applied to them must be as different. In these 
cases iodide of potassium and cod-liver oil are the great remedies ; not so with 
the neuralgic affections of the sciatic nerve. Bicarbonate of potass, which is 
often prescribed, is quite useless, and if persisted in for any length of time is 
worse than useless. Iodide of potassium ought to be given in good large doses, 
and larger in syphilitic than in rheumatic sciatica. Not less than ten grains 
should be given three times a day to begin with, and the quantity should be 
gradually increased. Cod-liver oil is to be given at the patient can take it, and 
continued for a long time. Small doses are of little worth. Now, of the true 
neuralgias, it is especially important to give in the first variety — that is, the 
one which occurs in a decidedly nervous temperament, and is very likely the 
result of nervous exhaustion — tonics. Steel and strychnine should be given, 
and persevered in ; these may not suffice wholly to get rid of the pain, but they 
45 



SCI 706 SCR 

will strengthen the constitution, and so enable other remedies to be used with 
more advantage. The strychnine may be given either as liquor strychnine 
(solution of strychnine), from five to ten minims for a dose, or the tincture of 
mix vomica in like quantity may he prescribed. Liquor strychnine is best 
when given along with iron. Of iron the two best preparations are the sac- 
charated carbonates and the neutral chloride. The carbonate may be given 
in doses of 20 or 30 grains, the chloride in 20 or 30 minim doses. The liq- 
uor ferri perchloride may be used if the other is not obtainable. Arsenic is a 
remedy not to be overlooked in dealing with sciatic neuralgia, especially if 
there is any likelihood of malarial complications. The preparation commonly 
employed is Fowler's solution, of which the dose is two or three minims, given 
immediately after food. It is true that arsenic is of more value in other forms 
of neuralgia than sciatica ; nevertheless its use in an obstinate case — and sci- 
atica is very obstinate sometimes — should never be overlooked. 

Of the local means of relieving sciatica, chief among them we would place 
the hypodermic injection of morphia, especially over the spot where the pain 
is most severe. If the spot be also tender, it may be necessary to use ether 
spray to alleviate the pain of the injection. The quantity injected should not 
in the first instance exceed one fifth of a grain ; but it may be shortly repeated 
if successful. The value of this injection lies as much in the rest from pain 
it gives as in its action on the nerves. Very often, however, it is not possible 
for a sufferer to procure this injection of morphia at all times when his pain is 
severe, and it is hazardous to allow him to have the command of the injection, 
as he is apt to increase the dose unnecessarily and speedily. When this is the 
case a small blister over the pained spot, with some lead and morphia lotion to 
apply whe;i the skin is removed, will do great good. Of course such a lotion 
must be very weak. An ointment may be made to produce similar effects. 
A good many men like to use atropine in small quantity along with morphia 
when given under the skin ; and some give it by iftelf in the same way, fre- 
quently with success. The dose to be given must not exceed the sixtieth part 
of a grain. 

The local use of electricity in sciatica is a recent introduction, but already 
it has attained to important dimensions. The kind of electricity is, however, 
important. That in ordinary use — induced electricity, whether the original 
current be magnetic or chemical, it matters not — is useless. The current 
must be continuous, and it is important that it should be as nearly as possible 
constant. The kind of battery matters less. One now in general use is a 
modified Smee's battery, which seems to give satisfaction ; but the intensity of 
the current in Smee's is rather high, so that the same number of cells of Smee's 
cannot be used as of a battery of low intensity, like Daniell's. The constant 
current battery made by Messrs. Weiss seems to do well ; but we may yet 
hope for something better in the same way. 

All forms of sciatica are apt to return, and so if a patient has once suffered 
from the malady he ought to take great care that it does not return, or the 
consequences may be disastrous. To this end over-fatigue, bodily or mental, 
should be avoided, and flannel constantly worn next to the skin. 

Scirrhus, a name applied to one variety of cancer. See Cancer and Tu- 
mors. 

Scrivener's Palsy, or Writer's Cramp. See Paralysis. 

Scrofula is a constitutional condition generally inherited from one or both 
parents, and increased by bad feeding in early life. The most characteristic 
features of a scrofulous individual are — a heavy figure, dull, pasty complex- 



SCU 707 scu 

ion, with a prominent upper lip and a coarse mould of countenance ; mind and 
body lazily disposed, nostrils expanded, and nose rather turned up. When 
children they are very liable to inflammation of the eyelids, giving a red, an- 
gry look to the part, while most of the eyelashes are absent ; often, too, the 
glands enlarge, and more especially those under the jaw and in the neck ; this 
swelling comes on from a common cold, or in the course of an illness, and 
sometimes the gland breaks up into abscess, which points and leaves, after re- 
covery, an ugly seamed scar ; such people generally have several of these scars, 
from abscesses having formed at different times. Eczema is another condition 
to which scrofulous people are very subject when young ; it appears on the 
head and behind the ears ; discharge from the ear, earache, and deafness are 
not uncommon symptoms. Bronchitis, inflammation of the lungs, and perhaps 
consumption may ensue. Nor do the intestines escape, for on any slight irrita- 
tion, diarrhoea is apt to come on. Sometimes the mesenteric glands in the ab- 
domen swell, and this may be associated with dropsy and chronic inflammation 
of the peritoneum. Nor are diseases of the joints uncommon, and these may 
go on for months or years, and be very distressing to the patient, being ac- 
companied by discharge of matter and disease of the bone. Scrofulous people 
are therefore liable to a great many diseases in consequence of their constitu- 
tional malady. As a rule, persons subject to this affection ought not to marry, 
as their offspring will be more or less affected : marriage between cousins thus 
affected should be strongly prohibited. The general health of such people may 
be much improved by careful feeding in childhood, cod-liver oil, sea-bathing, 
and an out-door country life. 

Scurf. This is a popular term applied to those cases in which the epithelial 
scales of the skin are shed. It is often so in the heads of children, where 
branny scales are shed. Washing the part with camphor water, once or twice 
a week, is a good thing. On a larger scale it is seen in cases of psoriasis 
and in some cases of eczema. Sometimes it is called scurvy, but this is quite a 
wrong designation. 

Scurvy or Scorbutus depends upon a state of mal-nutrition, following the 
use of a diet which is deficient in fresh vegetable matter, and tending to death 
unless the causes producing it are removed. Scurvy has been known for many 
years. In the long sea voyages of the navigators of the fifteenth and sixteenth 
centuries, the crews suffered most terribly from this disorder, and many lives 
were lost. It was looked upon in former times as an infliction of Providence, 
as a warning against those who presumptuously strove to seek after unknown 
lands ; yet now we know that it is a disease which can be readily cured by 
adopting proper measures, and by means which every habitable country affords. 
Scurvy only occurs when fresh vegetable nutriment has been for some time 
completely or partially withheld. It ^s most common among sailors, because 
on long voyages they have so much salt food, and no fresh vegetables. Yet 
it may occur amongst landsmen. In 1846 an outbreak of scurvy occurred 
amongst some laborers employed on the Scotch railways. Their food con- 
sisted of bread, salt pork, butter, cheese, coffee, tea, and sugar. Potatoes were 
out of the question, as they were far too dear, because the crop in that year 
had totally failed. Fresh vegetables were never thought of, and were indeed 
in most places unprocurable. In Carlisle, in the same year, the persons chiefly 
afflicted were weavers and their wives and daughters working in the factories, 
shoemakers, and comparatively few of any other kind of artisans. Bread, oat- 
meal, treacle in very small quantities, tea, and coffee, with an occasional her- 
ring, formed their entire food. None had tasted potatoes after the harvest of 



SCU 708 SCU 

1846, or for a period of seven or more months. Tn the Crimean war the al- 
lied armies suffered very severely in the winter of 1854 and in 1855. As 
soon as the supply of fresh vegetables and lime-juice became more plentiful the 
disease gradually disappeared. The French suffered worse than the English 
troops, as they had no lime-juice served out to them, and all the vegetables in 
the Crimea were soon eaten when the troops landed. The disease first showed 
itself in the winter of 1854-55, but as the spring advanced and vegetation 
came on the disease diminished. But as the summer approached, the rays of 
the sun dried up the ground around the camps. No herbs, and especially no 
dandelion, could be procured, and the disease again made great ravages. The 
above are rough illustrations of its mode of production, but in former years there 
were recorded terrible tales of whole crews being attacked on a long voyage 
with this malady, and many used to die. 

Symptoms: First, there is a change in the color of the skin, which is pale or 
sallow ; then the mind becomes listless, and the patient is averse to taking 
exercise and seems apathetic. There are pains about the limbs, and so the 
sufferer is glad to lounge about and rest himself. Gradually purplish spots, or 
petechias, are observed, especially about the legs and thighs ; they are not 
usually raised above the surface of the skin ; then larger patches form, as if 
numbers of these small spots had run together; and often there is an appear- 
ance as if the patient had been bruised. The lips are pale, the face becomes 
bloated, the conjunctiva; of the eyes become swollen and red. The gums, at 
first pale, begin to swell at their free margins, so as to encroach upon and 
almost envelop the teeth ; they then become spongy, dark red, or livid, not 
painful, but disposed to bleed when irritated. Sometimes the teeth are 
loosened and fall out; there is also a sickening fetid odor from the breath. 
Chewing is now rendered impossible, and even fluid food is swallowed with 
difficulty. Often swellings occur in various parts of the body, and chiefly near 
the bend of a joint ; the most common seat of this condition is the ham, and 
next the elbow, or beneath the jaw. There is often breathlessness and attacks 
of syncope or fainting, and this is dangerous, as sudden death may in this way 
take place ; therefore, any one who is bad with scurvy should be kept in the 
recumbent posture, and not be allowed to sit erect. In bad cases ulceration of 
the skin often comes on, and may spread rapidly, and be attended with danger- 
ous bleeding. Very little difficulty can occur in making out a case of scurvy, 
and especially if the antecedent conditions be known. 

Treatment: This must consist in supplying the patient with the material, by 
the deficiency of which his disorder has been produced. It is wonderful how, 
in a very bad case, an immense improvement will take place in a few hours by 
giving lime-juice ; amongst the vegetables which may be given are oranges, 
lemons, limes, cabbage, lettuce, potatoes, onions, mustard and cress, dandelion, 
sorrel, scurvy-grass, and grapes. An ounce of lemon-juice should be issued 
daily, when vegetables are short. The other articles of diet must be so ar- 
ranged in a case of scurvy as to be easy of digestion. The following sugges- 
tions have been issued by the Board of Trade for the information of ship-own- 
ers and ship-masters : — 

" Every ship on a long voyage should be supplied with a proper quantity of 
lime or lemon juice. 

" The juice, having been received in bulk from the vendors, should be ex- 
amined and analyzed by a competent medical officer. All measures adopted 
for its preservation are worthless, unless it be clearly ascertained that a pure 
article has been supplied. 



SCY 709 SEA 

" Ten per cent, of brandy (spec, grav., 930), or of rum (spec, grav., 890) 
should afterwards be added to it. 

" It should be packed in jars or bottles, each containing one gallon or less, 
covered with a layer of oil, and closely packed and sealed. 

" Each man should have at least two ounces (four tablespoonfuls) twice a 
week, to be increased to an ounce daily if any symptoms of scurvy present 
themselves. 

" The giving out of lime or lemon juice should not be delayed longer than a 
fortnight after the vessel has put to sea." 

Scybala is a term applied to the fasces, or contents of the bowels, when 
they are passed not in a natural and proper form, but in hard, small masses, 
more like marbles or excretions of sheep than what is ordinarily considered 
healthy. This condition denotes a costive habit of body, and should be cor- 
rected by gentle purgatives or by diet. 

Sea-sickness is a condition well known to many as one of surpassing 
discomfort, and one, too, which seldom induces that sympathy which enables 
ixs to meet far more serious ills with greater equanimity. 

Much has been written on sea-sickness, but the exact mode of its causation 
is not yet quite manifest, though some of its causes are identical with those 
which produce nausea on shore. Some delicate people cannot ride with their 
back to the horses of a carriage or to the engine of a train. If they do they 
speedily become giddy and faint, with a tendency to sickness, though that is 
rarely induced. We . thus have seen the same cause come into play more 
forcibly in a boat but a little way off laud. The waves running past the boat 
and the course of the boat in the opposite direction tend to make an individual 
giddy, and so to favor the advent of sea-sickness in its aggravated form. 
Under such circumstances a fixed look on the shore at a distance may preserve 
the individual from being actually sea-sick, though he may be faint. 

Even on shore unpleasant sights and smells may cause nausea and sickness. 
It is no uncommon thing for a young student to get sick at his first 
operation, especially if his stomach is irritable ; and, as is well known, evil 
smells are even more powerful in this direction than foul sights. To an indi- 
vidual with a tendency to nausea, the smell of bilge water and tar, or of grease, 
oil, and the like on shipboard, still more the sight of others in the act of 
being sick, are powerful inducements to go and do likewise. 

But these things, at least some of them, persist ; sea-sickness does not. It 
either passes off on landing, or, if the voyage is one of some duration, it grad- 
ually fades, leaving the traveler very hungry. It is quite plain, therefore, that 
the immediate cause of the feeling of sickness is the unaccustomed motion 
of the vessel; once the individual has become accustomed to that, the feeling 
passes away, and the benefit of the sea air is felt. Under ordinary circum 
stances an individual goes on board ship without any preparation; as soon as 
the vessel begins to feel the motion of the sea a little the passengers begin to 
feel queer, especially it' they have been eating and drinking more than has 
been good for them before putting to sea. If to this the individual superadd 
giddiness, induced by looking at the sea rushing past, there is speedily an end 
to it ; the sea claims her own. There can be no question of the fact that the 
motion is the main cause of the nausea, for it is much worse in a small boat 
dancing freely on the water than in a large vessel, which is comparatively 
steady, and it is worse in what is called a chopping sea than in a regular, even 
swell, especially if the vessel be small enough to respond to all the motions of 
the waves. The motion communicated to the vessel is communicated to the 



SBB 710 SBI 

passengers ; the crew have their sea legs on board. To them the motion is 
nothing ; they balance themselves as easily as on land. But the freshly- 
embarked passenger cannot do this ; he cannot balance himself ; he is in con- 
stant danger of foiling, or seems to be so, and his body is agitated in 
endeavors to support himself. These violent efforts induce motion in the 
organs contained in the abdomen, and doubtless also the nerves which supply 
these. Of course, if these viscera are overloaded, the evil comes all the more 
speedily. A sudden feeling of nausea causes the entrance to the stomach to 
relax ; the motion superadded to contraction of the abdominal walls speedily 
causes evacuation of its contents, and one act of vomiting begets another. 
Meanwhile, the original cause of the mischief, the motion of the vessel, con- 
tinues ; and the stomach, now rendered irritable, responds more easily to this 
stimulus, and so the sickness is kept up. Just behind the stomach and liver 
lie an important group of nerves which partly control the heart's action ; the 
motion of the organs in the abdomen much affect that, and so perhaps the 
feeling of nausea, as well as the attempts at vomiting, is kept up. But 
vomiting always ends in producing intense depression ; it tries every muscle 
in the body, — nothing exhausts like it; and when to the former nausea 
and retching is superadded this feeling of exhaustion, the full misery of sea- 
sickness is developed ; but by and by, as the system becomes habituated to this 
motion, as it becomes habituated to almost everything, the new sensations pass 
away, perhaps to return no more. Prevention is better than cure, and of noth- 
ing is this truer than sea-sickness. As, moreover, many of us cannot stay at 
home forever, it is better to try to understand the best method of avoiding the 
scourge if we can. In a short voyage we may expect or hope to avoid sea- 
sickness ; in a longer one we can hardly do so. 

Should we desire to avoid the terrible nausea and depression, it is best to 
have the bowels well opened the day before, so that they shall not be loaded. 
We should also take care that the stomach is not overloaded, but as retching 
on an empty stomach is not pleasant, it is desirable to take a little food an 
hour or two before embarkation. Drinking or smoking, especially in those 
not accustomed to either, is strenuously to be avoided, as tending to render 
the stomach irritable. When the individual goes on shipboard he should select 
a spot where the motion is likely to be least; that will be as near the centre as 
possible, and then, as the motion of the body standing is greater than sitting, 
and sitting than lying, it is best for him to lie down upon his back as soon as 
possible. 

As to internal remedies, all kinds of things have been tried ; none do so well 
as spirit of chloroform, which used to be called chloric ether. Thirty drops, 
or even a teaspoonful, of this may be taken in a little water as soon as the 
traveler goes on board and has lain down. For it is not given with a view 
to cure, but with a view to prevent the nausea. Certain it is that in a goodly 
number of cases the spirit of chloroform enables the stomach to meet the 
shocks better either by stimulating it or by soothing it ; at all events, in a 
short voyage there is a good chance of escaping. In a longer voyage, when 
the sickness is passing away, drachm doses of aromatic spirit of ammonia, with 
a little spirit of chloroform, should be given ; but a still better "pick-me-up " 
is iced champagne. Fortunately, the two are not incompatible. 

Sebaceous Glands. See Skin. 

Seidlitz Powders. Nearly all chemists have their own receipts for the 
preparation of these cooling powders, which do not appear in the Pharma- 
copoeia, but are nevertheless useful as a gentle aperient. Each dose requires 

I 



SEN 711 SEP 

two powders to prepare it, the white paper containing an acid, the blue an al- 
kaline powder. The latter consists of Rochelle salts, tartrate of potass and 
soda, and bicarbonate of soda, the acid being usually tartaric acid. These are 
mixed together with water, and drunk while effervescing. 

Senega is the root-stock and rootlets of the Polygala senega, growing in 
North America. The rootlets have a peculiar heel on one side ; their color is 
grayish -yellow. The taste is sweetish and acrid, causing flow of saliva. The 
active principle, senegin, also causes sneezing when applied to the nostrils. 
Two preparations of senega are in use, namely, an infusion and a tincture. 

Senega seems to act mainly on the mucous membranes, especially on those 
of the lungs. It also acts on the skin, and sometimes on the kidney. Some 
esteem it to possess certain influence over the heart and womb. It is, how- 
ever, used almost entirely in chest disease, as a remedy in chronic bronchitis, 
whooping-cough, and the like. Here it is seldom prescribed alone; generally 
other substances, as paregoric and carbonate of ammonia, are combined with 
it. It has been used in renal dropsy and in painful menstruation. The dose 
of the tincture is a drachm, of the infusion half an ounce to an ounce. 

Senna, as used in medicine, is of two kinds, the so-called Alexandrian or 
Egyptian senna, and East Indian or Tinnevelly senna. The substance is the 
leaf of various species of cassia. They all have a peculiar odor, and all, if 
examined, will be seen to have one side shaped differently from the other at 
the base of the leaf where it joins the stalk. Alexandrian senna usually con- 
tains, as imported, the leaf of a totally different plant, which is irritating and 
gripes a good deal. This is usually removed by hand before it is sold, and the 
senna is spoken of as picked. 

East Indian senna has a leaf very much larger than the Alexandrian kind. 
In some samples the leaves are broken and mixed with what may be consid- 
ered impurities. Senna readily yields its virtues to water. These are said to 
depend on a substance in senna called cathartine, but this is by no means cer- 
tain. Its preparations are a confection, infusion, mixture, tincture, and syrup. 
The confection is a good, useful preparation, consisting of senna, coriander, 
tamarinds, cassia pulp, prunes, extract of licorice, and sugar. It is useful 
in piles. The mixture, best known as black draught, contains sulphate of 
magnesia (Epsom salts), extract of licorice, tincture of senna, tincture of 
cardamoms, and infusion of senna. The tincture contains, besides senna, 
raisins, caraway, and coriander ; the syrup, coriander and sugar. Senna is 
hardly ever given as powder ; the infusiou is most commonly employed, ex- 
cept among children, where the tincture or syrup takes its place. About 
an ounce may be given of the infusion, the same of the mixture, and of the 
confection a drachm or more. The syrup is given to children in the dose of 
a drachm or more. 

Senna, as is well known, is a purgative, stimulating the motion of the 
bowels, and also aiding slightly in promoting their flow, but a salt of some 
kind, Epsom or Rochelle, is generally added to increase its efficacy in this 
way. Senna is seldom given alone, as it is apt to gripe, and for this reason 
spices are usually administered along with it. Senna is more generally used 
than any other purgative when it is simply desired to have the bowels cleared 
out, as it is apt to leave no ill consequence behind. It should not, however, be 
given if there is any tendency to inflammation of the bowels. 

Septicaemia. This is an acute disease, which resembles pyaemia very 
much in its general characters, and which is supposed to be caused by the ab- 
sorption into the blood of putrid material from the surface of a wound or 



SER 712 SET 

ulcer. It generally occurs after phlegmonous erysipelas, sloughing, or other 
forms of unhealthy action ahout a wound which has been caused either by ac- 
cidental injury or by the knife of the surgeon. The following are the most 
prominent symptoms of this disease : great prostration ; the patient lies help- 
lessly upon his back, as in bad typhoid or typhus fever, and at last falls into 
a state of intense collapse ; this prostration is increased by profuse perspiration 
and obstinate diarrhoea ; the tongue is dry and brown, and there is often much 
irritability of the stomach, indicated by nausea and frequent vomiting. The 
nervous symptoms are very characteristic ; the patient appears drowsy and apa- 
thetic, and sensibility seems to be lost. There is low muttering delirium, with 
short intervals during which the patient seems conscious and discourses ration- 
ally. There is rarely much restlessness or violent delirium. The frequently 
repeated tits of rigors or chills so characteristic of pyaemia are generally ab- 
sent in this disease. The patient sinks slowly, and during the last twenty- 
four or thirty-six hours of life is in a state of coma and collapse, during 
which the action of the heart and lungs is carried on very feebly and almost 
imperceptibly. 

Serous Apoplexy is a term often used, but it is a wrong expression ; such 
cases are nearly always due to chronic Bright's disease, and should be called 
renal coma. See Apoplexy and Coma. 

Serpentary consists of the dried root of the Aristolochia serpentaria, a 
native of the United States. It also goes by the name of Virginia snake-root, 
and must not be confounded with the black snake-root, also growing in Amer- 
ica. The part employed is the root or root-stock with the rootlets attached. 
These are of a pure brown color, and have a peculiar odor and taste something 
resembling camphor. It contains bitter matter, a volatile oil, and some resin. 
Its preparations are an infusion and a tincture. Serpentary acts as a stimulant ; 
some men think much of it, some but little. It seems in the hands of some to 
do good in certain forms of indigestion and certain conditions of the bowels. 
It also acts on the skin as a stimulant, though not very powerfully. It seems 
to do good in chronic rheumatism and subacute gout. The tincture is com- 
monly employed in doses of a drachm. The powder and infusion are not often 
given. 

Serpents, Bites of. See Snakes, Bites of. 

Serum. When blood is drawn from a vessel of the body it separates into 
two portions: the solid partis called the clot; the liquid part is called the 
serum. The serum is a clear, yellowish fluid, and differs from the liquor san- 
guinis in not containing any fibrine. See Blood. 

Setons. By a seton is meant a long wound artificially made under the 
skin, the walls of which wound are kept in a state of irritation and suppuration 
by the presence of some foreign body. It differs from an issue in being a 
tubular wound under the skin, and not an open ulcer. A seton may be estab- 
lished by transfixing a pinched-up fold of skin by a large flat needle armed 
with a strand of cotton or silk thread, or by passing a bistoury through the 
base of the fold and then carrying the thread through the canal thus made, by 
means of a small-eyed probe. After the thread has been allowed to remain at 
rest for two or three days and has set up irritation and some discharge, it is 
pulled a little further through the wound, so that a fresh portion may be in- 
cluded and the soiled portion be cut away. This manoeuvre is repeated every 
second or third day, and when the strand is almost used up a fresh strand is 
attached and substituted for it. Instead of cotton or silk thread many surgeons 



SEW 713 SEW 

by dry and offensive-smelling discharge. Setons are established for the pur- 
poses of setting up counter-irritation, and of causing a chronic discharge so as 
to produce a drain upon the system. With the former object in view they are 
often useful when applied to the temple in some affections of the eye, and to 
the back of the ear in cases of deafness. As a means of producing a constant 
drain upon the system a seton is often established in old people who are 
threatened with an attack of apoplexy, or who suffer from constitutional dis- 
turbance in consequence of the closing by cicatrization of a large chronic 
ulcer. Chronic abscesses and tumors with fluid contents are often treated by 
the introduction of a long strand of silk thread. As the fluid flows slowly 
away from the orifices of the seton, irritation is set up in the walls of the sac, 
which contract, and are finally glued together by inflammatory conditions. 

Sewage. The disposal of sewage is one of the unsettled questions of the 
present day. Every one is agreed tliat it should not run into and pollute our 
rivers, nor is there any doubt as to its great value for agricultural purposes. 
The real difficulty, then, lies in adopting some means by which all the solid 
matters shall be retained and given back to the earth for . fertilizing purposes, 
and that this shall be done cheaply and at a remunerative price. At present 
there are two opposing parties, the one being in favor of irrigation, the other 
of precipitating the solid matters, and allowing the clear effluent fluid to return 
into the river or sea. The irrigationists first prepare a piece of land for the 
purpose by running shallow grooves between the ridges of ground, so that the 
slush and sewage from the large town shall run all over the field and sink 
into the earth by downward filtration ; in this way the crops are not hurt be- 
cause they are planted on these ridges, while all the fertilizing properties are 
removed from the sewage and are retained for the growth of the crops, and 
the clear water will drain off into a river, or may be carried into the sea. 
There must be special arrangements made as to the levelling and draining of 
the land, but these are only matters of detail. Those in favor of precipita- 
tion add various substances, as lime, clay, blood, alum, coal-tar, iron, zinc, 
etc., to the sewage, and this will make it throw down a precipitate. Cream of 
lime and phosphate of lime answer the purpose very well. The sewage from 
a large town is conveyed by pipes to the "farm," where there are several 
tanks and reservoirs ready to receive it ; when a tank is partly filled, some 
precipitant, as lirne, etc., is well mixed with it, and the mixture is allowed to 
stand ; in a few hours nearly all the solid matters are thrown down as a dirty, 
slushy layer at the bottom of the tank, while the supernatant fluid is quite 
clear ; this can then be run off and returned to the soil. To this plan there 
seem two objections : the first, that the clear effluent fluid contains many sub- 
stances in solution which really are most fertilizing, and these are more or less 
wasted by the process ; the second, that the slush contains so much water that 
its conveyance to other parts is expensive; this has been lately remedied by 
causing the slush to pass slowly over a platform beneath which a fire is burn- 
ing ; as the slush slowly passes along, much water is driven off, and an almost 
powdery mass is produced ; this, of course, increases the cost of production, 
but then the charge for carriage is diminished, as it is now much more port- 
able. An objection to the irrigationists may rest on the fact that it may be 
difficult to obtain enough land in the vicinity of the sewage works for the pur- 
pose, and the more so near a large town, for it is clear that one cannot go on 
irrigating a given area beyond a certain amount. The practical difficulty 
might perhaps be solved by carrying on both processes at the same time, or 
by allowing the clear, effluent fluid of the.precipitants with its fertilizing solu- 



SHA 714 SHO 

ble matter to percolate through the soil, while the solid or semi-solid slush 
could be sent to more distant parts. It is quite clear that there is no one plan 
which will do for all places, as the expense would be too great unless the town 
were of considerable size. In a small place it is well worth while to adopt 
the plan of earth-closets, by which dry earth is daily mixed with the excreta, 
and no disagreeable smell results ; this might be removed in the dry state once 
a week, and mixed with the land ; it would amply pay a farmer to supply 
weekly dry earth and to remove the excreta free of charge for the benefit he 
would derive from an increase in the crops he would grow. Many years will 
probably ehipse before any scheme will work well ; the difficulty in all these 
cases lies in the fact that you may have enormous quantites of slush lying on 
the land and poisoning the surrounding atmosphere at a time when it may not 
be wanted for farming operations. It is very important that when sewage is 
run into the sea it is carried out below low water, and that the pipes have 
valves so as to prevent any reflux ; also that no drain should enter close to the 
mouth of a river, as the tide will wash it back towards the town, and cover 
the banks with a most noxious and loathsome slime. 

Shaking Palsy, also known as Paralysis agitans, is a malady most com- 
mon in advanced life. In it there is a continued agitation of the body, or 
certain parts of it, which is worse when the individual is engaged in any pur- 
suit, so that by and by he is incapacitated from all occupations. Commonly it 
begins in the upper extremities and head, afterwards affecting the lower 
limbs. The disease is progressive, but advances slowly. Sometimes strych- 
nine and galvanism by the continuous current do good for a time, but as a 
rule cures are not effected. See Paralysis. 

Shampooing. See Turkish Bath. 

Sherry. See Wine. 

Shingles. See Herpes. 

Shock. This condition, which is also called collapse and prostration, is an 
immediate result of severe injury, and consists in general depression of bodily 
power, and in partial or complete arrest of the heart's action, consequent upon 
an intense and violent impression upon the nervous system. A similar condi- 
tion is produced by the action of certain poisons. 

The following are the symptoms of well marked shock : the surface of the 
body cold and very pallid ; the bloodless condition of the skin is most evident 
in the face and lips, presenting a strong contrast to the usually florid appear- 
ance of this portion of the body ; the forehead is covered by drops of cold, 
clammy perspiration ; the breathing almost imperceptible ; the pulse weak, 
irregular, and in extreme cases imperceptible ; great muscular debility — pros- 
tration ; the patient is in a state of stupor, and the sensibility is benumbed. 

The symptoms of shock vary very much in degree in different cases, accord- 
ing to the nature of the injury and to the bodily or mental condition of the 
patient. Their intensity is much increased in cases where there has been 
much haemorrhage ; then there is more mental disturbance, and the patient 
presents all the symptoms of severe syncope. In some cases there are nausea, 
hiccup, and vomiting. In cases of injury to the head resulting in compression 
or laceration of the brain, the symptoms of shock may be associated with con- 
vulsions and palsy. 

The duration of shock varies very much. In less extreme cases the symp- 
toms subside in the course of one or two hours ; in severe cases they may last 
for thirty-six hours or two days. In cases of recovery the patient passes from 
a state of shock to one of perfect or imperfect reaction. When the reaction is 



SHO 715 SHO 

perfect the pulse becomes stronger and fuller, and the breathing deep and well 
marked. The most favorable signs are returning warmth of the surface of the 
body and slight restlessness on the part of the patient, with an inclination to 
lie on his side. In the course of a few hours there may be some fever indi- 
cated by a hot skin, a flushed face and bright eye, and a rapid pulse. These 
symptoms, however, in favorable cases soon pass off, and the complete recov- 
ery is established. With imperfect reaction, on the other hand, the febrile 
symptoms increase in intensity, and then after a time give way to symptoms 
of nervous excitement and general exhaustion. There are great mental excite- 
ment, with or without delirium, muscular trembling, and much restlessness. 
These symptoms are associated with others, indicating rapid exhaustion, such 
as vomiting, a cold and moist skin, and a low. fluttering pulse. In bad cases 
these symptoms increase in intensity, and finally the patient dies in a state re- 
sembling coma. In children convulsions often occur during the states of 
shock and of imperfect reaction. Patients who have been accustomed to take 
large quantities of beer, wine, or spirits generally present during this state of 
imperfect reaction all the symptoms of violent delirium tremens. In individuals 
who are naturally weak and delicate, reaction, though favorable in its course, 
and steadily progressive, may be very slow, so that complete recovery is not 
attained for several days after the occurrence of the injury. 

By far the most frequent cause of shock is injury. Cceter is paribus, the more 
important and necessary to life the injured organ may be, the more intense are 
the symptoms of shock. Severe and even fatal shock may be caused by in- 
juries which produce no morbid appearances in any part of the body. A blow 
over the pit of the stomach or, compression of the testicle may often give rise 
to intense and alarming symptoms. In railway accidents shock is often pro- 
duced without any visible hurt or subsequent symptoms of injuries to internal 
organs. Sudden and violent injm*ies to limbs, with extensive crushing of the 
soft parts, and compound fractures are always followed by shock. The most 
intense shock resulting from visible injuries is probably met with after burns 
and scalds, either when a considerable depth of soft structure has been de- 
stroj^ed, or when the injury, though superficial, has involved a considerable 
extent of the surface of the body. A very superficial scald is almost always 
fatal in children, when a considerable portion of the skin covering the front of 
the chest and abdomen has been thus burnt. Intense pain in connection with 
any kind of injury generally causes much shock. With gun-shot wounds there 
is generally well-marked shock, which is favored or intensified by the cir- 
cumstances under which it is received. Professor Longmore remarks on this 
point that panic may lead to severe symptoms of shock, although the wound is 
not of a very serious character. " A soldier," he says, " having his thoughts 
carried away from himself, his whole frame stimulated to the utmost height of 
excitement by the continued scenes and circumstances of the fight, when he 
feels himself wounded is suddenly recalled to a sense of personal danger ; and 
if he be seized with doubt whether his wound is mortal, depression as low as 
his excitement was high may immediately follow." In all cases of shock 
following injury the symptoms are modified by the mental and bodily con- 
dition of the patient, by the nature of the accident and the circumstances 
under which it has taken place, and by the amount of disturbance to the ner- 
vous system and the organs of the chest. Much loss of blood increases to 
a considerable extent the intensity of shock. Symptoms resembling those 
of traumatic shock may be produced by the action of narcotic and corrosive 
poisons, and also by intense pain caused by disease. 



SHO 716 SHO 

The chief indications in the treatment of severe shock are to keep up the 
action of the heart and lungs, and to maintain the temperature of the body 
until the effects of the sudden and violent impression upon the brain and ner- 
vous system have passed off. In a case where there has not been much haem- 
orrhage, and where no large wound is present from which bleeding might be 
likely to occur before the arrival of a medical man, the patient should at once 
be placed in bed between warm blankets ; a bottle of hot water should be 
placed near the feet, and one under each arm-pit; if suitable stone bottles are 
not at hand, bricks or any other bodies which will retain heat for a time should 
be used. Care must be taken to prevent burning of the patient's skin by 
wrapping the heated bottles or bricks in flannel. Brandy should be adminis- 
tered frequently, and in small quantities, the spirit being slightly diluted with 
hot water. If there be much nausea or vomiting, an injection should at once 
be made into the rectum of beef-tea and brandy, or milk and brandy. When 
the shock is so intense that the breathing ceases or becomes almost impercept- 
ible, an attempt should be made at artificial respiration according to the meth- 
ods described in the article on Drowning. 

In cases of shock associated with profuse haemorrhage, brandy should not be 
administered very freely, nor should much warmth be applied to the surface 
of the body until the bleeding vessels have been closed either by ligature or 
by pressure. 

The treatment of the serious symptoms indicative of imperfect reaction 
should consist in supporting the system and preventing fatal exhaustion on the 
one hand, and in allaying nervous irritability and producing sleep by large 
doses of sedative drugs on the other hand. 

Short-sightedness. Myopia, or short-sightedness, is an opposite condi- 
tion of the eye to long-sightedness. To individuals who are short-sighted, 
objects appear indistinct until they are brought close to the eyes, and there is 
great difficulty in reading even large type at ordinary distances. This impair- 
ment of vision when the eyes are much used is often associated with symptoms 
of irritation of the retina and the parts within the eyes, and the patient com- 
plains of pain and a sense of fatigue in the eyes, and intolerance of light; 
objects are obscured by a yellow or light brown mist, or are partially blotted 
out from the Held of vision, and much trouble may be caused by vivid flashes 
of light appearing before the eyes, and by motes or muscce volitantes. The 
vessels in front of the eyeball are distended, and the lids become red and in- 
flamed. It has been stated that cataract frequently comes on in short-sighted 
individuals. In most instances both eyes are myopic, but very often one eye 
is more myopic than the other. If the eyes be much used the acuteness of 
vision diminishes rapidly as age advances, and the individual may finally be- 
come amaurotic. This condition, though not usually discovered until the age 
of fourteen years, is due, in the majority of instances, to a congenital anomaly 
in the conformation of the eyeball. The membranes at the back part of the 
eyeball, in the region occupied by the optic nerve and yellow spot being thinner 
than in the normal condition, are bulged backwards, so as to extend the long 
axis of the eye, and to separate the retina to too great a distance from the 
cornea. In consequence of this extension of the eyeball, rays of light pro- 
ceeding from external objects are brought to a focus before they reach the 
retina or visual membrane. The eye of a short sighted individual, when the 
impairment of vision is due to this anomaly, is egg-shaped and elongated from 
before backwards, and the sclerotic and choroid at the back part of the globe 
are thinned and distended. In some few cases short-siiihtedness is due to 



SHO 717 SIM 

abnormal convexity of the cornea and crystalline lens. It is still doubtful 
whether short-sightedness may not be produced through close study and 
prolonged observation of minute objects. Sir William Lawrence once, when 
attending a book sale, was struck by the number of persons wearing spectacles : 
out of twenty-three gentlemen in the room, he found that twelve had spec- 
tacles on. This surgeon learnt also that in one college in Oxford thirty-two 
out of one hundred and twenty-seven students used either a hand-glass or spec- 
tacles. Individuals who find themselves becoming short-sighted should refrain 
from study and examination of small and near objects, and take as much exercise 
as possible in the open air. When reading they should carefully avoid stoop- 
ing, and hold the head upright. When a tendency to short-sightedness has 
been discovered in a child, the chin ought to be supported by some apparatus. 
Patients in reading should first place a book with large type as far from the 
eyes as may be compatible with fairly distinct vision, and then day by day 
gradually increase the distance until they are able to see the letters distinctly 
at a distance of thirteen or fourteen inches, the ordinary focal length. In 
severe cases of short-sightedness, and when the patients cannot read without 
difficulty, it is necessary to have recourse to spectacles furnished with concave 
lenses, which increase the divergence of the rays of light, and remove their focus 
to a point at a greater distance from the front of the eye. 

Shortness of Breath is a common symptom in many diseases of the heart 
and lungs. See Dyspnoea. 

Sialogogues are substances which promote the flow of saliva : they are 
hardly used in medicine. Chief among sialogogues is horse-radish, which is used 
mainly as a condiment. Pellitory is also powerful this way, as is ordinary 
mustard. The mere motion of the jaws in chewing acts this way, so that 
masticating anything or chewing gum will excite salivation. 

Sick Headache. See Headache. 

Sick-rooms should be as capacious as possible, because then the patient 
has more air to breathe, and it does not require renewal so often as the air in 
a small room does, and thus a draught is prevented. A fair amount of ventila- 
tion is carried on by the door, windows, and fireplace, but at least twice a day 
the windows should be opened so as to cleanse the room. If the patient can 
leave the room for a short time, so as to allow of a free current of air, so much 
the better ; if not, the patient should be lightly covered over, so as not to feel 
any draught. In cases of fevers and any contagious disorders, it is best to 
remove from the room all unnecessary articles, as curtains, hangings, carpets, 
etc., and let there be disinfectants about. (See Disinfectants.) In chronic 
cases the sick-room should be made as cheerful as possible, and the amount of 
light should be regulated so as to please the patient ; in cold weather the fire 
should be kept nice and bright; when possible, flowers should be placed in the 
room. But there are a hundred little details and comforts which a practiced 
nurse will look after. A thermometer should be in the room so as to have 
the temperature properly regulated. 

Sight. This is a special function of the optic nerve, by which we become 
acquainted with the world around us. See Eye and Vision. 

Silk, Oiled. A very useful preparation of silk, which renders it impervi- 
ous to water or grease, and is chiefly used in surgery to lay over dressings of 
wounds so as to keep the lint, saturated with water, from becoming dry by 
evaporation. Less expensive textures are prepared from india rubber, but they 
have all a disagreeable smell, which does not exist in oiled silk. 

Simaruba is the bark of the simaruba, or mountain damson of Jamaica. It 



SKB 718 SKE 

grows throughout the West Indies, but is no longer officinal. The bark itself 
used to be imported in long tough pieces ; its color was rather pale, its epider- 
mis rough ; the taste is very bitter. Being so tough and fibrous it was not 
easily managed, and was really never much used. Its properties seem to de- 
pend on a bitter principle similar to that contained in quassia, and as quassia 
is so much more easily managed simaruba has been expunged from the Phar- 
macopoeia. It may be used in the same way as quassia. 

Skeleton. The skeleton of a full-grown human being consists of two 
hundred distinct bones, exclusive of the little bones in the internal ear. They 
are thus distributed : — 

The spine 26 bones. 

Skull . 8 " 

Face 14 " 

Hilis and breast-bone .... 26 " 

Upper extremity 64 " 

Lower extremity ..... 62 " 

These bones are divided into four classes, known as Long, Short, Flat, and 
Irregular. 

The Long Bones are those which exist in the limbs, and are employed in loco- 
motion ; their characteristics are, that they consist of a shaft and two articular 
extremities, these extremities being covered with what is termed articular car- 
tilage, and being capable of mutual movement upon each other by one or 
another form of joint, the gliding movements of such joints being assisted by 
the presence of bags containing joint oil {synovia), which is placed between 
these articular cartilages. The shaft of a long bone is cylindrical, or nearly 
so, and its extremities are expanded. The shaft consists of compact tissue, 
whilst the extremities are composed of spongy tissue, having a thin layer of 
compact tissue coated over them. The long bones are the cubit, the two bones 
of the fore-arm, the thigh bone, the shin and splint bones, the bones of the 
fingers and toes, and the collar bone. 

Short Bones. These are compact, strong bones, having several articular 
surfaces for mutual adaptation, and are found in those parts of the body where 
strength and limited motion are required, such as in the wrist, bones of ankle 
and instep. They consist of spongy tissue, with a coating of compact struct- 
ure. 

Flat Bones. These bones afford broad flat surfaces for the attachment of 
muscles, and for the protection of cavities ; they consist of two layers of com- 
pact tissue, containing a layer of spongy tissue between them. They are the 
skull bones, blade bones, haunch bones, breast bones, and ribs. 

Irregular Bones are those which, as their name would suggest, cannot be 
grouped with the previously named, such as the bones of the spine, jawbones, 
and several of those bones which make up the skull. 

The natural position of the human skeleton is erect, and this is in great meas- 
ure due to combined muscular action ; moreover, the natural architecture of 
the skeleton is such as to adjust its own centre of gravity : thus all those 
joints which transmit weight to the ground lie in one vertical plane, and such 
a line w r ould be described as passing from the top of the head, through the 
joints between the head and first bone of the spine, through that between the 
last bone of the vertebra^ and the sacrum, and through those between the sa- 
crum and haunch bone, the hip, knee, and ankle. (See Locomotion.) The 
spine, consisting of a great number of bones, peculiarly articulated together 
by interposed elastic cushions, increases in size from above downwards, and, 
moreover, possesses several well-marked curves. The object of these cushions 



SKI 719 SKI 

and curves is to receive the shock of sudden blows and falls, and to disperse 
their effects ; again, the curves are arranged alternately, so as to distribute the 
weight with greatest advantage to the centre of gravity of the body, which 
passes through all the curves, and falls on the centre of the base of the column. 
It will be observed that all the bones of the limbs are slightly curved, thus 
assisting in the individual and mutual transmission of shock. The pelvis (sa- 
crum and haunch bones) is very broad and strong in man, and the plane of its 
arch is in such a direction that the weight is transmitted vertically from the 
sacrum to the heads of the thigh bones. The thigh bone, being curved inwards, 
allows of the weight of the body being brought under the pelvis, and trans- 
mitted to the broad expanded ends of the bones forming the knee-joint. The 
foot, in its turn, consists of an arch, or rather a double arch, which receives 
the transmitted weight at its crown directly through the leg bones. Thus it 
will be seen that the upper limbs take no part in the maintenance of this natural 
upright condition, the composition of the skeleton being so arranged as to be 
subservient to it. 

Skin. The skin forms the external covering of the body : there is an upper 
layer called the epidermis, or cuticle, which is made up of flat, rounded cells, 
and which are being always shed off gradually and replaced by new ones ; 
beneath this is the tough cutis, or true skin, which is chiefly made of fibrous 
tissue ; in the skin are numerous hair follicles and sebaceous or sweat glands. 
The skin not only serves as a coat to protect internal organs, but also other 
useful purposes : it eliminates a large quantity of water daily, which is called 
perspiration or sweat, and this is always going on, although, unless violent 
exercise be taken, it is insensibly carried on. Carbonic acid, urea, and fatty 
matters are also excreted by the skin to a certain degree. When a blister is 
applied, it is the epidermis which is raised, while a serous fluid is formed under 
it ; so again, when the skin peels after scarlet fever, it is only the upper layer 
of the epidermis that is shed. To enable the skin to act properly, it must be 
kept quite clean, although this is very seldom done ; cold-water bathing is not 
enough, but an occasional hot bath must be taken so as to cleanse the pores 
thoroughly. The skin is liable to many diseases, but only the names need be 
mentioned here, and the reader must refer to the articles on those subjects 
for further information. 

(1.) Those diseases which begin or appear as pimples or papules : strophu- 
lus, lichen, and prurigo. 

(2.) Those diseases which are vesicular at first, or begin with a little blister 
or watery head : eczema, herpes, miliaria, sudamina. 

(3.) Those diseases which are pustular, or contain a little matter : impetigo, 
ecthyma, and small-pox. 

(4.) Those depending on the presence of a parasite, either animal or vege- 
table : ringworm, itch, etc. See Ectozoa, Epiphyta, and Parasites. 

(5.) Those diseases attended with tubercles, or raised lumps, larger than a 
pimple: acne, molluscum, lupus, cancer, yaws, elephantiasis. 

(6.) Those attended by too much or too little coloring matter in the skin, 
and forming, therefore, white or dark colored spots : leucoderma, freckles, vitil- 
igo, xanthelasma, Addison's disease.- 

(7.) Those diseases where the skin is harsh and rough : ichthyosis, xero- 
derma. 

(8.) Those diseases in which there are haemorrhages under the skin, and so 
purple spots or patches are seen which do not disappear on pressure : purpura, 
scurvy, bruises, malignant disorders. 



SKI 720 SLB 

(9.) Those diseases which arc attended with fever, and where there is a rash, 
as in the exanthemata : scarlet fever, measles, erysipelas, etc. 

Skin-grafting. This consists of removing some scales of epithelium from 
a healthy portion of skin, and applying them to an old ulcer which will not heal 
readily; these scales thus grow and form new centres, from which a healthy 
cicatrization will presently ensue. 

Sleeplessness, technically known as insomnia, is one of the most trouble- 
some conditions with which we are called upon to deal. Sleep is absolutely 
essential to all, for the repose and repair of the nervous centres, which in our 
waking hours are constantly, though unknown to us, engaged in the fulfillment 
of certain important functions. In early life the greater part of our time is 
occupied in eating and sleeping. In adult life about one-third of our time is 
passed in this manner, but elderly people often suffer from sleeplessness. 

Sleep is ordinarily preceded by a feeling of languor and heaviness, during 
which we see some of the unobserved functions of the nervous system make 
themselves apparent. Thus, first of all, the eyelids droop ; we are not aware 
of any strain in keeping them open, yet the moment our attention, involuntary 
though it be, is taken off, they gradually sink. So too the head, ordinarily held 
erect, falls forwards, and the limbs fall into the easiest posture. Even if the 
individual lies down, it will be noticed that as sleep comes on a different posture 
is assumed, one which allows of the relaxation of all his limbs and all his mus- 
cles. The respirations too are slower, gentler, and more prolonged ; they are 
carried out with the least possible amount of work, and the same may be said 
of the heart. Sleep, then, might be defined as the condition of least action in 
the human body, mentally and physically. 

It is evident that interfering with this repose, which is absolutely necessary 
for the perfect nutrition of the body, must be fearfully exhausting, especially 
if there is continuous bodily and mental exertion. Indeed, death may result 
from continuous want of sleep, and this is sometimes had recourse to as a pun- 
ishment in China. Continued sleeplessness is therefore a most serious thing; 
it is often the first indication of insanity, and is one of the most troublesome 
symptoms of violently insane persons. Mental anxiety frequently banishes 
sleep, but when the body is worn out, sleep comes and relieves the sufferer. 
Violent passions, though for a time dispelling sleep, ultimately bring it on in 
the same way through bodily exhaustion. 

To procure sleep, especially of a sound and refreshing kind, is often of the 
very highest importance. If any one is about to undergo severe mental or 
bodily exertion, a good sound sleep is of even greater importance than a good 
meal. Indeed, sleep is of essential importance to enable all to perform their 
allotted tasks, and so a few words on the best means for procuring sleep may 
be of value. 

Dyspeptics are seldom sound sleepers, and in many cases the first thing to 
be done is to get the digestion in good order. This little fact shows the im- 
portance of dealing with every case- on its own merits, and not by mere routine. 
Thus, we have known an individual who passed sleepless or worse than sleep- 
less nights, and was troubled with evil dreams and nightmare as soon as his 
eyes were closed, have chloral administered. As a consequence, the dreams 
and nightmare were worse than ever, but a blue pill and a black draught speed- 
ily secured sound and refreshing sleep. Constipation and interference with 
the functions of the liver are serious enemies to satisfactory repose. 

To many, a due amount of exercise in the open air is absolutely indispensable ■ 
if sleep is to be procured, and it is often observed that a buffeting with the 



SLO 721 SMA 

wind causes sleep sooner than any other form of exertion. The diet too must 
be attended to, if sleep is to be refreshing ; here every man must be a law to 
himself, for what sometimes soothes and comforts one man may excite another, 
and altogether prevent sleep. There is, however, one great rule, and that is, 
never to go to sleep with an undigested meal in the stomach, if it be at all a 
heavy one. To this end many do better by making their chief meal early in 
the day, and only taking a light meal in the evening. Tea and coffee taken 
late in the day are particularly prejudicial to the interests of sleep. The in- 
fluence of these, however, differs in different individuals : to some tea is more 
stimulating than coffee ; to others the reverse is the case. 

Going to bed at a certain regular hour, be that what it may, is powerfully 
conducive to sleep ; habit here, as in other things, becomes all-powerful. It 
is, too, advisable to have thoroughly done with the work of the day some time 
before going to bed. If that work has been of a bodily description, the rest 
will often be enough of itself; if it has been head-work, a change is often 
best. For many individuals there is no preparation for sleep equal to a pipe 
and a novel ; to others this would be poison. 

For refreshing sleep, it is essential that the bedroom be well ventilated, and 
many who make it a regular practice to sleep with the windows open find it 
of great value. Undoubtedly the refreshing nature of the sleep is enhanced 
by fresh air. Then, too, the bed should be in the middle of the room, and not 
in' a corner of it ; no curtain of any kind should surround it. Feather beds are 
an abomination ; a good firm mattress is best. The pillows should be adjusted 
to the height of the shoulders, so that when one lies in the natural position on 
one side, the head is in a line with the rest of the body; the neck straight, 
not to be bent either upwards or downwards. 

To many a " night-cap " is essential, be it a glass of wine, a drink of ale, 
or a tumbler of grog. If indulged in with discretion, there is nothing to be 
said against the practice, except this, — sliould the individual be so situated as 
to have to go without his accustomed stimulant, he will most probably pass a 
sleepless night. 

The great thing, in most cases, to procure sleep is to obtain absolute rest of 
mind. To men of active brain, this is sometimes singularly difficult, and many 
plans have been proposed to overcome the difficulty. They all consist in this, 
in attending to something of absolutely no interest, and which is of a dull, uni- 
form nature. 

Of course all these things fail, especially in the presence of pain, and then 
more powerful means must be tried. Chief among these are opium, morphia, 
and chloral hydrate, but this we do say, that no man ought to take either or 
any of these on his own responsibility, for thereby habits are readily acquired 
which may be hard or even impossible to get rid of. If ordinary means and 
ordinary remedies do not suffice, the sufferer ought to consult some one of skill, 
in whom he has full confidence ; that is important. 

Slough. The dead part of the tissue of the body which is separated and 
thrown off by the healthy part after inflammation. It often becomes necessary, 
when this process is taking place, to assist nature by removing this source of 
annoyance, and to prevent the foul odor that arises from it by the use of dis- 
infectant lotions, such as weak solutions of Condy's fluid or carbolic acid. 

Small-pox, or Variola, is a febrile, eruptive, and contagious disorder, 
which in past times raged with much violence in this country, but in recent 
periods has been vastly controlled by the discovery of vaccination. 

History : About its origin not much is known ; the earliest records mention 



SMA 722 SMA 

a disease which was probably smallpox as far back as the sixth century ; 
siuce then it has appeared with more or less virulence at various periods. 

Varieties: The most common varieties are the discrete, in which the pus- 
tules are distinct ; the confluent, in which the pustules run together ; the 
malignant, which is often associated with purpura and an eruption resembling 
measles — a very dangerous form ; the modified, which comes on in those 
partially protected by vaccination, and a kind that runs a very mild course. 
In cases of small-pox there is : (1.) The stage of incubation, which lasts twelve 
days from the date of receiving the poison. (2.) The stage of eruptive fever 
and invasion, lasting forty-eight hours. (3.) The stage of maturation, wherein 
the rash is fully developed, lasting about nine days. (4.) The stage of sec- 
ondary fever or decline, lasting a variable time, according to the severity of 
the disease. Discrete small-pox is the simplest form of the disease, and is 
rarely attended with danger to human life ; confluent small-pox destroys the 
greatest number of lives, and may prove fatal to as many as 50 per cent. In 
the distinct or discrete form the primary fever is less intense than in the con- 
fluent form ; in the latter, there is often delirium, and more especially in those 
who are intemperate, such as draymen, potmen, tailors, compositors, etc. The 
malignant variety is terribly fatal ; the blood seems profoundly poisoned from 
the first, and is more fluid than usual ; bleeding from the mouth, nose, and 
bowels is not uncommon ; in women, there is also bleeding from the womb, 
and if they are pregnant, abortion will ensue. In modified small-pox, the 
patient is often able to go about the whole time, and the rash may suddenly 
decline on the fourth or fifth day, and recovery follow. 

Symptoms: The disease begins with shivering or rigors, pain in the back, 
vomiting, thirst, headache, and a general feeling of indisposition ; in children, 
convulsions may come on. In many cases the rash of small-pox in vaccinated 
cases is preceded by a more or less scarlet or roseolous rash which is mottled 
over the body. If the finger be pressed on the forehead, a shotty feeling may 
be noticed, for the rash of small-pox generally commences there ; at first a 
pimple forms, but afterwards a pustule, and then it dries and scabs over, and 
leaves a pit or depression behind. When the rash comes out, the temperature 
falls, but rises again about the eighth or ninth day ; in mild cases, however, this 
secondary fever is hardly perceptible. The eruption usually appears first ou 
the forehead, face, and wrists, and then on the rest of the body, coming out on 
the legs and feet about two days later. The eruption takes about eight days to 
arrive at its full development; during this time there is much swelling of the 
face and eyelids, so that the patient cannot see for a few days ; in bad conflu- 
ent cases, the face seems covered with a mask, and a disagreeable odor pro- 
ceeds from the body. Boils are apt to form in cases of confluent small-pox; 
the patient is also subject to pleurisy, pneumonia, and bronchitis ; sometimes 
the tongue is much swollen and dry, and the patient may be unable to close the 
mouth or to speak ; this is a very bad symptom. Inflammation of the ear, fol- 
lowed by an abscess, is not uncommon in this disorder, and erysipelas, gan- 
grene, and pyaemia are now and then met with. Inflammation of the eye and 
ulceration of the cornea may add to the general mischief. For a pustule to form 
on the eye is very rare, but it is common to see one in the soft or hard palate. 
Small-pox may be mistaken for measles, but in the latter disease there is run- 
ning at the eyes and nose and sneezing, and the rash comes out about the fourth 
day ; it may be mistaken for chicken-pox, but in this disease there is little or 
no fever, the rash comes out in twenty-four hours, is vesicular and not shotty, 
more abundant on the trunk, and not so much on the face and forehead. 




PLATE XXV. 



SME 725 SNA 

Mortality : The death-rate of confluent small-pox is 50 per cent., and of dis- 
tinct small-pox four per cent. Confluent small-pox is very rare in those who 
are vaccinated. Age has an influence on the disease, for it is most fatal in chil- 
dren and old people, but least fatal between 10 and 15 years of age. Small- 
pox is decidedly an infectious and contagious disorder: riding in a cab or om- 
nibus in which a patient has been recently, or even passing one in the street, 
will give the disease ; a mild case may give rise to a severe one, and vice versa. 
It may attack an individual a second time, but this is a very rare occurrence. 

Treatment : There is no medicine which can check this disorder. The 
patient should be at once isolated, and it is best, when an epidemic is about, 
that small hospitals should be built away from other dwellings, where these 
cases can be treated and the spread of the disorder diminished. For diet, they 
may have milk, tea, gruel and beef-tea, chicken-broth, and, in fact, the treatment 
which has been laid down for fevers generally. There should be great pains 
taken to ventilate the room without having too much draught, and keeping 
it at a temperature of 60°. Great cleanliness must be observed, and all linen, 
clothes, etc., must be disinfected after being used. Bed-curtains, carpets, and 
hangings of any kind must be dispensed with. Flour, starch, or hair powder 
may be abundantly peppered over the face and body to relieve the itching and 
discomfort, and to absorb any acrid discharge. It is doubtful if any good will 
arise from using anything to prevent pitting; gutta percha in chloroform does 
no good, but if the face be washed over in the early stage with nitrate of silver 
it may lessen the marking ; olive oil, cold cream, and glycerine and water will 
relieve the patient when they are locally applied. After recovery, the stains 
are shallow and of a brownish color, becoming paler after a few months. 

In the article on Vaccination, the subject of the prevention of small-pox is 
very fully entered into, and therefore need not be repeated here ; that arti- 
cle should be read with this one, if the reader is anxious to understand tho 
relations of the two disorders. 

The number of deaths from small-pox in a year varies very much, according 
to the prevalence of the epidemic. 

For information with regard to disinfection, etc., see Sanitary Regu- 
lations. 

Smell. This is a special function of the olfactory -nerves, which are two 
in number, and are distributed over the lining membrane of the nose. 

Smoking. See Tobacco. 

Snakes, Bites of. In warm countries the number of venomous snakes 
is large, and the poison they secrete much more active and greater in quantity 
than in cooler climes. The more rapidly the symptoms of poison appear after 
the bite of a snake, the more dangerous they are likely to be. The two fangs 
of the reptile commonly enter and produce two minute wounds, from which 
only one or two drops of blood may at first issue. A smarting, severe, burn- 
ing pain is immediately perceived, 'the part begins to swell, and a puffiriess 
almost to the bursting of the skin spreads in a short time over the whole limb. 
There is fever, often with delirium, small pulse, pain in the region of the 
heart, and convulsions. These symptoms arc attended with a feeling of anx- 
iety and lassitude, laborious respiration, thirst, nausea, vomiting, and syncope. 
Death from the bite of a viper has been known to occur in thirty-six hours. 
If the individual survive the first effects, the wounded part may become livid 
and gangrenous, and he may sink under the irritative fever set up. Accord- 
ing to Fontaine, out of more than sixty cases of viper bites only two were 
fatal, and in one of these gangrene commenced in the wound in three days, 



SNE 726 SOA 

and the person died in twentj^ days. In one instance a woman aged sixty-four 
died in thirty-six hours, after being bitten on the thigh by a viper. Such seri- 
ous effects from the bite of a common snake are. however, very uncommon ; 
with the exception of slight local and general irritation, it is rare to hear of 
any ill effects following the bite of a common viper. Not so with the more 
formidable snakes of other countries. In India and the East great numbers 
of persons annually lose their lives through the bites of poisonous snakes. 
The rattle-snake in America, the cobra di capello in India, and other smaller 
venomous reptiles, are well known and dreaded. 

The treatment in case of a bite from a poisonous snake should first be the 
application of a ligature between the part bitten and the heart, or of a cupping 
glass, in order to prevent absorption. The wound should be enlarged and well 
washed. If absorption has taken j)lace, and the limb is swollen, the whole of 
the skin may be smeared with oil, and attention directed to the constitutional 
symptoms. Brandy and ammonia should be given to prevent depression. 
Strong acetic acid, which coagulates the poison, may be applied, when the 
person is seen soon after the accident. There is no known antidote to the 
poison of the cobra. The serpent charmers of the East appear to secure them- 
selves from injury by extracting the poison bags under the fangs, or by caus- 
ing the snake to exhaust itself by biting other animals, before handling it. 

Sneezing is a convulsive action of the respiratory muscles, caused by irrita- 
tion of some part of the lining membrane of the nostrils, either by the presence 
of some particles of matter, such as dust or snuff, or owing to the congestion of 
the membrane induced by what is called a cold in the head. 

Snuif is usually composed of dried and powdered tobacco, but many herbs 
are used in the same way, and are sold under the name of cephalic snuffs, for 
headaches and the like. A pinch of snuff may sometimes be useful in reliev- 
ing the irritation of the lining membrane of the nose and head by sneezing, 
but when taken to excess snuff is extremely injurious. 

Soap, as used in medicine, is of two kinds, hard and soft ; both are made 
from olive oil, but into hard soap soda enters as an ingredient, into soft soap 
potash. Olive oil consists mainly of two substances, olein and palmetin ; these 
being made up of oleic acid and palmetic acid combined with glycerine. If now 
to either of these an alkali be added, what is called saponification takes place ; 
the acids combine with the alkalies, and glycerine is set free. The substance 
is no longer a fat ; it is a soap. Hard soap is grayish-white in color, but that 
commonly used, called Castile soap, is veined and marbled. Soft soap, again, 
is a semi-fluid mass resembling honey. It is yellow and semi-transparent, often 
showing white points where crystals have begun to form. These soaps ought 
to be well neutralized by the alkali, so as to have no greasiness about them. 

Hard soap is employed in making soap cerate plaster and soap plaster, and 
in the preparation of a useful liniment commonly known as opodeldoc. This 
liniment contains hard soap, camphor, oil of rosemary, spirit, and water. Soft 
soap is used in turpentine liniment. The intention of the soap in this, and its 
addition to many other liniments, is to enable the part to which it is to be 
applied to be well rubbed without suffering from the results of friction on the 
skin. In these cases it is the rubbing which does the good, not the liniment. 

Hard soap is often used for a ba^is for pill-making, but the other ingredients 
ought to be carefully selected. Thus, some substances, as resins of a purga- 
tive kiud, are best given with an alkali ; substances of an acid nature, again, 
should not be given with soap. Soap and water is a favorite enema with some 
practitioners, but the soap in that case is nearly useless ; it is the mechanical 



SOD 727 SOD 

result of the water which produces the desired motion, ouly the soap may 
soften the parts concerned. 

Soda, as an alkali, is used as liquor sodaa, that is, solution of caustic soda. 
This is made by heating carbonate of soda with slaked lime, when caustic soda 
is set free.. This liquid is colorless, and has an intensely burning taste. The 
solution, when evaporated to dryness, constitutes caustic soda or hydrate of 
soda. The solution is powerfully alkaline, and might be used in a good many 
cases instead of liquor potassse, but this last substance seems to be preferred 
for internal use. The caustic soda in a solid form may be used in the same 
way as caustic potass for destroying the edges of ulcjrs, etc. It does not melt 
so readily, and so is not apt to run on to places where it is not desired, but it 
is not so much used as the other. 

Carbonate of soda, or washing soda, is of great importance economically, 
not much medically, save for cleanliness. It is now made from common salt, 
but used to be made from sea-weed ashes. It occurs in large irregularly crys- 
talline masses, which, when dried, yield up their water of crystallization and 
fall into powder. This is dried carbonate of soda. Neither is often used 
internally. The soda salt, mainly used for its alkalinity, is the 

Bicarbonate of soda, which occurs only in powder. It is only slightly alka- 
line, and is not at all caustic. The preparations are an effervescing solution 
— medicinal soda-water — and a lozenge. Ordinary soda-water contains no 
soda, only carbonic acid ; if it is desired to have soda in it, the specially pre- 
pared soda-water must be used. Bicarbonate of soda is much used as an 
antacid, and to render other substances alkaline. It sits better on the stomach 
than bicarbonate of potash. It does not act so much on the kidneys, and is 
not given in acute rheumatism. For ordinary antacid purposes, especially to 
idlay heart-burn, it is more used than the potash salt. The dose of bicarbo- 
nate of soda is from five to thirty grains, but more may be given, though sel- 
dom necessary. 

Sulphate of soda, better known as Glauber's salt, is a substance which un- 
deservedly has fallen out of repute. It is a waste process in making hydro- 
chloric acid ; it is also found abundantly in certain mineral waters, as well as in 
sea-water. The salt occurs, when pure, in prisms, and is colorless, transpar- 
ent, and neutral. Its taste is exceedingly bitter, and given internally acts as a 
purgative, producing copious watery motions. It is the most important pur- 
gative constituent of many mineral waters. It may be given in doses of two 
drachms to half an ounce. It is best given mixed with some other purgative. 

Acetate of soda is used only in the preparation of arseniate and phosphate 
of iron. By itself it is hardly ever used, acetate of potash taking its place. 

Sulphite of soda is much more important, not for its soda, but for its sul- 
phurous acid. In making it, sulphurous acid is passed through carbonate of 
soda to saturation. It exists in prisms which have a slight odor of sulphurous 
acid, readily soluble in water. It is given internally in the same cases as sul- 
phurous acid, especially to arrest vegetable growth in the form of sarcinse, 
etc. Externally it may be used as a lotion, where the acid would not be 
desirable. The dose is twenty grains to a drachm. 

Hyposulphite of soda is frequently employed in the same way as the sul- 
phite, but in the Pharmacopoeia it is introduced only for analytic purposes. 
It occurs in crystals readily soluble in water. Sometimes it is used as a 
mouth-wash. 

Nitrate of soda is a very deliquescent salt, and so cannot be made use of 
for gunpowder. It is used only in making arseniate of soda. 



SOD 728 SOR 

Phosphnte of soda, or tasteless purging salt, is got by adding to a solution of 
bone earth in sulphuric acid, carbonate of soda to neutralization, or more. The 
salt then formed appears in fine large crystals of a saline taste. In good large 
doses it purges, and, having no disagreeable taste, is very useful for children 
and delicate persons. It requires to be given in doses of half an ounce or so. 
It is best given in soup or broth, in which it is as nearly as possible tasteless. 
In smaller doses it acts on the kidneys, but is not much used this way. The 
dose is twenty or thirty grains. 

Chlorinated soda owes its efficacy not to the soda it contains, but to the 
chlorine. It is a bleaching solution constituted in the same way as bleaching 
powder, and is used for similar purposes. It is alkaline in reaction, and is 
sometimes made into a poultice. Internally, it has been given to get rid of 
fetid sloughs in the alimentary tract, but is better used as a gargle, as in ulcer- 
ated mouths and sore throats. Externally, it may be used, much diluted, as 
a wash to fetid sores. It is not much given internally. The dose is ten or 
twenty drops, freely diluted. 

Chloride of sodium, or common salt, is more important as a food than a 
medicine. If not used, ill-health follows, the bowels get disordered, aud worms 
form. In large doses it is emetic, and it may even give rise to dangerous con- 
sequences. It is chiefly used as an emetic in cases of poisoning where no 
other remedy is at hand. Two or three tablespoonfuls may be given well 
stirred about in lukewarm water, followed by copious draughts of the same. 
Warm salt-water baths are frequently useful in chronic rheumatic pains. See 
Salt. 

Citro-tartarate of soda is a salt in many respects similar to Rochelle salt, 
whicli contains tartaric acid only. It is this substance, in the granulated form, 
which is commonly called citrate of magnesia. If well prepared and well kept, 
it constitutes a good laxative and sits well on the stomach. If not kept in 
carefully-stoppered bottles, the carbonic acid is gradually given off, and it will 
not effervesce. The dose is about a drachm or two drachms. See Rochelle 
Salt. 

Soda-water, a well-known effervescing beverage, containing properly a 
weak solution of bicarbonate of soda with carbonic acid gas, which is pumped 
in till the water is well charged with it. It is then bottled, tightly corked, and 
wired. In many cases of fever and thirst this is a very pleasant and grateful 
beverage, and when mixed with a little brandy or wine it forms an exhilarating 
draught in periods of exhaustion and depression, often being preferable to 
champagne, as it contains no sugar. 

Softening. This is a term generally applied to a disease of the brain, in 
which the tissue is more or less altered in consistence. See Cerebral 
Softening. 

Sore-throat. This is a common symptom in many diseases. (1.) It may 
accompany an attack of scarlet fever, when there will also be the usual rash 
on the second day. (See Scarlet Fever.) (2.) It may come on with an 
attack of diphtheria, in which case there will be an ashy gray membrane on 
the fauces and back part of the mouth, without much swelling. (See Diph- 
theria.) (3.) It may come on in the course of a common cold, and be 
slightly relaxed, or the throat may be inflamed, and quinsy produced. The 
best plan is to wrap some warm flannel round the throat, inhale steam by 
putting the mouth over a jug of boiling water ; keep in bed or in a warm room, 
so as not to breathe in a cold atmosphere, and have something warm at bed- 
time, so as to encourage a good perspiration. (See Quinsy.) (4.) Relaxing 



SPA 729 SPE 

and damp weather, or living badly and working hard, will in some people pro- 
duce a relaxed condition of throat. For this two or three glasses of good port 
wine and swabbing the throat with a solution of tannin and glycerine, or 
tincture of steel and glycerine, is the best remedy. (5.) Sore-throat is com- 
mon with costermongers, and those who have to be exposed to all kinds of 
weathers: they should be treated as if they had quinsy. (6.) Sore-throat now 
and then comes on in clergymen, but it is very doubtful if it is caused by 
speaking too much. It is chiefly found among curates and the younger clergy. 
Cold bathing, out-door exercise, and tonics, with regular living, will generally 
cure the case. They are generally at the time pale, thin, and out of health. 
(7.) Sore-throat is common in those who have had syphilis, and in them there 
is no swelling of the part, but generally ulceration of the tonsils. These 
ulcers have a grayish surface, are generally symmetrical, and have a rounded 
outline ; there may be also other general symptoms of the disorder, but those 
who have once had a bad throat are very liable to another slight attack on 
taking cold. Iodide of potassium and mercury form the best remedy, while 
the throat should be brushed over with some astringent solution. 

Spanish Fly. See Cantharides. 

Spasm means the violent and uncontrollable action of some particular set 
of muscles. Spasms are generally described as of two sorts, namely, tonic and 
clonic. In tonic spasms the muscles of a part contract violently, and remain 
rigid and immovable by the will of the patient for a greater or less length of 
time. Such contractions occur in tetanus and in ordinary cramp. Clonic 
spasms, again, consist in sudden contractions and relaxations regularly alter- 
nating. The jumping of the legs and arms, which occurs under certain condi- 
tions, is an example of this. 

Spasms, again, in the ordinary sense of the word as used by the vulgar, 
mean gripes, and commonly depend on indigestion and constipation. In most 
cases they are best relieved by a purgative containing a good deal of stimulant 
substance, such as the essential oils. In children the so-called spasms depend 
almost invariably on imperfect digestion of food, which ferments in the bowels, 
and so gives rise to diarrhoea and gripes. To do any permanent good in these 
cases it is necessary completely to reform the diet, as they are most commonly 
due to giving starchy food too early, or to the milk given turning sour. Lime- 
water given along with the milk is a good thing. One particular form of 
spasm, called trismus nascentium, is very fatal to children when newly born. 
It seems due to a foul atmosphere. 

Spasm of Glottis. See Laryngismus Stridulus. 

Spearmint, which grows naturally in marshy places in this country, is only 
officinal in the form of oil. This oil is colorless, or pale yellow, and is dis- 
tilled from the fresh herb. There is an officinal preparation of it, namely, 
spearmint-water, which may be used as a vehicle for other remedies. The oil 
is stimulant and carminative, and is given along with purgatives, to prevent 
them from griping. The dose of the oil is about one or two drops. 

Speculum. The real meaning of this word is a mirror or looking-glass. 
In surgery it is an instrument which is used for widening the natural passages 
and discovering the nature of disease which cannot be seen by the naked eye. 
It is chiefly used in cases of disease of the uterus. 

Speech, as the main means of communicating our ideas, one to another 
must be looked upon as one of the most important of human faculties. The 
same faculty is possessed by some of the lower animals, especially parrots, but 
iu them it is merely imitative. The mechanism of speech is peculiar, — not 



SPE 730 SPE 

confined to any one organ, though mainly depending on movements in those 
situated at the upper part of the windpipe, called the larynx. Iu it are situ- 
ated two bodies, which unite the properties of cords and membraues. These 
move from before backwards, and can be so adjusted by direct and indirect 
action of muscles that almost any part of them may be permitted to vibrate, or 
certain parts only. The cords commonly called the vocal cords are set in 
motion by means of air ejected from the lung, and according as a greater or 
less extent of each cord is allowed to vibrate, so a grave or a shrill note is 
produced. But this, though the origin of voice, is only a small part of speech ; 
most animals possess power of emitting sound so originating, but entirely want 
the faculty of speech. After the sound is produced by the vocal cord it has to 
be modulated in the upper portion of the throat and mouth, some sounds being 
produced in the throat, some by the tongue, some by the teeth, and some 
by the lips, the ultimate product being articulate speech. But speech also 
implies a language, if ideas are to be communicated, and here enters a totally 
new element. 

It has been noted that in certain forms of brain disease the faculty of speech 
is lost. Sometimes this would seem to be due to a want of articulating power, 
but in others it is a real want of language." This is known as aphasia, and is 
commonly associated with disease of one particular portion of the brain, and 
paralysis of one side. The individual is capable apparently of forming ideas. 
but he cannot express them either by reading or writing. In some cases he 
will have only a single sentence to express every idea and emotion ; sometimes 
only a single word, which word, in varying tones, is the only means the un- 
happy patient possesses of communicating with the outer world. As far as the 
organ of voice is concerned, that is as perfect as ever ; but the faculty of lan- 
guage is gone, and to articulate speech is impossible. 

Some forms of language cannot be spoken. Thus the emblematic language 
of the ancient Egyptians and Mexicans, commonly called hieroglyphics, that 
is, sacred carvings, was of this kind, whilst many savage languages are in an 
unwritten state. In this way we sec that the faculty of speech is something 
very complex. Into its idea both the function of voice and the power of fram- 
ing a language which shall contain a sufficient number of symbols to indicate 
daily wants may enter. The part of the brain where the faculty of language 
seems to be centre! is commonly assumed to be the left posterior frontal con- 
volution. Injury or disease of this part gives rise in most cases to the condi- 
tion spoken of as aphasia; but any injury or disease which may intervene be- 
tween this spot and the motor nerve centres which control the motions of the 
organ of voice may also interfere with the communication of the ideas, else- 
where framed, and commonly conveyed through speech. In this case, how- 
ever, the individual would be able, if originally educated, to communicate his 
ideas in writing, which an aphasic individual cannot. There seems to be still 
another form of loss of speech, where the individual forgets words and letters 
necessary to communicate ideas. This is commonly spoken of as amnesia, 
whilst loss of the power of written language is called agraphia. These dif- 
ferent faculties have yet to be studied carefully ; but the knowledge we now 
possess enables us to understand the comjdexity and difficulty of the subject. 

Spermaceti, which is a nearly pure form of a fat called cetine, is obtained 
from the head of the sperm whale. The head of this animal is of enormous 
size, and in cavities in its upper jaw is lodged this substance, mixed with oil. 
When it cools the spermaceti crystallizes, and the oil is poured off. It occurs 
n white crystalline masses, and has little odor or taste. It consists of palmetic 



SPI 731 SPI 

acid combined, not with glycerine, but a substance named ethal. Its only 
preparation is the well-known spermaceti ointment, consisting of spermaceti, 
white wax, and almond oil, This is largely used as an emollient, and applied 
to coverings of various kinds to keep them from adhering to sores. Sper- 
maceti is also contained in the blistering paper of the Pharmacopoeia. 

Spigelia, the root of the Spigelia Marilandica, or Carolina pink, a native 
of North America, is no longer officinal. The root consists of a kind of head, 
whence are given off many rootlets of a brown color. It contains some oily 
and bitter matter, and used to be much employed for destroying worms. It is 
still used for that purpose in the United States. In large doses it purges con- 
siderably, and sometimes produces peculiar effects of a narcotic kind. Usually 
this substance is combined with a purgative when administered, which is best 
in the form of infusion. The dose is from a drachm to two drachms. 

Spina Bifida. This is a congenital swelling situated over some part of 
the spine. Jts most frequent seat is in the region of the loins, but it is occa- 
sionally met with at the back of the neck, and less frequently on the back. It 
is due to arrested growth of the posterior arches of one or more vertebral 
bones ; the membranes which loosely envelop the spinal cord become distended 
with fluid, and are bulged out through the tissues in the walls of the canal, 
and form under the skin a soft and rounded tumor. When the malformation 
affects several of the vertebral bones the base of this tumor is broad, but when 
only one or two of the arches are deficient, or merely fissured, there is more or 
less of a pedicle or stalk. The size, conformation, and appearance of the 
tumor, and the symptoms caused by the malformation, differ very much in dif- 
ferent cases. The state of things is usually as follows : in the lumbar region, 
just above the sacrum, and in the middle line of the back, is a large fluctuat- 
ing and rounded tumor, evidently containing fluid, and the surface of which is 
covered by thin and distended skin. At the base of this tumor a fissure, or 
large hole, can generally be felt in the posterior part of the spinal column. 
When the child is placed upon its belly the tumor shrinks to a slight extent, 
and the skin becomes flaccid ; in the erect position of the child the tumor 
swells and the skin becomes stretched and smooth. As the child grows, seri- 
ous nervous symptoms, such as convulsions and palsy of the lower extremities, 
make their appearance. In most cases spina bifida terminates fatally, and the 
patient dies in convulsions, which in some instances are immediately preceded 
by giving way of the walls of the tumor. The affection, however, does not 
always cause death ; several cases have been recorded in which the patient at- 
tained an advanced age without suffering any ill effects from the tumor, which 
continued to grow, though not out of proportion to the rest of the body. A 
more favorable and occasional termination of cases of this kind is a closure, 
through adhesive inflammation, of the walls of the orifice between the spinal 
canal and the tumor. A closed and comparatively harmless cyst is thus 
formed, which is called a false spina bifida. The walls of the tumor formed 
in cases of spina bifida are composed of the skin and extended membranes of 
the cord, and sometimes a portion of the cord itself spreads out into a thin 
membrane. The contents of the tumor are a thin clear fluid, a portion of the 
cord, and some of the spinal nerves. 

In consequence of the close connection between the tumor in spina bifida 
and the contents of the spinal canal, all surgical attempts at a radical cure of 
this affection are extremely hazardous. The too frequent result of such inter- 
ference is acute inflammation of the cord and its membranes, causing convul- 
sions, palsy, and finally death. 



SPI 732 SPL 

In cases, however, where the tumor is increasing very rapidly, and is attended 
with severe symptoms of nervous irritation, which, if allowed to persist, would 
most certainly prove fatal, the surgeon generally feels disposed to give relief 
by puncturing the distended skin with a fine needle, so as to allow the fluid 
contained in the sac to flow away in drops. This proceeding has in some in- 
stances been attended with success. When the tumor grows slowly, and whilst 
the child remains in good health and free from acute nervous symptoms, the 
treatment should be limited to affording mechanical support by means of a 
bag-truss, air-pad, elastic bandage, or some suitable contrivance of the like 
kind, and to covering the surface of the tumor every evening with a layer of 
collodion. 

Spinal Cord. This may be looked upon as a prolongation of the brain 
downwards. It lies within the spinal column in the vertebral canal safe from 
any external violence, unless the injury be very severe. It sends off on each 
side numerous nerves which supply every part of the body. Like the brain, 
it is covered by three membranes, and it consists of two portions, a gray mat- 
ter, where various nerve-cells are met with, and a white portion, which is 
formed of nerve-fibres, which convey motion and sensation. Any injury to 
the cord will cause more or less loss of motion and sensation in the parts be- 
low, and then paraplegia is said to occur. The cord is liable to inflammation, 
and the patient is said to have myelitis ; to chronic degeneration, causing pro- 
gressive locomotor ataxy ; to cancerous and other tumors, causing paraplegia ; 
to destruction, through fracture or dislocation of the vertebrae surrounding it ; 
to concussion, as in a railway accident ; and to inflammation of its membranes, 
or spinal meningitis. See Paraplegia and Progressive Locomotor 
Ataxy. 

Spinal Meningitis is a technical name for inflammation of the membranes 
of the spinal cord. 

Spine. The spine, or spinal column, is composed of a number of strong 
pieces of bone called vertebra; ; they are twenty-four in number, and are divided 
into the cervical, dorsal, and lumbar vertebra?. Each piece is provided with a 
central hole or cavity, and when one fits over the other a long canal is formed 
with bony walls, in which the spinal cord can lie with safety under ordinary 
conditions, and is preserved from harm. The spine, like other bones, is liable 
at times to fracture and dislocation, and such accidents are dangerous in propor- 
tion to the injury done to the delicate cord within. 

Spirits. See Alcohoe. 

Spleen. This is an organ which lies on the left side of the abdominal 
cavity. It is connected with the lymphatic system, and plays an important 
part in the formation of the blood ; nothing certain, however, is yet known 
about its functions. It is much enlarged in some cases of leucocythremia and 
in ague ; in the latter disease it is called the ague-cake. It is liable also to 
waxy degeneration. See Degeneration. 

Splints. In cases where fracture or severe sprain necessitates the keeping 
of a limb or member in absolute rest, wooden or metal " splints " are requisite, 
and in the present article such appliances will be treated somewhat in detail, 
both as regards their form and uses. In the article on Accidents, a rough-and- 
ready method of maintaining rest and extension is described, such as improvised 
splints, made with walking sticks, band-boxes, newspapers, etc., but wheu 
proper materials are at hand, it will be much to the comfort of the patient if 
they be employed. "Whatever material splints are made of, it is of the greatest 
importance that they be well padded, and such paddings may be made of cotton 



SPL. 733 SPL 

wool, tow, strips of old blankets, lint, or soft linen. They should be maintained 
in position by strapping, bandages, or fillets, that is, broad tapes secured by 
buckles. The test of a fracture being in proper position, or of a sprained limb 
being in the best position of rest, is the feeling of ease on the part of the pa- 
tient. In applying the retaining materials, care of course must be taken to 
make them firm, but not tight. 

Fractures and severe sprains, moreover, may be treated by the application 
of " splints " which are applied in a plastic condition, allowing of their subse- 
quent setting firm, thus : pasteboard or gutta percha, softened iu boiling water, 
and accurately moulded to the limb ; these should be lined with wash-leather, 
and perforated with a gun-punch in several places to allow of the escape of 
perspiration. Again, a solid casing can be made with gum, starch, or dextrine, 
or plaster of Paris ; an ordinary flannel bandage being first applied, a jean 
roller bandage is to be evenly put on, and its surface thoroughly smeared with 
these materials in solution during adaptation. Stiff shoe-leather soaked in 
boiling water is an excellent material. As these bandages or " splints " set 
very quickly and very hard, it is well to guard against cedema or swelling of 
the limb, so that before the application of the solidifying material a tape must 
be laid lengthwise on the limb, with its ends projecting above and below tho 
bandage ; then, if the apparatus require removal, a pair of stout scissors or 
shears can be insinuated between it and the skin and thus avoid wounding the 
flesh.- Splints may also be made of perforated sheet iron, zinc, tin, or wire 
gauze, etc. 

Special Splints for the Upper Extremity. Angled Splints. These consist of 
some light material, generally perforated metal, having a movable joint, the 
various positions in which it can be fixed being obtained by an arrangement of 
slots and screws, such splints being necessary in fractures of the bones entering 
into the conformation of the elbow-joint, or after operations, such as resection, 
or the removal of dead bone or tumors. 

The Pistol-shaped Splint is used for fracture of the lower end of the radius 
(Colles' fracture), and consists of a piece of boai'd, cut straight at first, and 
then bent downwards in its own plane, being made of a suitable breadth to fit 
the fore-arm and hand, being in form somewhat like a pistol, its object being to 
fix the arm in such a position that the hand is bent towards the ulnar side. 
Gordon's Splint for this fracture is sometimes used, and consists of an anterior 
and posterior splint, having on the outside of the front splint a rounded, 
tapering, projecting margin, the posterior splint tapering towards the hand. 

Special Splints for the Lower Extremity. Liston's Splint. This consists of 
a narrow deal board, having at its upper end two holes, through which a band 
passes, for the purpose of gaining extension from the perinaeum, and at its 
lower extremity two deep notches, through which pass the turns of the band- 
age which bind it to the limb (foot), witli a hollow on its side for the outer 
ankle ; its length should be from just below the axilla to four or five inches be- 
low the foot. Its use is for fractures of the thigh-bone. Its method of appli- 
cation is as follows : The splint must be thoroughly padded with wadding, tow, 
or old blanket, the ankle carefully bandaged, and the perineal band adjusted ; 
then the instep and ankle should be secured by means of the notches at the 
extremity. The requisite extension is made by tightening the perineal band 
through the holes in the upper extremity of tho splint. 

Dr. Smith's Splint " consists of a couple of light iron rods, bent at such an 
angle as to suit the shape of the thigh and leg when slightly flexed. The rods 
are connected together at their lower end, and an interspace is left between 



SPO 734 SPR 

them sufficient to receive the limb. From one rod to the other strips of band- 
age are fastened transversely, side by side, so as to form a trough, fitted to the 
shape of the leg and thigh ; upon this the limb is laid, and then the rods are 
attached to cords, which are suspended from a point ahove the bed, and which 
are regulated by pulleys." This form of splint is remarkably simple, cheap, 
and clean. 

' Mclntyre's Splint is a convenient form of apparatus for fractures of the leg, 
or for use after operations on that limb. It consists of a concave iron splint, 
with x thigh-piece and foot-piece, and a joint at the knee regulated by a screw, 
so that it can be fixed at any angle, and the limb kept perfectly at rest. The 
splint requires to be very carefully padded, as the sharp metal edges are liable 
to cause severe sores unless properly protected. 

Dupuytren's Splint is in shape very like a long Liston's splint, only much 
shorter. It is useful in fractures or injuries of the lower limb, especially 
fractures of the fibula. 

It would be impossible to mention every form of special splint which has 
been devised ; moreover, they have been adverted to and their method of appli- 
cation detailed in the article on Fractures. (See Fracturks.) Suffice it to 
say that the general principles for their manufacture and adjustment, and some 
slight mechanical knowledge, and ordinary common sense, will suggest a con- 
trivance suited to an emergency until medical advice can be obtained. 

Sponge. An organic porous marine substance, in reality the skeleton of a 
motozoon, found in the seas of the southern parts of Europe in large quantities. 
Though now generally used only for purposes of cleanliness, burnt sponge was 
at one time employed largely as a remedy for goitre and other scrofulous 
tumors, its efficacy depending on the large quantity of iodine it contains. The 
subsequent discovery of other sources of iodine set it aside as an article of 
medicine. Sponges require great care and cleanliness if used in surgery, or in 
the cleansing and dressing of wounds and sores. They should be rinsed well 
and dried after each occasion for use, and great care should be taken that the 
same sponge be not used for two patients or for two purposes. On this 
account the use of lint, which can be thrown away after every dressing, seems 
preferable. 

Spongiopiline. This substance is an invention of Mr. Markwick, for 
which he obtained a prize at the London Exhibition. It is intended to be used 
for fomentations and poultices, and consists of a mass of shreds of w r ool and 
sponge, backed by india rubber, so that whilst the thick substance retains the 
moisture and heat, the waterproof back may prevent its escape. It is a very 
useful and cleanly substitute for a more elaborate poultice when such an appli- 
cation is quickly necessary, 

Sprains. Of the Back. These are usually caused by a fall from a height, 
or from a weight coming down suddenly on the neck or shoulders. The 
structures suffering are the fibrous ones generally, such as the muscular fascia, 
tendons, and ligaments. There is considerable swelling in the loins soon after 
the accident, and great pain on any attempt at motion. The inconvenience 
arising from a severe sprain in the back lasts a long time ; so that a person 
may be confined to his bed or sofa for a fortnight, and it may be many weeks 
or even months before he completely loses pain. There may be some transient 
effect produced on the kidneys, and blood may be found mixed with the urine 
for a few days, but rarely any bad effects ensue. The treatment consists in 
giving a mercurial purgative, followed by Dover's powder, poppy fomentation 
to the back, made with an old soft blanket covered with thin oil-silk, and with 



SPR 735 SQU 

dry blankets ; or the part may be covered with thick compresses of cotton wool 
soaked in a solution of tincture of arnica, in the proportion of an ounce to a 
pint, and laying gutta-percha tissue or oil-skin over it. When the person can 
sit up, some stimulating liniment or compound tincture of iodine may be used, 
and a warm plaster applied to the loins. 

Knee. Sprains or ricks of the knee are very common and very painful, set- 
ting up great swelling in the articulation. The treatment of course depends 
upon the severity of the injury. If there be much pain and inflammation, 
apply leeches, hot fomentations, and poultices. In all cases perfect rest, cold 
lotions, lint soaked in tincture of arnica, and well-applied bandages are the 
best methods of curing the results of the accident. The patient must not get 
about too soon. 

Ankle. The lower extremity is the most frequent seat of sprain of all the 
limbs, and particularly the ankle-joint, and the ridiculous fashion of wearing 
high-heeled boots, whereby the base of support for the body is diminished, is a 
frequent cause of the accident. In the slighter sprains of the ankle the liga- 
ments are stretched, or, perhaps, a little lacerated ; but in the severe ones they 
are completely torn. Severe sprains are often mistaken for fractures, and 
should the case be one where, from swelling and pain, there be any doubt, it 
should be treated as a fracture, bearing in mind that proper treatment of frac- 
ture is the best that could be adopted for a sprain. 

Spray. Operations done " under the spray " are those performed by the 
method of Professor Lister, whereby an antiseptic spray is made to envelop 
the site of the operation during its progress, in order to exclude septic ferment 
or germs in the atmosphere from the wound. The hands of the operators 
and the instruments are washed in the antiseptic, and the dressings are satu- 
rated with it. Wounds thus treated heal by first intention. 

Spray Producer. See Fluids, Atomized. 

Squill consists of the bulb of the sea onion (Urginea scllla or Scilla mari- 
tima) sliced and dried. It grows along the shores of the Mediterranean, partly 
in the water. The bulb is pear-shaped, and often of considerable size. It is 
covered with brown scales, overlapping like those of the lily. The outer ones 
are membranous, the inner white and fleshy, these being cut across. Squill is 
commonly seen in small white pieces, consisting of transverse sections of these 
scales. It has a bitter taste and is not easily powdered until well dried ; in 
that state it may easily be converted into powder, but, if allowed, the powder 
speedily absorbs moisture from the atmosphere, so that it becomes a solid, 
adherent mass. Squill seems to owe its efficacy to a resinous substance, which 
is not, however, separated for use. Its preparations are vinegar of squill, 
oxymel of squill, made by mixing squill vinegar with honey, a syrup, and a 
tincture. There is also a compound squill pill, a very useful preparation ; it 
consists of squill, ginger, ammoniacum, hard soap, and treacle. To this a little 
opium may be added. Squill is also contained in the ipecacuanha and squill 
pill. Given internally squill acts mainly, at least in ordinary doses, as an ex- 
pectorant and a diuretic. In larger doses it may produce vomiting and purg- 
ing. It is chiefly given in lung diseases, to favor the secretion of a normal 
mucus and to render the secreted matters less viscid. This kind of secretion is 
mainly seen in advanced cases, so that squill is rarely given in acute cases. In 
these it seems probable that the irritant action, or stimulant action, might 
be a disadvantage, and so foster the malady we desire to cure. Squill is often 
given as a diuretic, but here too rarely by itself. Most frequently it is com- 
bined with mercury and digitalis. Sometimes it seems to be of special benefit 



SQU 736 STA 

in this form in dropsy from heart disease, but seems less likely to be of value 
where the kidneys are affected. The dose of powdered squill is about two 
grains, of the compound pill from five to ten grains, of the tincture twenty 
drops, and of the oxymel half a drachm to a drachm. 

Squint, or, as it is technically called, strabismus, signifies an habitual 
malposition of the eyeball, owing to irregular action of the recti muscles, 
usually the external or internal. Squint is either convergent or divergent, as 
the eye or eyes are directed towards the nose or towards the temple ; the latter 
variety is rare. Squint is either single or doable, as one or both eyes converge 
or diverge ; and it is important to determine which eye is at fault, and to what 
degree, or to what degree both are at fault in the double variety. The causes 
of squint are various. If slight, and first in one eye, then in the other, it is 
most likely due to some intestinal or gastric irritation, such as worms, teeth- 
ing, or a hydrocephalic condition. In almost all confirmed forms of squint in 
children the opththalmoscope shows ill development of the optic nerves. 
Squint may be congenital, but it usually makes its appearance about the third 
or fourth year, and an operation should be proposed as early as possible, so as 
to secure the advantage of binocular vision, and at an early period of educa- 
tion. Before any operation is resorted to for the cure, a careful examination 
with the ophthalmoscope should be made, in order to determine whether there 
be any organic disease of the brain, etc., or whether the movements and posi- 
tion of the eyeball are hindered by the presence of any tumor. In a temporary 
squint the defect may be remedied by removing any gastric or intestinal irrita- 
tion, the administration of tonics, or the use of concave glasses if there be 
extreme myopia. The operation for squint, as now performed, is very simple, 
and requires very simple instruments. The instruments required are a spring 
speculum, a delicate blunt hook, and a pair of fine, blunt-pointed scissors curved 
on the flat. The lids being separated, an assistant draws the eyeball outward 
with a double hook or a pair of fine-toothed forceps ; next, a fold of the con- 
junctiva is pinched up with a pair of forceps, just above the lower edge of the 
tendon of the internal rectus, and it is then nicked. The blunt hook is then 
passed through this opening in the conjunctiva, under the tendon to be 
divided, which is now drawn out, and the operator enabled to pass one blade 
of the scissors along the hook and divide the tendon. Both internal recti 
generally require division, but of course when the inversion is obviously con- 
fined to one eye the faulty one alone is to be operated on. An anaesthetic is 
generally needed in these cases. See Eye. 

Staphyloma. By this term is meant an unnatural protrusion of the 
tunics of the eyeball. 

Staphyloma of the cornea. Of this condition there are two varieties. In 
one the cornea, rendered soft and weak in consequence of a slow inflammatory 
process, yields to the pressure of the clear aqueous fluid collected in the ante- 
rior chamber of the eye, and forms a rounded or conical prominence in front 
of the globe, which presses upon, aud in some cases protrudes between, the 
eyelids. This condition is usually associated with more or less marked corneal 
opacity. In cases where the cornea remains clear the patient complains of im- 
pairment of vision, and is often short-sighted. In the other variety of staphy- 
loma a portion of the cornea has been destroyed by ulceration ; the gap thus 
formed is filled up by portions of protruded iris, which become adherent to its 
margins. The protruded and exposed iris is subsequently thickened by the 
formation of delicate scar tissue on its surface, but still yields to the pressure 
of the aqueous fluid, and forms a projection in front of the globe. The most 



STA 737 STA 

marked instances of this kind of staphyloma may be observed in patients who 
have had an attack of purulent ophthalmia, which has caused sloughing and 
removal of nearly the whole of the cornea. Patients afflicted with the latter 
form of staphyloma usually suffer from frequent attacks of ophthalmia, and of 
pains and inflammation in the displaced iris. Distension of the staphyloma by 
accumulation causes much pain and irritation, which is generally relieved for 
a time by rupture of the protruded membrane. This, however, is always fol- 
lowed by closing of the orifice and re- accumulation of the aqueous humor. 
Sympathetic inflammation often attacks the opposite eye. The palliative 
treatment consists in guarding the eye against possible causes of irritation, and 
in applying the ordinary means of relief during the recurrent attacks of oph- 
thalmia. When there is painful distension of the staphylomatous cornea and 
iris in consequence of a great accumulation of aqueous humor, considerable 
though temporary relief may be effected by making a small puncture into the 
thinnest and most prominent part of the projection. When the opposite eye is 
affected with sympathetic inflammation it becomes necessary to remove a part 
or the whole of the damaged globe. 

Staphyloma of the sclerotic. This term is applied to protrusion of a portion 
of the sclerotic, due either to thinning of the membrane itself, or to thinning 
or rupture of the subjacent tunics — the choroid and retina. This condition 
may be caused by wounds of the sclerotic, blows on the eyeball, or slow 
inflammatory changes, resulting in a loss of firmness and diminished resistance 
in the tunics of the eye. Staphyloma may affect the anterior, lateral, or pos- 
terior portions of the globe of the eye. In cases of anterior or ciliary staphy- 
loma may be perceived one or more bluish, small, and irregular- shaped prom- 
inences, which contrast strongly with the surrounding portions of white and 
smooth sound sclerotic. The cornea and the walls of the anterior chamber 
generally remain healthy. The same changes occur in staphyloma of the lat- 
eral portions of the sclerotic. This affection, which is called equatorial staphy- 
loma, is often associated with much impairment of vision and severe recurrent 
attacks of ophthalmia. Posterior staphyloma generally occurs at that part of 
the sclerotic which corresponds to the optic nerve and yellow spot. This is fre- 
quently a congenital condition, and is the cause of that defect of vision known 
as myopia, or short-sightedness. 

Starch. This substance is found very abundantly in the vegetable king- 
dom. Its presence was at one time thought to be characteristic of plants, but 
it has recently been found in animals. It occurs in the form of irregularly 
shaped granules, which vary in size from ^i^ to ^^^ of an inch in diameter. 
These granules are simple or compound. They vary in size and shape with 
every species of plant, and are insoluble in water, but are easily diffused 
through it. They are thus separated from the insoluble cellulose, amongst 
which they are deposited in plants. In order to separate the starch, the plant 
is bruised or crushed, and put into a vessel of water, when the cellulose sinks, 
and the starch is diffused through the water, which is decanted and set aside till 
the starch has deposited. On being mixed with water, and exposed to a tem- 
perature of 180°, the starch gelatinizes, and mixing with the water thickens it. 
This occurs in the cooking of starch, and lies at the foundation of pudding 
making. Starch is turned blue by iodine, which is the best test of its pres- 
ence. It is composed of carbon, hydrogen, and oxygen, of which carbon 
constitutes one half by weight, and the hydrogen and oxygen are in the pro- 
portion to form water. When starch is taken as an article of diet, the carbon 
is burned in the system in contact with the oxygen of the air, and carbonic 



STA 738 STO 

acid gas is formed and heat given out. Starch is readily converted into glu- 
cose, or grape sugar, by the action of nitrogenous substances, especially the 
salivine of the saliva, and it is in the form of glucose that it enters the blood 
of animals. All starch in food not converted into glucose is waste. Starch is 
therefore less readily convertible into aliment than sugar. 

Starch is abundantly present in all the common forms of vegetable diet ; it 
exists almost in absolute purity in arrowroot, tapioca, and sago. These sub- 
stances are therefore not nutritious or flesh-forming, simply heat-giving to the 
human body. Potatoes and rice can never form the staple food of a vigorous 
people, because they consist chiefly of starch, and contain little or no flesh- 
forming matter. 

During the growth of plants starch is converted into dextrine, gum, and 
sugar ; it also assumes different properties in certain groups of plants : thus it 
exists in an amorphous form in sea-weeds and lichens, and is then called lichen- 
ine ; and there are other varieties, as inuline, found in the elecampane. 

Starch is extensively used in the arts, and in surgery for making stiff band- 
ages, which are put on wet, and dry hard and firm. It is also useful in a finely 
powdered state to dust over a delicate skin after washing, to dry it perfectly 
and prevent chapping. 

Stavesacre is the seed of the Delphinium staphisagria, a plant growing in 
the south of Europe. The seeds have a curious cocked-hat shape, and dark- 
brown color, and are pitted on the surface; they contain an alkaloid called 
delphinia. Stavesacre is no longer officinal. The seeds have considerable ir- 
ritant properties, and give rise to vomiting and purging ; sometimes, also, they 
seem to have some stupefying effects. In ointments the powder has been a 
good deal employed for destroying vermin in the heads of dirty children. In- 
ternally, it has been rarely used. 

Stethoscope. This is a wooden instrument which conducts the sounds in 
the chest to the ear of the listener. It is very useful, and one can hear better 
with it than by placing the ear to the wall of the chest, and it is obviously 
more convenient in many cases. 

Stimulants. This word in medicine means something having power to 
excite the organic action of an animal, or to increase the vital energy of an 
organ. A stimulant may be either local or general, as it is applied to a part 
or taken into the system. 

Stings. See Accidents. 

Stomach. The stomach, from its important functions, controlling the 
whole system of nutrition, merits greater consideration than it is apt to receive 
at the hands of many. Any disease of such an organ implies so much inter- 
ference with all other functions as to preclude, in great measure, their proper 
fulfillment. Even the functions of the brain are intimately dependent on those 
of this organ. Common acute inflammation, such as often affects other organs, 
is rare in the stomach, except when excited by some powerful irritant swal- 
lowed. On the other hand, the slighter form of inflammation, commonly 
called gastric catarrh, is much more common than is supposed, and is, indeed, 
the ordinary form in which the stomach resents ill-treatment: ordinarily, this 
form of malady is reckoned as indigestion merely. See Ixuigestiox. 

The two most important maladies of the stomach are simple and malignant 
ulceration, the latter commonly going by the name of cancer. Cancer of the 
stomach — a painful and intractable malady — commonly affects one or other 
of the orifices of that organ, and of the two by far the most frequently that 
next the bowel called the pylorus. Disease in this region interferes sadly 



STO 739 STO 

ith nutrition, prevents the half-digested food from passing onwards into the 
stric tract, and so starves the patient. As a consequence of this obstruction, 
too, the organ commonly becomes dilated, the food, only half digested, collects 
and putrefies, and so vegetable organisms form in it. After being retained in 
the stomach for a time, giving off foul-smelling gases, the whole contents are 
ejected — a foul -smelling, black-looking mass, often resembling coffee-grounds. 
The pain at these times is severe, but not at others, the great want felt being 
really a want of food." In the simple ulcer of the stomach there is also, as a 
rule, vomiting, but the part most frequently affected being the posterior wall 
at some distance from either orifice, there is not that regularity in its occur- 
rence that there is in cancer. In simple ulceration of the stomach there is a 
serious danger always possible, that arising from bleeding. If the ulcerated 
process goes on until the ulcer reaches the deeper and larger blood-vessels of 
this organ, it is quite possible for one of these to give way before it is closed 
at either extremity, and so the blood is poured out from it so rapidly that life 
is endangered. Most frequently under such circumstances the blood is vomited, 
and this vomiting of blood may be the first symptom of danger. At the same 
time, however, the blood will in part pass into the bowels, and, being there 
partly altered and blackened, is so discharged. This constitutes melama, vomit- 
ing of blood being termed hgematemesis. Often it is not easy to diagnose 
between the simple and malignant variety of ulceration, though this is impor- 
tant, the simple form being tolerably amenable to sound treatment, the malig- 
nant not at all so. When bleeding does occur, it constitutes a danger so serious 
as to demand instant attention, for if the bleeding does not stop the patient 
will die. Frequently, too, it will be found that the bleeding recurs again and 
again, tasking the resources of the physician and the strength of the patient to 
the uttermost. Here are the rules to be adopted : The patient must be kept 
at absolute rest, and ice given freely. Let the patient crush the ice roughly 
with the teeth, and swallow it in lumps. Let ice be placed outside the body 
over the stomach. The best thing to give is dry champagne, in small quan- 
tities, well iced ; if that is not to be had, iced brandy and soda, only, the smallest 
quantity of brandy. The best medicine is gallic acid, made into a paste with 
water, 20 or 30 grains for a dose, with perhaps 10 or 20 drops of dilute sul- 
phuric acid. There are a score of other remedies, but these are the best, and, 
as a rule will succeed if any will. But as regards food — there is the real 
difficulty. It is best to face it from the beginning, and give no food by the 
mouth, but only nutrient enemata. If the case is a severe one, that is the best 
plan ; in slight cases a little iced milk is best to be given. But in all cases 
of real difficulty there is nothing like nutrient enemata — strong beef -tea. 
The bowels ought, however, to be well washed out with soap and water before 
giving these enemata, time being of course allowed for them to settle again. 
Then, too, as regards these enemata : those for washing out the bowels should 
be large — a pint at least ; those to be retained for nourishment small — not 
exceeding two ounces, slowly and carefully thrown up. 

In cancer not much can be done except to give the patient relief from pain. 
That is best done by small, very small, morphia pills, or by injection of mor- 
phia under the skin, one-fifth of a grain to begin with. Then, too, to prevent 
fermentation of food, carbolic acid and creasote had better be tried, or the sul- 
phite of soda used shortly after the food has been swallowed. Food should only 
be given in very small quantity at a time, with a view to preventing vomiting 
if possible. It is common in advanced cases to find it necessary to give nutrient 
enemata as in simple ulceration, but with a totally different view. In cancer 



STO 740 STO 

the patient is bound to die, in simple ulcer not so ; in the one case we can only 
palliate, in the other we try to cure — and as a rule we are successful. 

Stomach-pump. This is an apparatus by means of which, in cases of 
poisoning, fluids can be introduced artificially into the stomach, or be withdrawn 
from this organ. It consists in a small pumping apparatus, to which is attached 
a long elastic tube, of sufficient length to be passed down the gullet into the 
stomach. This tube, at the point where it passes into the mouth, is usually 
guarded from the action of the patient's teeth by a perforated gag of wood. 
The stomach-pump, though not used so frequently and indiscriminately as in 
former days, is, however, an invaluable and indispensable aid in the treatment 
of cases of poisoning by opium and other narcotics, and of extreme drunken- 
ness caused by poisonous quantities of spirits. It may be laid down as a gen- 
eral rule that the stomach-pump ought always to be used when the patient, 
under the influence of a narcotic or alcoholic poison, is too much exhausted or 
too insensible to swallow emetics or antidotes, or where, as in cases of attempted 
suicide, he obstinately refuses to swallow. One or two pints of lukewarm 
water should first be pumped into the stomach, and then be withdrawn with 
part of the contents of the stomach and of the poison. This process should be 
repeated until the injected water, when pumped back again, is found to be clear 
and colorless. Very often, however, the simple introduction of the stomach- 
pump, or the presence of a small quantity of warm water, will cause vomiting; 
but in cases of intense narcotic poisoning, the stomach is generally insensible 
to the presence of the tube, and requires to be well washed out. When in 
cases of poisoning the patient is able or willing to swallow, and vomiting can 
be produced by the frequent administration of warm drinks, the stomach-pump 
ought not to be used. This instrument is not always a harmless one, and when 
used by inexperienced hands, and in circumstances exciting haste and confusion, 
may do considerable mischief. The mucous membrane of the throat, gullet, 
or stomach may be wounded by the violent introduction of the tube, and some 
bleeding from the raw surfaces may be produced. A more serious accident is 
the introduction of the tube into the air-passages instead of the gullet and 
stomach. A case has been recorded in which, after death from sulphuric acid 
poisoning treated by the storaaeh-pump, the windpipe, bronchi, and large por- 
tions of the spongy tissue of the lungs were found choked and plugged with 
chalk mixture, which it had been intended to introduce into the stomach. 
Another danger attending the use of the stomach-pump is laceration of the 
mucous membrane of the stomach, strips of which are drawn into the orifices 
of the tube as the fluid contents of the stomach are being withdrawn. This 
occurs only in cases where the inner coat of the stomach has been softened by 
some corrosive agent, and on this account it has been laid down as a rule that 
the stomach-pump ought not, except under special circumstances, to be used 
in cases of poisoning by the mineral acids. 

Stone. The solid precipitates of the urine give rise to the formation of 
concretions in the urinary passages, which are known by the names of gravel, 
stone, or calculus. The conditions of the constitution of individuals in whom 
they occur are termed diatheses, and the presence of gravelly or sedimentary 
deposits in the urine passed, together with any irregularity causing irritation 
in the urinary organs, should be most carefully attended to, with a view of 
preventing the formation, if possible, of calculus. In order to discover the 
condition of the urine, a microscope, a urinometer, test tubes, test papers, and 
reagents, to be afterwards mentioned, are necessary. Urinary calculi are formed 
from the following salts : (1) uric acid, urate of ammonia, lime, magnesia, or 



STO 741 STO 

soda ; (2) oxalate of lime ; (3) phosphates of lime, magnesia, or ammonia ; 
(4) cystin ; (5) uric or xanthic oxide. The existence of these several de- 
posits may be detected as follows : (1.) The lithic or uric acid deposit has, to 
the naked eye, a pink or reddish, sandy appearance as sediment, the urine hav- 
ing been originally passed clear. The urine itself is acid, turning blue lit- 
mus paper red, and has a high specific gravity. vThe existence of urates in 
the urine denotes a weak state of the system, and often some irregularity of 
the digestion or error in diet will cause a deposit. It is most frequently met 
with either in childhood or between the ages of 40 and 60, and is hereditary. 
The symptoms of a fit of gravel are pain in the loins, spasmodic retraction of 
the testicle, frequent painful micturition, some fever, and derangement of the 
digestion. (2.) The oxalate of lime is deposited from urine which is highly 
acid, containing much lithate ; it appears under the microscope as minute octa- 
hedral crystals. (3.) The phosphates arise either from excessive mucous 
secretion in the bladder, or from an insufficiently acid condition of the urine. 
(4.) Cystin is rare, the urine being of a yellowish-greeu color, and having an 
aromatic or fetid odor. (5.) The uric or xanthic oxide is the rarest of all the 
deposits, and has been chiefly discovered in children in the form of a calculus ; 
it appears to have much the same chemical character as cystin. Calculi are 
formed as follows : there being a nucleus in some part of the urinary passages, 
the prevailing deposit forms round it, generally concentrically ; this nucleus 
(see Lithotomy) may either exist withiu the body or be introduced from with- 
out, but most frequently it is found to consist of uric acid or oxalate of lime. 
These small masses may enlarge and remain within the kidney {renal calculi). 
or they may pass by the ureter in the bladder, where they receive additions, 
constituting vesical calculi, frequently becoming fixed in some pouch in that 
viscus, or in the prostate gland. The stones when found have characteristic 
appearances, and can be readily enough recognized by their external aspect, 
or, of course, more thoroughly after section. Thus: (1.) The uric or lithic acid 
is by far the most common, and generally oval, flattened, fawn or mahogany 
colored, and its section shows its formation in concentric lamina?. (2.) Phos- 
phate of lime is rare as a stone ; it is pale brown, friable, and laminated. 
(3.) Triple phosphate forms white or pale gray stones, composed of small 
brilliant crystals- (4.) The fusible stone, formed of triple phosphate of lime, 
is a white, friable, mortar-like mass. (5.) The mulberry calculus is composed 
of oxalate of lime, and resembles the fruit of a mulberry, being dark red, rough, 
and covered with tubercles. Alternating calculi are composed of alternating 
layers of deposit. 

Renal Calculus, or stone in the kidney, usually consists of uric acid or oxa- 
late of lime. The symptoms of stone existing in the kidney are well marked : 
there is a dull aching and feeling of weight in the loins, and a sharp prickling 
feeling in the region of the kidney. The urine is occasionally bloody, and 
there is frequent desire to pass water, great pain in the lumbar region gener- 
ally, and a violent spasmodic retraction of the testicle of the side affected. The 
passage of such a stone down into the bladder should be expedited by dilu- 
ents or diuretics, such as Vals or Vichy water, or solution of bicarbonate of pot- 
ash, warm baths and fomentations, and cupping, and leeches to the loins. Cal- 
culi will frequently remain impacted in the kidney, causing abscess or wast- 
ing of the glands. The passage of a stone from the kidney into the bladder is 
very much the same as the preceding, only there is violent sickness and shiv- 
ering, faintness, and often collapse. Warm baths, large doses of opium, and 
diluents are the remedies. See Urinary Calculus. 



STO 742 STR 

Storax or Styrax is a kind of liquid balsam obtained from the bark of a 
tree, Liquidambar orientate, growing in Asia Minor. This balsam is after- 
wards purified. It occurs in two forms: a thick liquid of the consistence of 
honey, and brownish-red, nearly solid masses, softening with heat. 

Storax contains, as do all balsams, cinnamic acid, which, when pure, occurs 
in flat crystals ; also styracin and styrol. Styracin is a compound containing 
cinnamic acid and styrone. It is crystalline when pure, and insoluble in water. 
Styrol is a colorless oil which by oxidation may be converted into benzoic 
acid. Its odor is aromatic. 

Storax if pure should be soluble in alcohol or ether, and is by chemical 
means capable of being broken up into a variety of products. Storax is not 
nowadays much used in medicine. It belongs to a group of substances which 
have fallen into disrepute. It is contained in compound tincture of benzoin, 
commonly callei Friar's balsam. The whole group of balsams were at one 
time much employed as applications to cuts and wounds, and doubtless were of 
service, but with an improved system of dressing they went out, and are now 
little used in regular practice. 

Stout. See Beer. 

Stramonium commonly implies the leaves of the Datura stramonium, or 
thorn apple, growing in this country, but the seeds of the same plant are also 
now officinal. The leaves are larger and much indented at the edges, with a 
peculiar rank, disagreeable odor. These should be gathered when the plant is 
flowering. The seeds are very small, kidney-shaped, and rough on the surface, 
and have a peculiar taste. All parts of the plant contain an alkaloid identical 
with that contained in belladonna, but called daturia instead of atropia. This 
may be obtained in white crystals, which yield a peculiar odor on being moist- 
ened by sulphuric acid. The preparations are made from the seeds only, and 
are an extract and tincture. The leaves are mainly used for smoking. 

The properties of stramonium are much like those of belladonna, as might be 
expected from their similarity of composition. Nevertheless, stramonium, more 
perhaps from habit than anything else, is most frequently given for maladies 
which are not usually treated by belladonna. Stramonium is in point of fact 
prescribed almost entirely for spasmodic lung affections, especially asthma. For 
this malady, whether merely spasmodic or partly dependent on disease of the 
organ itself, stramonium is usually prescribed in the form of tincture, or the 
leaves are given for smoking. These generally do well, and procure relief 
for a time, at all events. 

Stramonium is sometimes given with the intention of relieving pain. An 
ointment may be made of the leaves and spread over a painful part, but this 
plan is not often adopted. For smoking, twenty grains of the dried leaf may 
be made into a cigarette and smoked, taking care to inhale the smoke. This 
at first gives rise to cough, but by and by profuse expectoration follows, and 
then comes relief. Some mix stramonium with tobacco, but the smoke of this 
is more irritating, and cannot well be inhaled. In some cases stramonium 
fails altogether, and in all the dose must be increased. The Datura tatula has 
been used for smoking, like the Datura stramonium. A quarter of a grain to 
half a grain of this extract and twenty minims of the tincture are the ordi- 
nary doses. 

Streams, or Rivers, may be polluted by the refuse from large towns and 
villages which are situated along their banks. In the neighborhood of manu- 
facturing places, the water in the river is generally black and filthy, and of 



STR 743 STR 

water from the open country it improves in color, and much of the organic 
matter becomes oxidized by its contact with the oxygen of the open air. Most 
of the water supply of London is taken from the Thames above Teddington 
and Moulsey, before any of the metropolitan sewage can enter ; but then the 
river has received the drainage from numerous towns and villages above. Of 
late years all these places, as Windsor, Oxford, Twickenham, and Richmond, 
etc., have had to take measures to prevent their sewage entering the river, and 
there can be but little doubt that a time will come when the waste refuse will 
be valuable for agricultural purposes, and then the rivers will be far purer for 
drinking purposes. See Sewage. 

Street Accidents. In large and populous cities a day rarely passes in the 
course of which certain accidents" do not occur. Under ordinary circumstances 
the injury in the majority of cases is caused by the individual being knocked 
down or run over by a vehicle. Occasionally the accident consists in the fall 
of a ladder, or of some smaller object detached from the front of a house or 
dropped from a window. In many cases, again, the cause of the injuries may 
be a slight fall, an inadvertent step, or carelessness on the part of the indi- 
vidual. In the first class of accidents the injuries vary much in nature and 
degree ; they may be restricted to slight bruising, or to simple wounds of the 
scalp, or may consist in simple fracture of one or more limbs, in severe com- 
pound fracture with much comminution of the broken bones, and in rupture or 
laceration of internal organs, as the stomach, liver, or kidney. The most se- 
vere of these accidents are those caused by street cars. The passage of one 
of the wheels of a vehicle of this kind across a limb causes a very bad com- 
pound fracture ; the skin is stripped away over a considerable portion of the 
limb ; the muscles are torn and bruised, and the bones of the limb are each 
broken into several pieces. The extreme severity of these accidents is due to 
the weight of the vehicle, and the size and peculiar conformation of the wheel. 
The injuries caused in accidents of the second kind also vary much in charac- 
ter ; in the majority of instances they consist in cut head, and contusion or 
fracture of the bones of the skull. The two most frequent of the injuries 
which are due to falls and slips on the part of the individual, are simple frac- 
ture of the neck of the thigh bone and fracture of the splint bone of the leg 
just above the ankle. The former injury usually occurs in people over sixty 
years of age, and is caused by a slip off the edge of the pavement ; the latter 
is often produced by the individual stepping out of a vehicle which is still in 
motion. Under certain unusual conditions, as during a heavy frost, and with 
overcrowding of the streets in the event of a procession, an illumination, etc., 
the number of street accidents is very much increased. Those caused by a 
slippery state of the streets result generally in simple fractures and injuries to 
the scalp or head; those caused by overcrowding, in compression of the ab- 
dominal or thoracic organs and fracture of the breast bone and several ribs. 

Stricture. Stricture, or contraction of any of the natural passages in the 
body, may occur as the effects of disease or injury; but by the term stricture, 
in its general sense, is meant that affecting the urethra, or channel by which the 
urine passes from the body. Stricture of the urethra may be either spasmodic 
or permanent. 

Spasmodic stricture is of frequent occurrence in persons who have an irrita- 
ble urethra, the result of repeated attacks of gonorrhoea, or who may have some 
slight organic stricture, and the symptoms are liable to come on after too much 
drink, irritation of the lower bowel from piles, etc., getting wet, horse exercise, 
or some unnatural condition of the urine. An inability to pass water after a 



STR 744 STR 

too long voluntary retention of the urine in the bladder must be distinguished 
from permanent stricture, as it depends upon spasm of the neck of the bladder 
or urethra from some such cause as above. 

The symptoms are as follows : the individual has a great desire to pass water, 
and on straining finds himself unable to do so; the bladder becomes distended, 
and appears as an increasing tumor above the pubes, and, if not relieved, the 
continued efforts at evacuation may terminate in rupture of the urethra and 
extravasation of the urine. (See Extravasation of Urine.) In such cases 
of stricture, especially those arising from debauch of any sort, and when such 
symptoms have not previously existed, a hot hip-bath and a good dose of opium 
cause speedy relief. The tincture of iron, in ten-drop doses every ten minutes, 
is often of use. If the symptoms still continue, the catheter must be passed, 
and a large one used for choice, a No. 8 or 9. 

Permanent stricture, or, as it is called, organic stricture, is a contraction of 
the urethral canal in one or more places, owing to the infiltration of plastic 
effusion, and fibroid degeneration of the tissues. A constriction is thus pro- 
duced, varying in tightness, in some cases almost blocking up the canal, whilst 
in other and simpler ones it is very slight. Occasionally a fibrous band is 
found stretching across from one side of the canal to the other, forming what 
is termed a bridle stricture. Organic strictures are generally situated in that 
part of the urethra just in front of its bulbous portion ; frequently they are 
found nearer the orifice. The most freemen t cause of stricture is neglected 
gonorrhoea, and perhaps the ill effects of improper remedial agents ; patients 
often treating themselves, or getting into the hands of the quacks. Stone in 
the bladder and injuries of the urethra may also be cited as causes. The 
symptoms of an organic stricture are difficulty in micturition, small stream of 
urine, generally forked or dribbling, pain during the act of making water, and 
frequent desire to do so. This form of stricture is often complicated with 
abscess, terminating in fistulas or sinuses in the perinamm. The treatment 
consists both of constitutional and mechanical means. As far as regards -the 
constitutional, any stomach disorders, irritating urine, or inflammatory tendency 
must be removed, and temperance, rest, early hours, warm baths, and alkaline 
remedies will do much towards assisting such mechanical means as may from 
the nature of the case be deemed necessary. The mechanical treatment of 
stricture is of such importance that experienced surgical advice must always 
be taken as early as possible; and we can do little more in a work of this nat- 
ure than refer to some of these methods. In the first place, the stricture may 
be dilated by bougies, expanding instruments, a catheter retained in the bladder, 
caustics, incisions, or external division. The bougie is frequently advised to be 
used by the patient himself, after having been instructed in the method of using 
it; it must be flexible and strongly made, to avoid its breaking in the passage. 
By the introduction of bougies of gradually increasing thickness, distension is 
combined with compression, and by this means the ring-shaped cicatricial con- 
striction of the urethral canal is frequently overcome ; and, if applicable to the 
case, this constitutes by far the most satisfactory course of treatment. . 

The treatment by expanding instruments consists .in the introduction of some 
appliance whereby mechanical distension is obtained, either sudden and forcible, 
or gentle and gradual. Many ingenious methods are in use, and are more or 
less effective in different cases and in different hands. Treatment by the reten- 
tion of a catheter in the bladder is of value in cases of hard, gristly, cartilaginous 
strictures, and in cases of false passage. It consists in tying a small catheter 
in the bladder, and subsequently a larger one, until the stricture suppurates and 



STR 745 STU 

becomes dilated. Caustics are occasionally applied to the canal by instruments 
specially adapted, called porte caustiques ; lunar caustic, or nitrate of silver, 
is the agent employed. Division of the constricting portion is effected in some 
instances by internal section, some contrivance being introduced carrying a 
cutting edge, such as the urethrotome. The urethra has in some cases of 
complication to be opened from without, in order that the urine may como 
away ; the operation by means of which this is effected is termed perineal sec- 
tion, and is one requiring great manipulative skill and considerable patience 
on the part of the surgeon. 

Stroke is the popular name for a paralytic shock, or an apoplectic fit. 
(See Apoplexy, Paralysis, and Hemiplegia.) 

Strophulus. See Red Gum. 

Struma. See Scrofula. 

Strychnia is an alkaloid of a most potent character obtained from nux 
vomica, St. Ignatius's bean. It is sometimes used by itself, and is a valuable 
tonic, especially in cases of nervous exhaustion. It is also given with great 
advantage in certain forms of paralysis, especially when the parts begin to im- 
prove. Its great power, however, renders it dangerous, and it should never 
be given save by authority. The dose is about one twenty-fourth part of a 
grain. See Nux Vomica. 

Stumps. After amputation of a limb or portion of a limb, the resulting 
stump is liable to several affections, and of these neuralgia is one of the most 
frequent ; it is most commonly met with after amputation below the knee, and 
in the arm or fore-arm. In such cases the part must be carefully defended 
from pressure in the adaptation of an artificial limb. It depends on some 
change in the structure of the nerves in the stump, but if such change cannot 
be clearly detected, the treatment to be adopted is that used for neuralgia 
generally, such as iron internally and the light application of lunar caustic to 
the part. In the case of the formation of neuromata, or nerve tumors, the 
course of treatment lies in their excision, or of a refashioning of the stump. 

Exfoliation, or necrosis of the end of the bone or bones in a stump, occa- 
sionally occurs after an amputation, and the sequestrum may consist merely of 
a thin scale of bone, or in severe cases of a portion of bone involving th^ whole 
thickness of its extremity, tapering upwards, of a cancellous texture. In some 
instances when the stump has been badly formed, or the flaps have sloughed, 
the end of the bone projects, forming what is called a conical stump. The 
treatment of such cases is obviously a repetition of the original amputation 
main higher up in the limb. 

Barsce sometimes form over the ends of bones in stumps, generally occurring 
after blows on them. The fluctuation and general character of these swellings 
closely resemble abscess. In the case of abscess early incision is necessary, 
and in the case of the bursas rest and fomentation are generally sufficient. 

IIcBinorrhage occurs usually a few hours after the stump has been formed, 
when the patient is warm in bed and has fully recovered from the state' of shock. 
The treatment of such cases consists in the opening up of the flaps and applying 
ligatures or styptics, or both, to the bleeding points. Pressure in slight cases 
is often sufficient; at all events it should be employed in the course of the 
main arterial trunk, until surgical aid arrives. 

Stupor is that state of partial insensibility which often precedes coma ; it 
may be caused by a stroke, by drink, by opium, or carbonic acid poisoning, in 
cases of renal disease, etc. ; the treatment depends, of course, upon the cause. 
See Coma. 



ST. 746 SUF 

St. Vitus's Dance. See Chorka. 

Stye. This is an inflammation in one or other eyelid, which results in a 
little matter forming, which must be let out. For two or three days it is very 
painful and red. Bathing with hot water is the best thing, and when a yellow- 
ish spot is seen, then the matter is pointing, and on being pricked with a needle 
or knife-point the pus exudes, and gives relief at once. 

Styptics are substances applied to a part to arrest bleeding. Most of these 
are astringents, and seem to act by causing the minute bleeding vessels to shrink, 
and so prevent further haemorrhage. Cold is the best and simplest styptic, 
especially if applied as ice. That will arrest most bleedings. Astringent sub- 
stances, like galls in powder, catechu, etc., which contain tannin, matico in 
powder, alum, especially burnt, may all be employed. Perchloride of iron is 
also a powerful styptic ; but one of the most powerful of all is solid nitrate of 
silver, applied so as to touch the bleeding orifice. If a large vessel bleeds, it 
must be tied or twisted, or otherwise secured. 

Sub-involution is said to occur when the womb does not return to its 
usual size after delivery, but is larger and heavier than it ought to be. Such 
women are liable to menorrhagia, pain in the back, and inability to walk far. 
Tonics must be given, and a liberal diet, and rest in the horizontal position. 

Sudamina are minute vesicles, or little bladders, containing fluid, seen in 
profusion on the chest in cases of rheumatic fever and some other diseases ; 
they require no treatment. 

Sudden Death is generally caused by disease of the heart and large ves- 
sels. It may be caused by an accident, as falling from a scaffold, or by being 
run over ; drowning generally takes at least five minutes to kill a person, and 
one may be resuscitated after having been in the water ten minutes, or even 
a little longer. Strangulation and hanging make a person insensible in a 
minute; but death will not take place for three or four minutes if the person 
die by suffocation. If, however, the person breaks his neck in falling, he will 
die immediately. Poisoning very rarely causes sudden death, except where 
prussic acid is used, and then death may supervene in a minute or a minute 
and a half. Deaths by chloroform are also sudden. Cases of apoplexy gen- 
erally die within twelve or twenty-four hours ; rarely, if ever, in less than 
three hours. Aortic disease and fatty heart are by far the most common 
causes of sudden death which occur in this country ; apoplexy or a stroke is 
never a cause : syncope or fainting, rupture of an aneurism, ulceration of a 
vessel, profuse haemoptysis, are more rare causes of sudden death. In all cases 
an inquest should be held, and a post-mortem examination made. 

Sudorifics are remedies which cause and promote perspiration. They are 
also called diaphoretics. Of course the simplest is heat ; but sometimes that 
alone does not answer well ; the skin does not open, and the heat becomes 
very disagreeable. If, therefore, heat alone be used, as in the Turkish bath, 
it is advisable to bathe the surface in water if the perspiration does not come 
freely. Of the sudorifics in common use only one or two deserve mention. 
These are the acetate of ammonia, which some esteem as a diaphoretic, others 
despise. But undoubtedly the two most important are the compound ipecacu- 
anha powder, or Dover's powder, and the antimonial powder, or James's pow- 
der. Sometimes tartar emetic and laudanum are given. Sudorifics are very 
useful in certain stages of certain complaints. Thus, if an ordinary cold be 
caught, at the early stage, with shivering, dry skin, and discomfort, a good 
perspiration may completely dispel it. 

Suffocation means simply death for want of air, and this may be produced 



747 





Fig. cxxxv. 



Fig. cxxxvi. 





Fig. cxxxvi i. 



Fig. cxxxix. 





Fig. cxl. 



Fig. cxli. 





Fig. cxliii. 



PLATE XXVI. 



SUG- 749 SUL 

by any cause which prevents the free access of atmospheric air to the lungs ; 
thus hanging, drowning, choking, and inhaling noxious gases, all induce suffoca- 
tion. A frequent cause of suffocation in very young children is the anxiety of 
the mother to prevent cold air getting to them, and covering them up, head 
and all, to keep them warm. This often takes place in bed, when the infant, 
sleeping with the mother, slips down into the bed under the clothes, and 
breathes only the impure air which is confined there, till it becomes asphyx- 
iated and dies. These sudden deaths are often said to occur from fits or con- 
vulsions, when in reality they are simply cases of suffocation. See Apncea. 

Sugar of Lead. See Lead. 

Suicide. The most common form of suicide is by hanging, then by stab- 
bing or cutting, drowning, taking poison, and by gunshot wounds, etc. The 
number of suicides seems to be on the increase. In England, in the six 
years 1859-64, the annual average was a little over 66 to every million of 
population ; but in the six years 1865-70, the annual average was nearer to 
68 than to 67 in a million of the population. In the first six years the sui- 
cides of a year only once reached 70 per million ; in the years 1868-69-70, 
the ratios were 70, 73, and 70 per million. The range in the twelve years 
was from 62 per million in 1857 to 73 in 1869. In recent years there has 
been an increase in the cases of suicide by drowning, but a decrease in the 
number of those who hang themselves. 

Sulphur is employed in medicine in two forms — sublimed sulphur and 
precipitated sulphur or milk of sulphur. Sublimed sulphur is commonly used. 
It is prepared by fusing virgin sulphur, and conducting the vapor into a cool 
chamber, where it consolidates into bright yellow powder without taste or 
smell. It burns with a blue flame, and produces the unpleasant fumes of sul- 
phurous acid. The precipitated sulphur is pale yellow, and its powder is much 
finer. The preparations of sulphur are a confection and an ointment. The 
confection contains sulphur, cream of tartar, and syrup of orange-peel. It is 
a valuable laxative in piles, or where it is not desired to do more than gently 
open the bowels, as in fissure of the anus or in strictures of the rectum. It is 
mainly, however, as an external application that sulphur is employed. Sulphur 
ointment still remains the great remedy for the itch, but it is useful in other 
forms of skin disease. Itch is due to a small acarus, which burrows in the 
skin and gives rise to the intolerable itching. By rubbing the skin thoroughly 
with an unguent, these burrows may be broken down ; but something more is 
required — the acarus and its eggs must be destroyed ; this the sulphur or the 
ointment seems to do. It is important before using the sulphur that these 
burrows should be exposed, and nothing does that so well as a good hot bath 
and an effectual rubbing with soft soap. After that a single application of 
sulphur ointment, if well rubbed in, may cure. With delicate skins this plan 
will not do, as a good deal of irritation may be produced. Frequently it is 
enough to use this treatment to certain parts of the body, especially the hands, 
arms, and inside of the thighs, where usually the crop of eruption is richest. 
Simple cleanliness may suffice for other parts, but usually the ointment should 
be applied every night for a night or two, and only washed off in the morning. 
The clothing must subsequently be disinfected by heat, or the malady is 
prone to return. If there has been much inflammation round the spots, a lit- 
tle carbolic acid lotion or ointment may be applied. See Itch. 

Sulphuric Acid is the most powerful of all the acids. It is made by burn- 
ing sulphur, and afterwards oxidizing the sulphurous acid by the fumes of 
nitre. Sulphuric acid thus prepared is a heavy, oily-looking fluid, commonly 



SUL 750 SUP 

known as oil of vitriol. It is intensely acid, and speedily chars any vegetable 
substance added to it. Commercial oil of vitriol often contains arsenic, from 
the use of impure sulphur. The diluted acid is used in two forms : as aro- 
matic sulphuric acid, which is flavored by cinnamon and ginger, and dilute 
sulphuric acid, in which water alone has been added. The strong sulphuric 
acid is rarely employed, even as a caustic ; it is unmanageable, and less pow- 
erful reagents are preferred. Internally the aromatic or dilute sulphuric acid 
is mainly used as an astringent. In this way it is of much service in the wast- 
ing sweats of consumption ; and it may be of service where there is a chronic 
mucous discharge from the bowels. It is also of importance as an astringent 
in diarrhoea, especially if combined with opium. The ordinary dose of dilute 
or aromatic sulphuric acid is about ten or fifteen drops, well diluted with 
water, or some such vehicle. In diarrhoea that quantity ought to be given 
iyith as much laudanum, if irritating substances have been expelled. 

Sulphurous Acid is a remedy of some importance. It may be prepared 
in a variety of ways, but it is most commonly obtained by reducing sulphuric 
acids by means of charcoal. It is most easily prepared by burning sulphur in 
the open air. It has the well-known odor of burning sulphur. Sulphurous 
acid is a powerful deoxidizing reagent, and is powerfully destructive of vege- 
table life. Applied to the skin it causes some reddening ; and if any vegeta- 
ble parasite is present, as is not un frequently the case in skin disease, it is 
destroyed. Hence arises its value in such maladies. Internally, if there is 
any tendency to fermentation, and if fungi are present in the stomach, it does 
great good. Used as spray in certain forms of sore throat, sulphurous acid is 
also of great use. It may be freely applied, and subsequently used somewhat 
diluted as a gargle. Sulphates and hydrosulphates, especially of soda, are fre- 
quently given internally in its stead. See Soda. 

Sumbul, or Musk Root, is the root of a plant growing somewhere iu 
Central Asia. It reaches us mostly by way of Russia; partly also by way of 
Bombay. Its odor resembles that of musk, and at one time it was supposed 
likely to become a valuable remedy. Subsequent experience has not con- 
firmed this view, so that here it is little used. See Musk. 

Sun-stroke is almost a misnomer. The word ought to be, as the thing is, 
heat-stroke. It is true that the direct rays of the sun do sometimes produce 
illness, but the really troublesome thing is the excessive heat. Thus, the 
rays of the sun concentrated in a valley may prove very deadly, but still more 
destructive are the hot winds and dry sandy deserts of certain parts of the 
world. But even more fatal than heat-stroke are the close, confined houses 
of the poor in the narrow lanes and alleys of crowded cities. See Heat- 
stroke. 

Suppositories are forms of remedies similar to medicated pessaries. They 
consist of some basis, most frequently called butter, which, while taking shape 
and possessing a certain consistence, shall yet melt gradually, and so expose 
the medicated materials they contain to gradual absorption. They are gener- 
ally introduced into the rectum before rest, and allowed to remain there. Most 
frequently they contain some sedative, as opium, morphia, or belladonna, but 
occasionally also astringents. 

Suppression of the Urine takes place when the kidneys do not secrete 
their proper amount of urine, and then the blood becomes poisoned, because 
those substances are retained in the blood which ought to be voided ; there is 
thus an important difference between these cases and those of retention of 
urine, which may arise from a stricture, or from paralysis of the bladder, and 



SUS 751 SYM 

which are relieved by passing a catheter. In cases of suppression, the loins 
must be cupped, and a sharp purge must be given. It often comes on at 
the end of old-standing kidney disease, and hastens the termination of the ill- 
ness. 

Suspended Animation. See Drowning. 

Sutures. The edges of wounds or surgical incisions are approximated by 
what are termed sutures, and theee sutures are applied by different modifica- 
tions of needles and threads. The needles are various in shape and size, 
straight and cylindrical, straight and triangular, or curved and double-edged. 
Hare-lip pins are of great use in many forms of wound. The threads are 
either hempen, silken, catgut, horse-hair, or metal. It must be borne in mind 
that no suture should be used until all bleeding has ceased, and every foreign 
substance removed, and exact apposition attained. The needle should be 
passed through the integument so deeply that it does not give way on the nat- 
ural tension of the parts, and the thread and its knot should not be drawn so 
tightly that they cut the pierced tissue, or strangulate it. 

There are different forms of suture. The interrupted consists in the approx- 
imation of the edges of a wound by entering a needle armed with a thread on 
one side of the wound or incision, and bringing it out through the other. The 
edges of the wound being held in apposition, either a double knot or a single 
one with a bow is tied, and the suture is fixed. 

In the uninterrupted suture the armed needle is passed continuously from 
one side to the other, until the whole length of the wound is traversed. 

The quill suture is of use in cases where some degree of force is necessary 
to keep the edges of a wound together, and also for approximating the deeper 
parts ; it is applied by passing a double ligature, and inclosing portions of quill, 
rolls of strapping, or pieces of bougie, as points d'appui. 

The zigzag suture is much on the above principle, and is applied by thrust- 
ing the armed needle through the lips of a wound in the first place, and then 
entering it a short distance on, on the side of its emergence ; then again pass- 
ing it through the lips of the wound, and repeating the proceeding on the oppo- 
site side. 

The twisted suture is applied with the assistance of hare-lip pins ; the pins 
transfix the lips of the wound at intervals, and the thread is twisted around 
each in succession as a figure of 8, passing from one, to the next in order. 

Metal sutures are preferable in some instances, as they give rise to less local 
irritation. 

Sutures should be removed at an interval of a day or more, and those 
causing the greatest irritation should be removed first. In fact, as soon as 
irritation to any extent is seen at their points of passage, they should be re- 
moved. 

Adhesive plaster should be removed from a wound when it gets black ; it is 
then useless and irritating, and its place, of course, should be taken by a fresh 
piece of strapping. 

Sympathy is an awkward sort of term applied to the evils which result 
from the influence of one kindred diseased organ on another. This same in- 
fluence may be seen also in health. One of the best examples is the filling 
out of the breasts, which commonly takes place in women just before the 
monthly period. The breasts may also become swollen, hard, and knotty iu 
ovarian disease, as if the female were pregnant. The headache of indigestion 
is another familiar instance of sympathy. So, too, is the pain experienced in 
the right shoulder when the liver is diseased, and the pain extending down the 



SYN 752 TAL 

thigh vvlien passing a stone from the kidney. The vomiting, which is one of 
the most troublesome things accompanying the passage of a gall-stone, is com- 
monly spoken of as sympathetic, though it may not really be so. In short, the 
curious alliance between parts brought about either by an alliance of function 
or by a common origin of nerve supply, might be illustrated by numerous ex- 
amples, but by none more telling, perhaps, than by the aptness of one eye to 
become diseased when the other is. 

Syncope. This is a technical term for a faint produced by shock or ex- 
citement, or by the failing power of a weak heart. It often is the proximate 
cause of death in heart disease. Brandy, ether, and other stimulants should be 
used to rouse the heart to act more vigorously. 

Syphilis. See Venereal Disease. 

T. 

Tabes Mesenterica. This is strictly a disease of childhood, and is a sure 
sign of a scrofulous constitution. It is in reality tubercular disease of the 
mesenteric glands, and is better recognized by general symptoms than by any 
discoverable enlargement of the glands, which seems to be the origin of the 
disease. Emaciation, loss of appetite, and relaxation of the bowels are among 
the earliest symptoms, and tenderness and distension of the abdomen suggest 
the existence of diseased glands. The condition of these glands can be ascer- 
tained only by very careful examination, and a practiced hand is needed to un- 
dertake it. The course of the disease is slow, but its duration is difficult to 
estimate on account of the obscurity of the earlier symptoms. It seems to 
occur more frequently in bo} 7 s than in girls, and is seldom found in children 
under three years of age ; most commonly between the fifth and tenth years. 
The children do not necessarily die; they sometimes recover. The treatment 
should consist in relieving, if possible, the oppressed glands. An ointment of 
iodide of lead may be rubbed into the body twice a day, and the syrup of the 
iodide of iron given internally. The diarrhoea, which is so frequent a symp- 
tom of this disease, should be arrested as soon as possible by small enemata 
of warm starch and opium. Unfortunately, this diarrhoea is so often the result 
of tubercular ulceration of the bowels that all efforts prove unavailing to ar- 
rest it. A light farinaceous diet, with a little boiled mutton or fish for dinner, 
but no bread, salt, or solid food, change of air, moderate exercise, and daily 
sponging of the body in tepid salt water contribute to the cure. The practice 
of thoroughly but gently rubbing the body, legs, and hips, and securing an 
amount of reaction after the bath, is desirable ; and, as recovery proceeds, 
small tonic doses of quinine and tincture of iron may be given. Cod-liver oil 
is also a most valuable remedy in this disease from its earliest stages. 

Taenia Mediocanellata. A tape-worm. See Entozoa. 

Taenia Solium. A tape-worm. See Entozoa. 

Taliacotian Operation. A name applied to the operation of forming a 
new nose, invented by Taliacotius, a celebrated Chinese surgeon, who lived 
about the beginning of the Christian era. He was the first who ever attempted 
to restore a lost nose, and his original idea was to cut a pear-shaped piece of 
culticle or skin from the patient's arm, all but a small pedicle, or stalk, which 
remained attached to the original limb and supplied nutrition and life to the 
excised piece. This was spread over the framework of the nose, the edges of 
the cheeks being first scarified, and the arm bound up to the head and tip of 



TAM 758 TAR 

the nose, where it remained until union had taken place between the new piece 
of skin and the surrounding edges, when the little point of union was severed, 
and the arm set free. When the patient objected to supply his own cuticle, 
Taliacotius was in the habit of obtaining the needed material from the arm, 
leg, or thigh of some one else. Mr. Liston, the great surgeon, revived this 
long-neglected operation, and formed new noses for his disfigured patients by 
cutting a piece of skin out of their foreheads, leaving it attached by a small 
kind of footstalk, and then inverting it on to the frame of the nose, when it 
was carefully plastered over and left to unite. In several cases this operation 
has been very successful. See Rhinoplastic Operation. 

Tamarinds, though contained in the Pharmacopoeia, can hardly be said to 
be remedies of importance. The pulp of the fruit of the tamarind-tree, which 
grows both in the East and West Indies, is the part used. The pulp is sweet- 
ish, and at the same time sour. The fruit, as preserved and sent over to this 
country, is used in confection of senna. The pulp is slightly laxative, and is 
rather pleasant. 

Tannic Acid, or Tannin, is a powerfully astringent substance contained 
in oak bark, and a great variety of other vegetable products. It is ob- 
tained by exposing powdered galls to damp air for a short time; next ether 
is added, and squeezed out of the mass ; the mass is again pulverized, and 
again ether is added ; this is squeezed out and added to the other, and the 
tannin is obtained by evaporation. Thus prepared, the acid is a yellowish- 
white powder, of a very astringent taste. It turns all iron salts blue-black, 
and throws down gelatine. Tannin is a powerful astringent, as may be seen 
by applying it to the lips. It then causes the vessels to contract and the parts 
turn white. In the body it is converted into gallic acid, so that substance is 
more frequently given internally instead of tannin. Generally its effects are 
astringent, and closely allied to those of gallic acid. 

Tape-worm. There are three kinds of tape-worm which infest the in- 
testinal canal; these are fully described in the articles on Entozoa and Par- 
asites. 

Tapioca is the starch obtained from the Jatropha or Janipha manihot. 
The juice of the root is acrid and poisonous, but it is washed away, and the 
starch collected. From this starch is made cassava bread ; after it has been 
perfectly purified it constitutes tapioca. Abroad tapioca is sometimes used 
for a poultice ; here only as an article of food. 

Tapping. This is the common or popular name for the operation known 
to surgeons as Paracentesis. It is performed when it is necessary to re- 
lieve some internal organ by withdrawing the fluid that surrounds and 
oppresses it, as in the case of dropsy of the abdomen or chest, and sometimes 
in cases of water on the brain. 

Tar, or Liquid Pitch, as it is called, is obtained by the destructive distil- 
lation of various species of pine. It is a thick, black, treacly-looking sub- 
stance, with a strong and peculiar odor. If water be shaken with it the 
water smokes up ; some of its substance becomes brown, and has some- 
thing of the smell of tar. This water was at one time much extolled as a 
medicine. The composition of tar is very complex ; its only preparation is an 
ointment consisting of tar and beeswax. From the various substances it con- 
tains tar is a stimulant of value, especially for outward application. In some 
ncorrigible forms of skin disease, especially in the hands and feet, tar has done 
good, especially if the disorder be of a scaly kind. In many of these cases it 
may be given internally as well as externally. Tar itself, or its vapor, has 



TAR 754 TAX 

been used with great advantage in certain cases of lung disease, especially in 
chronic bronchitis and diseases complicated by it. The dose is about thirty 
grains made into a pill. An ounce or two of tar-water may be taken at a dose. 

Taraxacum, also known as dandelion, is the root and underground stem 
of the Taraxacum dens leonis, a well-known plant in this country. The 
roots should be gathered in winter. When cut they yield a milky juice, which 
blackens on exposure to the atmosphere. This juice is exceedingly bitter, 
and probably contains the active principles. The preparations are a decoction, 
extract, and juice. These are given with various intentions, but whether 
these intentions are ever fulfilled is doubtful. It is supposed to act on the 
liver, and to favor the regular moving of the bowels, and being bitter it helps 
to give an appetite ; at all events its action is not marked. The juice is the 
best preparation ; the dose is one or two drachms. The extract is a conven- 
ient pill base. 

Tartar is the deposit on the teeth which occurs in those who do not brush 
their teeth properly ; it may be scraped off ; cleanliness will prevent it from 
forming. 

Tartar Emetic, or Tartarated Antimony, is the most important prep- 
aration of antimony. It is a powerful emetic and depressant, and in small 
doses it acts as a diaphoretic ; two grains often suffice to produce vomiting. 
It is mainly used for its depressant effects. It is not now much employed. 

Tartaric Acid is procured from cream of tartar, a natural deposit from 
wines. First of all a tartarate of lime is formed, and from this the tartaric 
acid is set free by means of sulphuric acid. It exists in transparent, rather 
irregular crystals ; its taste is sour, but on the whole agreeable ; it is freely 
soluble in water. In the system tartaric acid and the substance with which it 
is combined are converted into carbonates. Tartrates are nearly neutral or 
even acid salts, but this property of conversion enables us to give them where 
alkalies are required, and they sit on the stomach very much better. The 
acid may therefore be given as a cooling drink, and yet appear in an alkaline 
form in the urine. Most frequently this acid is used for the production of 
effervescing drinks; ten grains or so is the quantity ordinarily used. See 
Effervescing Draughts. 

Taxis. This term signifies an attempt to return or reduce a rupture by 
simple manipulation. In cases of reducible and moderately-sized rupture the 
contents of the hernial sac may under ordinary circumstances be readily re- 
placed by slight pressure, or slip back spontaneously whenever the individual 
lies down. But when the rupture is strangulated, and the neck of the protru- 
sion is tightly compressed by the opening in the abdominal walls, careful and 
delicate handling is required in order to overcome the resistance, and at the 
same time to avoid injury and rupture of the inflamed coats of intestine. The 
patient should then be placed in an easy recumbent position, with the hips and 
knees bent, and the thigh on the side of the rupture rolled inwards, in order to 
relax the muscular and tendinous structures about the neck of the sac. He 
should be charged to abstain as much as possible from moving the body aud 
lower limbs, and to keep his head in one position and the mouth wide open. 
The surgeon, by gentle compression and kneading of the rupture, and by 
moving the parts at the neck of the sac, then endeavors to direct the dis- 
tended intestine and other contents of the sac through the canal leading to 
the abdominal cavity. The direction of the pressure is made to vary accord- 
ing to the anatomical nature of the rupture. In umbilical rupture the attempt 
is made to pass the contents of the sac directly backwards ; in inguinal hernia 



TEA 755 TEA 

outwards and upwards ; and in femoral hernia, first downwards and back- 
wards, and then upwards and inwards. In successful taxis the rupture, when it 
contains intestine, generally first shrinks a little, and then suddenly disappears 
with a gurgling sound. When the sac contains much omentum it is reduced 
slowly and gradually. The duration of the manipulation, in cases of obstinate 
rupture, should be adapted to the nature of the case and the probable condition 
of the contents of the hernial sac. In cases where the rupture is indolent and 
free from pain and inflammation, and no remote symptoms of strangulation are 
present, the surgeon generally feels justified in continuing his manoeuvres for 
twenty minutes or half an hour. In cases of strangulation, however, and 
especially after vomiting, the rupture ought to be handled with the utmost 
gentleness, lest the walls of the inflamed and probably gangrenous intestine be 
ruptured. If the strangulated intestine cannot be reduced by gentle taxis, the 
patient may be placed in a warm bath, and the attempt be repeated. This, 
however, is not in all instances a safe proceeding, as the patient may have 
been much exhausted by vomiting, etc. At the present day, after the failure 
of the first attempt at reduction, and in the presence of undoubted symptoms 
of strangulation, the surgeon places the patient under the influence of ether, 
again tries the taxis, and then, in case of a second failure, proceeds at once, 
whilst the patient is insensible, to perform a cutting operation. 

Tea consists of the leaves of several varieties of a small shrub found in 
China and India. Th^ leaves are gathered in the fourth year of the growth 
of the plant, which is generally dug up and renewed in its tenth or twelfth 
year. The leaves are cropped with care by gatherers, who wear gloves, wash 
frequently, and avoid eating things likely to affect the breath. The differ- 
ences between teas result from the varieties of soil and growth, and also from 
the mode of curing and drying the leaves. Black tea consists of leaves 
slightly fermented, washed, and twisted. Genuine green tea is made of 
exactly the same leaves, washed and twisted without fermentation ; but com- 
mercial " green " teas are often black teas colored with Prussian blue. Prob- 
ably five hundred millions of men, or nearly half the human race, now use tea. 
The chief action of tea depends firstly on its volatile oil (less in old than in new 
tea), which is narcotic and intoxicating ; and secondly on a peculiar crystalline 
principle called theine. Theine excites the brain to increased activity, but 
soothes the vascular system by preventing rapid change or waste in the fleshy 
parts of the body, and so economizes food. Four grains of theine contained 
in half an ounce of tea act in this way ; but if one ounce of tea containing 
eight grains of theine be taken in a day by one person, then tremblings, irrita- 
tion of temper, and wandering thoughts ensue. When the system is thus sat- 
urated with theine, it is useful to resort to cocoa as a substitute for a few days, 
when the symptoms subside, and the use of tea can be renewed ; but it is un- 
advisable ever to take it in such quantities as to occasion such symptoms. 
Tea contains also a quantity of tannic acid, which, being an astringent, is 
useful as a gargle in sore throat, and as an injection in some cases. By chem- 
ical analysis one hundred parts of good tea contain : — 
Water 5 0' 



Theine 3 

Caseine or cheese . . . . .15 

Aromatic oil 75 

Gum 18 

Fat 4 

Sugar 3 

Tannic acid 26 25 

Fibre 20 

Mineral matter 5 



I" Water 5 

J Flesh-formers 18 

1 Heat-givers 72 

[ Mineral matter 5 



TEE 756 TET 

In an ordinary solution of tea the flesh-formers remain with the leaves, but 
may be taken up by soda in the water. Hence the practice of the poor, of 
adding soda to the water when making tea, extracts much of its nutritive prop- 
erties. 

Teething. See Dentition. 

Temperament.' This is a term used by physiologists to distinguish a 
peculiar organization of the system in different individuals, and they are usually 
grouped into four classes. Physiologists recognize : — 

(1.) The Sanguine temperament, characterized by plumpness of body, fair 
or red hair, blue eyes, a soft, thin skin, active circulation, and a full, quick 
pulse. 

(2.) The Phlegmatic temperament is distinguished by a round body, soft 
muscles, fair hair, pallid skin, and slow, languid circulation and pulse. All 
the functions, mentally and bodily, are torpid. 

(3.) The Bilious temperament, known by firmness of muscle and flesh, de- 
fined sharp features, black hair and dark complexion, a full, firm, and moder- 
ately quick pulse. 

(4.) The Nervous temperament, characterized by a small spare frame, quick, 
impulsive movements, and a delicate constitution ; the pulse is small and weak, 
and easily excited ; the whole nervous system is susceptible, the thoughts quick 
and imagination lively. 

Some physicians place great reliance on the indications of temperament in 
the treatment of disease, and find that those who possess a sanguine tempera- 
ment are most liable to acute inflammatory diseases ; the phlegmatic inclining 
to scrofulous complaints; the bilious to affections of the liver and digestive 
organs ; and the nervous to mental disorders and diseases of the nervous system 
generally. 

Temperature. The temperature of an ordinary adult when a thermome- 
ter is placed in the arm-pit is 98.4° Fahr. ; in the mouth, 99.5° ; the blood is 
about 100°. In fevers this temperature is much exceeded, and it may rise to 105° 
or 106° ; a higher temperature than this will generally prove fatal, unless it 
descend soon ; the highest temperatures recorded have been in some cases of 
rheumatic fever, when the body rose to 109°, and even to 111°. The tem- 
perature of a hot bath is about 98° ; of a tepid bath 70-75°. In describing 
the fevers, the value of the temperature as a symptom is noticed in each case. 

Tendo Achillis. The longest tendon of the body, and the great leverage 
of the heel, being the extensor miuscle of the leg. The ancients gave it the 
name from the fable that Thetis held the boy Achilles by the heel when she 
dipped him into the Styx, and made all the rest of his body invulnerable. 

Testicles. The male secreting organs in the human body, two in num- 
ber, situated in the scrotum, and containing the procreating fluid of. the male. 

Tetanus. This is an affection characterized by painful and rigid contrac- 
tion of the voluntary muscles, which is persistent and aggravated from time to 
time by very severe spasms. The two chief forms of tetanus are the traumatic, 
when it occurs after wounds, and the idiopathic, which comes on in the ab- 
sence of any manifest cause. In the former, the spasms are usually severe 
and acute ; in the latter they are milder and chronic. Traumatic tetanus, how- 
ever, is sometimes a subacute or even a chronic affection. The following are 
the symptoms that may be presented in a severe attack of tetanus following a 
wound : After certain common symptoms, such as a feeling of general uneasi- 
ness, headache, and feverishness, have been experienced, the patient complains 
of stiffness of the jaws and at the back of the neck ; swallowing is difficult, the 



TET 757 TET 

voice is low and husky, and there is a peculiar expression of the face due to 
contraction of the muscles which move the lips and eyelids ; the patient next 
suffers from painful cramp in the muscles of the face and neck, and, in conse- 
quence of permanent rigidity of the muscles of mastication and spasms of the 
gullet, is unable to take any food ; to this stage, in which the mouth is firmly 
closed, has been applied the name of locked-jaw ; the spasms then attack ihe 
muscles of the abdominal walls, and violent pain is felt at intervals at the pit 
of the stomach ; the front of the abdomen is retracted, and the muscles during 
the severe paroxysms feel to.- the hand like a hard board ; the voluntary muscles 
of the back and limbs finally become affected and very painful ; cramps are felt 
over the whole body, which as the affection progresses are divided by shorter 
and shorter intervals ; the bowels are generally bound, and there is often reten- 
tion of urine ; the symptoms increase in intensity, and at last death occurs 
either from pain and exhaustion, or in consequence of spasms of the diaphragm 
and other muscles of respiration ; the mental faculties generally remain unim- 
paired, until very shortly before death. The usual duration of an attack of 
severe and fatal tetanus is from three to six days. Cases, however, have been 
recorded in which death occurred within a few hours after the commencement 
of the symptoms. 

The symptoms of acute traumatic tetanus vary much in different cases ; the 
spasms may be restricted to a certain region or a certain set of muscles, or 
they may commence at the seat of the wound, and not, as is usually the case, 
in the muscles of the jaw. The ordinary tetanic symptoms may be complicated 
by epilepsy, delirium, and coma. In one remarkable case, reported by Sir G. 
Blane, there was intense general spasm unattended by pain. It is stated that 
in this patient the paroxysms of cramp were attended by feelings of pleasure 
and a strong tendency to laughter. 

There is no injury to the surface of the body, however slight it may be, of 
which acute tetanus might not be a result, and there is no relation between the 
extent and degree of the injury and the intensity of the tetanic symptoms. It 
has been known to follow slight contusions and blows with a stick or cane. It 
rarely occurs after clean cuts, and is mostly connected with contused wounds 
involving nerves and the fibrous structures, as fascia?, tendons, and ligaments. 
With regard to locality, it has been stated that tetanus occurs more frequently 
after wounds of the hands and feet and their respective digits. The interval 
between the receipt of the injury and the commencement of the tetanic symp- 
toms, the so-called period of incubation, varies in different cases. In the ma- 
jority, the symptoms come on between the fourth and the tenth day ; the period 
in many lasts from ten to twenty days ; but is extended over the twenty-second 
day in only ten out of every hundred cases. It has never been known to ex- 
ceed a month. The symptoms sometimes come after an interval of only a few 
hours, and one instance has been recorded in which a negro was attacked with 
tetanic spasms in a quarter of an hour after his hand had been punctured with 
a fragment of china ware. The shorter the interval,, the more severe are the 
symptoms. Tetanus, when it occurs before the tenth day after the injury, is 
usually fatal ; in cases occurring after the tenth day, the mortality is much re- 
duced. Tetanus is much more frequent in males than in females, and in the 
latter its symptoms are less severe. Tetanus may occur at any period of 
life, but in more than half the number of recorded cases, the patients were be- 
tween ten and thirty years of age. Among negro populations, especially in 
the West India Islands, acute tetanus often attacks new-born infants, and has 
been attributed to irritation of the stump left after division of the umbilical 



TET 758 TBT 

cord. It has been asserted that tetanus is most fatal in patients under ten 
years of age, and least fatal in patients between ten and twenty years of age. 
The accession of traumatic tetanus does not seem to be influenced in any way 
by morbid conditions of the body, or by previous states of bad health. The 
healthy and the unhealthy, the strong and the weak, are equally affected. 
Negroes and Asiatics are much more liable to attacks of tetanus than white 
races. Americans and Europeans are not rendered more disposed to tetanus 
by residence in the tropics. It has been stated that the disease is met with 
more frequently at periods of the year in which there are frequent and sudden 
changes of temperature. 

The course and symptoms of an attack of idiopathic tetanus resemble very 
much those of the acute traumatic form, but are rarely so intense. The chief 
causes of the so-called idiopathic tetanus are exposure to cold and wet, and in- 
testinal irritation. It is rarely met with in this country, but occurs frequently 
in the tropics. 

The symptoms of tetanus may resemble very much at first sight those of 
hydrophobia, and in some cases the medical attendant experiences considerable 
difficulty in establishing a perfectly satisfactory diagnosis. The following are 
the chief points of difference in these two dangerous affections : in tetanus the 
muscular spasm is persistent, and perfect relief never occurs for a single in- 
stant until a short time before death; in hydrophobia the spasms are always 
of brief duration, and alternate with periods of complete relaxation and relief ; 
the persistence of the muscular contraction in tetanus is most marked in the 
lower jaw, which in almost all cases remains fixed and immovable. In hy- 
drophobia there is a constant flow of saliva, and the patient complains of great 
thirst; in tetanus these two symptoms are usually absent; the countenance in 
tetanus is generally expressive of intense suffering ; in hydrophobia, not so 
much of physical suffering as of excessive restlessness and mental excitement; 
in the latter affection the mental faculties are always much disturbed, and the 
patient often falls into a state of violent delirium and maniacal excitement; in 
tetanus, on the other hand, the mind usually remains undisturbed, until the 
termination of the attack ; in hydrophobia there is an aversion to fluids, the 
very thought of which very much excites the patient ; in tetanus there is no 
mental aversion to flufds, but when an attempt is made to administer them, the 
patient endeavors to express by action his inability to open the jaws and to 
swallow. Any reliable history as to the bite of a dog about six weeks or two 
months previously will at once establish the diagnosis in doubtful cases of hy- 
drophobia. Tetanus, though a very dangerous affection, is not always fatal ; 
in acute cases, where the symptoms commence shortly after the receipt of a 
wound, recovery seldom occurs, but when the attack comes on after the tenth 
day from the receipt of the wound, and the tetanic symptoms last over fourteen 
days, recovery is the rule and death a rare exception. No case of recovery 
from hydrophobia has been hitherto recorded. Symptoms somewhat analogous 
to those met with in severe cases of tetanus are produced by poisonous doses 
of strychnia or strychnine, the alkaloid of certain plants belonging to the order 
Strychnos, namely, the mix vomica, the S. Sancti Ignatii, or St. Ignatius bean, 
aud the S. tieute,- all natives of tropical regions. The symptoms of poisoning 
commence soon after the strychnine has been swallowed, and set in with short- 
ness of breath, rigidity of the muscles of the neck and back, and painful tetanic 
spasms of the extremities ; the body is usually arched backwards, so as to rest 
on the head and heels. The muscles of the face are much convulsed, so as to 
produce a characteristic grinning expression, called the risus sardonicus. All 



TBT 759 THO 

the voluntary muscles are attacked at about the same time, and there is no 
persistent contraction of the muscles of the jaw ; in these respects, and also 
from the prominence, among the symptoms, of backward arching of the body, 
and from the occurrence of intervals of complete intermission, the phenomena 
of strychnine poisoning differ from those of acute traumatic and idiopathic 
tetanus. 

No continued success has yet attended the administration of any one of the 
numerous medicinal agents that have been tried in cases of severe tetanus ; 
calomel, opium, chloroform, belladonna, aconite, quinine, Calabar bean, and 
Indian hemp have all been extensively used, in some cases with undoubtedly 
good results, in others with signal failure. No drug is yet known which has 
the power of arresting the course of the disease, and of controlling its severer 
symptoms. So long as tetanus is to be regarded as a disease which must run 
a certain course, the chief indications of treatment will be the support of the 
patient's strength and the relief of suffering and pain. Fluid and easily 
digested food, with wine or spirits, must be freely supplied, and when the 
patient is unable to open the mouth or to swallow should be administered 
by enemata or through an elastic tube passed through the nose into the gul- 
let. Pain may be relieved by the internal administration of opium, by subcuta- 
neous injections of morphia, or by inhalation of ether. In many cases painful 
and violent muscular spasm has been much allayed by the application, along 
the spine, of bladders of ice. Great care must be taken to guard the patient 
from all causes of excitement and irritation, and the room in which he is con- 
fined should be kept darkened and at an uniform temperature. It is very 
important that there should be a speedy and free evacuation of the bowels. 
In cases of traumatic tetanus following a wound the injured part, if painful 
and inflamed, should be poulticed and kept as much as possible at rest. 

Tetter. A disease of the skin, which often appears on the face and the side 
of the mouth, and requires simple treatment, such as an alkali like bicai'bonate 
of potash or soda, internally, and the application outwardly of powdered oxide 
of zinc occasionally. 

Theine. See Tea. 

Thermometer. This is an instrument for measuring the temperature of 
a room. A tube of glass, with a bulb blown at one end, but open at the other, 
is filled partly with mercury ; on heating the mercury the bulb and tube be- 
come filled with mercury, and the vapor of mercury and all the air is driven 
out ; the open end is then herineticalby sealed in the flame of the blow-pipe. 
The freezing-point and the boiling-point are the two standards taken, because 
under ordinary conditions at the sea-level these are fixed points. The ther- 
mometer is immersed in melting ice, and then the point at which the mercury 
stands is scratched on the glass ; it is then placed in boiling water and the 
level Of the mercury is noted. On the Fahrenheit scale this distance is divided 
into 180 degrees, on the Centigrade scale into 100 degrees, and on the Reau- 
mur scale into 80 degrees. The freezing-point is called zero on the last two 
scales, but 32 on the Fahrenheit scale. 

Thoracentesis. The operation of puncturing the chest to allow the es- 
cape of an effused fluid. See Paracentesis Abdominis, Tapping. 

Thoracic Duct. A narrow tube lying in front of the spine, which con- 
veys the chyle and lymph from the receptaculum chyli into the blood by its 
communication with a vein at the root of the neck. 

Thorax. An anatomical name for the chest. 

Thorn Apple. See Stramonium. 



THR 760 TOB 

Thread Worms, or Oxyuuides, are often found in children ; they are 
like stoall pieces of white thread, and infest the lower portion of the bowel. 
See Entozoa. 

Throat. See Sore-throat. 

Thrombus occurs when a plug is formed in a vessel during life ; it is 
generally met with in veins, but may occur in the heart or in an artery. 

Thrush is a common affection in children. It may be seen in the mouth 
as small white specks on the lining membrane, but this may be so also in 
various parts of the intestinal canal. It is often due to mal-nutrition and bad 
feeding, and often to the milk being sour. The treatment must consist in 
altering the diet (see Diet), in washing the mouth with chlorate of potash in 
a watery solution, of- in letting the child suck honey and borax. Only liquid 
food should be given, and some lime-water in the milk is often beneficial. 

Tic, the common and short term for tic douloureux, is that form of neuralgia 
which specially affects the fifth nerve, the sensory nerve of the face. Either 
of its three branches may be affected, but in pure neuralgia it is most likely to 
be the uppermost. The other two, namely, the superior maxillary and inferior 
maxillary, are much more likely to be affected with a kind of counterfeit neu- 
ralgia or reflected pain, caused by bad teeth or gums. In all of these cases the 
jaws must be carefully examined ; and if any good is to be done all bad stumps 
are to be removed, and the gums, as far as possible, rendered free from ten- 
derness. See Neuralgia. 

Tin is a metal found in the form of various ores, of which tin pyrites and 
tinstone are the most important. Jt was first introduced as a medicine by Dr. 
Alston, the first professor of materia medica in the University of Edinburgh, 
and it has since been constantly employed as a vermifuge. The mode of ad- 
ministering it is to give at least half an ounce of the powder every morning 
for three successive days, while the stomach is empty, and then to carry it off 
with a brisk purgative. It is given in the form of electuary, made up with 
treacle or orange confection. It is undoubtedly effectual in cases of ascarides 
and lumbrici, but is less so in taenia. Its action is probably mechanical only, 
for there is no property in the intestinal secretions or other contents, in con- 
sequence of which tin could be dissolved ; and, besides, the worms are alive 
when discharged. A chloride of tin is a good disinfectant. 

Tobacco consists of the leaf of the Nicotiana tabacum, or tobacco plant, 
growing in America. Another variety of the plant, the N. rustica, is culti- 
vated in Asia Minor for Turkish tobacco. The leaves are large and oblong, 
covered with short downy hairs, and have a heavy odor when they begin to dry. 
The dried leaves only are used. 

Tobacco contains a peculiar and powerful alkaloid called nicotine. This, 
when freshly prepared, is colorless, but grows brown when older. It is ex- 
ceedingly powerful and very poisonous. The only preparation of tobacco is 
an enema, but that nowadays is rarely used. Tobacco is a powerful sedative, 
and causes, perhaps through the faintness it induces, general relaxation of all 
parts of the body, especially of the muscles. It is hardly ever given internally, 
and the enema, which used to be employed to procure relaxation in parts con- 
cerned in strangulated hernia, has been displaced by ether. 

Tobacco, in the form of snuff, may act as a powerful irritant, especially to the 
eyes and nose. But tobacco is almost invariably employed in the form of 
smoke, as from a pipe or cigar. Used thus there can be no doubt but that it 
produces a powerful sedative effect, calming and soothing, if used in the proper 
do^e. This is easily known, as a dose too strong, and that is entirely relative, 



TOL 761 TON 

speedily turns the individual sick and faint. This may sometimes be useful in 
procuring relaxation of parts under the influence of muscular spasm, as in 
asthma. It is an important question whether tobacco used in moderation does 
good or harm. Used immoderately, like everything else, it is a great evil ; 
used in moderation, it is often of good service. It has been said that it is apt 
to give rise to a certain form of blindness ; that would only arise from im- 
moderate use. Its use by young people is not desirable. 

Tolu Balsam is one of those substances allied to storax and balsam of 
Peru. They all contaiu cinnamic acid, and possess very similar properties. 
Tolu is lighter in color and denser than is the Peruvian balsam. It is seldom 
or never used, except as compound tincture of benzoin or Friar's balsam, 
which contains the substance. 

Tongue. In structure the tongue consists essentially of muscular tissue 
covered by mucous membrane. The muscular fibres, omitting those of mus- 
cles inserted into the organ, are arranged in two horizontal and several verti- 
cal layers, the former set lying immediately underneath the mucous membrane, 
and the latter passing vertically from between the horizontal layers, leaving 
intervals which are occupied by gland structure. ' The mucous membrane is 
furnished with papillce. (1.) The circumvallate, which are a dozen or so in 
number, and are arranged at the base of the tongue like an inverted V ; these 
papilla? are greatly concerned in taste, and are supplied by the glosso-pharyngeal 
nerve. (2.) The fungiform ; these are scattered over the tongue, and are. 
specially observed at the sides and tip. (3.) The conical or filiform are. dis- 
tributed all over the tongue. The tongue is divided into two symmetrical 
halves by a fibrous septum, the existence of which is marked by a raphe in 
the median line. 

Diseases. Tongue-tie is a condition in which the framum, or fold, seen on 
the under surface, extends to the tip, and appears to tie the organ clown to the 
underlying structures ; its division, by means of a pair of blunt-pointed scis- 
sors, readily remedies the defect. 

Inflammation of the tongue (glossitis) may be caused by wounds, or stings, 
or by the application of some acrid substance ; occasionally it comes on with- 
out any apparent cause. If the symptoms are not peculiarly urgent — that is 
if there be no great pain or swelling, or threatening of occlusion of the fauces, 
a leech or two under the jaw and a smart purgative usually afford relief. If 
the inflammation be very sudden, its progress rapid, and suffocation threaten, 
then a few longitudinal incisions should be made on its surface to allow of the 
escape of fluids. In very severe cases, where these measures afford no relief, 
and the symptoms are -ery urgent, tracheotomy must be performed. Glossitis 
is sometimes brought on by the excessive use of mercury ; the treatment in 
such cases consists of purgatives, astringent lotions, and careful bandaging of 
the organ, and full doses of chlorate of potash internally. 

Ulceration. Ulcers of the tongue may have their origin from several causes : 
either from local irritation, such as decayed teeth, or from some derangement 
of the digestive organs, in fevers, or from syphilis, or from the prolonged and 
mal-administration of mercury. In all cases there is a marked foulness of 
breath. The constitutional treatment of course varies with the case ; the re- 
moval of all obvious irritation, attention to the bowels, and locally the applica- 
tion of a solid stick of lunar caustic, the sucking a few crystals of chlorate of 
potash, and in syphilitic ulceration the application of a little calomel powder 
diluted with flour, are about the best remedies. Those connected with second- 
ary or tertiary syphilis are the most intractable, and frequently defy all treat- 



TON 762 TON 

ment. Malignant ulcers of the tongue are epithelial in their character, and 
their development is frequently ascribed to local irritation, such as a sharp 
stump of a tooth, the habit of smoking short clay pipes, etc., but such causes 
are very questionable. The margins of such ulcers are composed of hard 
granulating masses, implicating the substance of the tongue, and ultimately in- 
volving the glands at its base ; under the jaw and in the neck they are attended 
with great pain, and are usually deeply excavated. The pi'ognosis in these 
cases is very unfavorable. The treatment is unsatisfactory, and consists in 
removal as the only chance for the sufferer. 

Enlargement (hypertrophy) occurs in young persons, and is nearly always 
congenital. The tongue protrudes from the mouth, becomes ulcerated from 
contact with the lower teeth, and there is a constant dribbling of saliva. The 
treatment consists in attention to the state of the digestive system, bandaging 
the organ, and astringent lotions. In cases where this treatment is of no use, 
removal of a portion or the whole of the protruded part must be performed. 

Tumors in connection with the tongue are sometimes met with. Of the most 
frequent occurrence is ranula, to which a special article is devoted (see Rax- 
ula), encysted tumors, closely resembling ranula, fatty tumors, and nsevi. 

The ducts of the salivary glands, the parotid, and submaxillary, are some- 
times the seats of concretions composed of phosphate of lime and animal mat- 
ter, oval in shape, of a brownish or yellowish color, and of variable size, some- 
times being as large as a small egg. Occasionally they come away of their 
own accord by ulcerating through their confines, but the treatment consists in 
their removal by the knife and forceps. 

Wounds of the tongue almost always bleed very freely ; in slight cases, iced 
water or styptics will arrest the haemorrhage, or occasionally a vessel may be 
tied, or pressure may be kept up by a pair of common forceps, the blades of 
which are kept together by an elastic band. The edges of a severe cut or lac- 
eration should be approximated with sutures. All pain, swelling, etc., should 
be allayed by iced drinks, and astringent and disinfecting gargles or washes. 

Tonics. A class of remedies supposed to give strength and tone to the 
system, of which quinine and iron are examples. 

Tonsils. The tonsils are two glandular structures, situated between the 
anterior and posterior pillars of the fauces, one on each side. (See Fauces.) 
They are somewhat oval in shape, varying in size in different individuals. 
They consist of a congeries of mucous glands, and their internal surface is 
marked with small holes ; these are ducts leading from the cells in which the 
mucus is secreted. The use of the mucus is to lubricate the fauces during the 
passage of food, and it is expressed at the moment of deglutition. The tonsils 
lie in close proximity to some very important blood vessels — namely, posteri- 
orly, the internal carotid artery and the jugular vein, while externally are the 
trunks of the temporal and external maxillary arteries, and between the ves- 
sels and the tonsil is the superior constrictor of the pharynx. Hence any op- 
eration upon the tonsils must be conducted with great care. 

Diseases of the Tonsil. Tonsillitis, cynanche tonsillaris, or quinsy, is an 
inflammation of the tonsil and tissues immediately surrounding it, generally due 
to cold, exposure, or some peculiar condition of the body, sometimes to cutting 
the last molar teeth, the swallowing of some irritant, playing on wind instru- 
ments, etc. It commences with shiverings, feverish symptoms, redness, swell- 
ing, heat, and dryness of the fauces and tonsils. There is great pain in swal- 
lowing and attempts at articulation. It sometimes ends with a tardy ulcera- 
tion, or suppurates, or by becoming erysipelatous spreads down the air-pas- 



TOO 763 TOO 

sages. Sometimes small pustules or follicular abscesses appear, forming a yel- 
lowish, ulcerated surface ; again, a most formidable symptom is the formation 
of a thick, tough, whitish pellicle, resembling wash-leather, on the surface of 
the tonsil, pointing to diphtheria. (See Diphtheria.) The treatment con- 
sists, in mild cases, of the internal administration of minderus spirit, the exter- 
nal application of linseed-meal or hemlock poultice, and a gargle of warm 
water. The application of lunar caustic is of great value. In the severe diph- 
theritic cases, swabbing with glycerine and perchloride of iron, tonic treat- 
ment, good living, fresh air, and stimulants are necessary. If abscess occur, it 
requires to be actively treated at once, as respiration and deglutition are im- 
peded, and the matter should be evacuated. The left forefinger is to be intro- 
duced into the mouth, the tongue depressed, and a straight sharp-pointed knife, 
with its back resting on the tongue and its point directly backward, is plunged 
into the centre of the exposed tumor. The edge and point of the knife must 
be carried inwards towards the middle line, and never outwards, else the ves- 
sels already mentioned be wounded. If bleeding be very severe, a strong so- 
lution of the perchloride of iron must be applied to arrest it. 

Ulceration of the Tonsils is frequently caused by the irritation of carious 
teeth, or cutting the wisdom teeth. Again, a frequent cause is syphilis, and 
in such cases constitutional treatment with iodide of potass, or some mercurial 
combined with a tonic, and the local application of lunar caustic, or in severe 
cases nitric acid, is indicated. A disinfecting gargle of Condy's fluid, or chlori- 
nated soda is of value in all such cases, as the odor of the breath is offensive. 

Enlargement of the Tonsil is often the result of quinsy, and is frequently met 
with in scrofulous children or adults of weak habit. The tonsils in such cases 
are greatly enlarged, projecting, as fleshy excrescences, into the back of the 
fauces and sometimes almost entirely occluding them, interfering greatly with 
deglutition, speech, and breathing, producing a peculiar guttural tone of voice, 
and causing snoring during sleep. In young children, cod liver oil and other 
anti-scrofulous treatment may be of service ; in adults nothing is of any perma- 
nent good but removal, or partial removal, of the hypertrophied gland tissue. 
The gland is seized with a pair of long-clawed forceps, dragged out from its 
bed towards the middle line of the fauces, and a blunt-pointed curved bistoury 
(with its edge, all but an inch or so, covered with lint or plaster) is passed behind 
it and made to cut its way towards the middle line of the fauces, and away from 
its pillars. The bleeding and pain are very slight general^, and any bleeding 
can be controlled with iced water or tincture of perchloride of iron. The en- 
larged gland tissue hardly ever returns. In removing tonsils in children it is 
as well to administer ether. 

Toothache. This most distressing ailment is too well known to need de- 
scription, and is apt to attack any one, though some families and constitutions 
seem more subject to it than others. It is a sort of neuralgia, aud frequently 
depends on the condition of the general health, which reacts on the nerves, and 
especially on any susceptible nerve which may be exposed to contact with the 
air in a decayed tooth. Decay in teeth is occasioned chiefly by the collection 
of particles of food, which set up a fermenting action and extend the process 
of decomposition gradually to the bone of the tooth, and so wear away the 
enamel, and form a little point of opening for the nerve to become affected. In 
order to avoid this, great care should be taken to keep the teeth well cleaned, 
and when possible to brush them after every meal. When any tiny speck of 
discolorization is perceived, it is wise at once to go to the dentist and have the 
decay removed, and the aperture filled with gold. Any accumulation of tartar 



TOR 764 TRA 

on or around the teeth should be carefully removed. „When, however, tooth- 
ache has" 1 really seized a victim, the only chance is either to summon up cour- 
age to have the offender extracted at once, or to try one of the many remedies 
which exist, and have in some cases been found beneficial. Creasote, chloro- 
form, eau de Cologne, and brandy on wool will often cause a cessation of pain 
for a time ; but these are simply stimulants, and often sedative measures are 
more effectual. When the gum is much inflamed, a leech applied to it and al- 
lowed to draw freely will often give relief, and a poultice of bread and milk 
held in the mouth is sometimes comforting. Experience, however, goes to 
prove that endurance is the only remedy to be relied on in toothache ; that in 
time the pain will cease, and that if the sufferer cannot make up his mind to 
baar it the only effectual cure is extraction. 

Tormentilla is the root of an indigenous plant belonging to the rose tribe ; 
it is not now used in medicine. Its properties are astringent, and the substance 
may be used as an astringent when no more powerful remedy is at hand. 

Tourniquet. The tourniquet is an instrument for the mechanical compres- 
sion of a vessel in order to prevent haemorrhage. The first tourniquet was used 
in 1G74, and was the invention of the French surgeon Morel, and was a rude 
contrivance, consisting of a stick passed beneath a fillet or band, and twisted 
round so as to constrict the limb to the requisite degree of tightness. A great 
improvement was made upon this in the early part of the following century by 
J. L. Petit, also a French surgeon, and his tourniquet consisted essentially of 
two metallic plates, which could be separated from one another by means of a 
screw, so as to tighten a strap which was connected with them, and also encir- 
cling the limb. The common tourniquet now in general use is based upon that 
just described, and it consists of a firm, narrow, flat pad to compress the artery, 
a strong piece of webbing or band to pass round the limb, and a bridge furnished 
with rollers, over which the band passes, and a screw which raises the bridge, 
and thus tightens the band. The pad must always be so arranged that it com- 
presses the artery against the bone. On applying it the band should first of all 
be buckled tightly, when, by turning 'the screw, great pressure is obtained. 
Care should he taken that the screw be opposite the buckle of the band. 

Signoroni's tourniquet consists of an arc of steel with a hinge joint in the 
middle, and a screw by which the extremities of the instrument are pressed 
together. 

Cartes circular tourniquet is a contrivance which envelops the whole pelvis 
like a well-padded saddle, and the pressure exerted is produced by india-rubber 
bands acting upon the pad and its screw. 

Malan's tourniquet employs compression vertically by means of lateral press- 
ure obtained from side screws. 

Tourniquets are very useful in the absence of assistance, for,' if properly ad- 
justed, they at all events stop haemorrhage ; but they have this disadvantage, 
that when applied to an artery they also compress the vein or veins of the limbs, 
rendering the venous haemorrhage more profuse. 

Tracheotomy. The operation of opening the trachea, or windpipe, to 
save the patient's life. It is sometimes necessary in cases of croup and diph- 
theria, and when suffocation is imminent from the pressure of a foreign body 
in the air-passages. See Lauyngotomy. 

Tragacanth is a kind of gum obtained from a plant growing in Asia Minor. 
It is allied to gum acacia. The gum exists in flakes, not easy to powder till 
well heated. Part of it is soluble in water, and this suspends the rest, so that 
it forms a thick, tenacious mucilage, much denser than that formed by gum 



TRA 765 TRU 

arabic. This mucilage is useful for suspending heavy powders. A compound 
powder consisting of tragacanth, gum acacia, starch, and sugar, mixed with hot 
water and allowed to cool, is useful in the same way. 

Training, that is to say a system of physical education, is too much neg- 
lected among us. It is quite true that for boating and the like, training is 
looked to, but then the exercise is excessive, and likely in the long run to do 
harm rather than good. The systematic use of certain exercises and the regu- 
lation of food and diet are calculated to do good, but they must be sensibly 
conducted, or the reverse is the case. 

Trance. A curious and interesting phenomenon, presented occasionally in 
what is understood by cataleptic conditions of the body. The symptoms are so 
peculiar, and so often connected with deceptive action on the part of the patient, 
that they are most difficult to investigate. 

Trichina? are animal parasites which find their way into the muscles of the 
human body, often with fatal results. 

Trocar. A surgical instrument used for the purpose of perforating the 
abdomen or chest when fluid has to be drawn off by tapping, as it is called. 

Tropical Regions are fruitful sources of disease, both directly and indi- 
rectly. Life in the tropics is more wearing than in a cooler climate, and the 
malarious character of tropical regions renders them unhealthy to Americans. 
Then, too, the habits of tropical life and of our own cooler country are hardly 
compatible. The use of stimulants, almost demanded by the exhausting heat, 
is apt to lay the foundation of liver and kidney disease. It is, in point of 
fact, these two causes which mainly render the tropics unhealthy. If one 
can avoid malaria and so escape splenic disease, and at the same time contrive 
to keep clear of liver disease, there are many places worse than the tropics ; 
but to preserve health the life must be steady, and attention must be bestowed 
on appropriate clothing. What this must be will depend very much on the 
situation inhabited, but the broad rules laid clown are the guides to health there 
as here. Every one going to tropical regions ought to provide themselves with 
a little quinine and a little calomel. These are the two great remedies required. 

Truss. Trusses are mechanical contrivances for the support or for the 
prevention of the protrusion of any viscus, but most usually for the support 
of the parts concerned in abdominal rupture or hernia. If a hernial profusion 
occurs in either sex, mechanical treatment should be adopted at once, for 
whether the patient be in infancy, youth, or middle age, judiciously applied 
trusses frequently effect a cure, without further surgical interference, and at all 
events cause but little trouble or annoyance. A surgeon should always be 
consulted as to the form of truss needed, and should himself take the necessary 
measurements, and apply the apparatus in the first instance. It is a great 
mistake, and one productive of the worst results, to leave the advice of a 
truss to an instrument maker, and we often see instances, especially amongst 
the poor, of ill-fitting, ill-shaped contrivances, which not only do no good at all, 
but in many cases do absolute harm, by increasing the mischief they are de- 
signed to alleviate. A truss should be firm, light, and elastic, and preserve its 
shape, and the strength of the spring should always be equable, so that it may 
retain the rupture without irksomeness. A truss consists essentially of a pad 
attached to a metal spring, having straps so arranged that it may be kept in 
the desired position in any of the various movements of the body. There are 
many different forms, whether single or double, named after their inventors, such 
as Coles', the Mocmain, Salmon & Ody's, etc., for the general principles of 
which see Hernia. The best, however, anatomically considered, is Wood's or 



TUB 766 TUM 

the horse-shoe truss, which, by its peculiar arrangement, so adapts itself to the 
margins or pillars of the abdominal rings through which a hernia descends that 
by the pressure it exerts it tends to bind them together. The following hints 
on trusses are of value, as the experience of an authority on the matter : — 

" In the majority of cases, the circular spring truss is the best form. The 
curve of the spring and the relative position of the pad with it should be ap- 
propriate to the configuration of the wearer. A single piece of metal should 
form the spring and foundation of the pad. As far as practicable the spring 
of the truss should pass around the bony rim of the pelvis, fitting closely to 
the figure, and should lie out of the region of the great muscles of the but- 
tock (glntcei). The form of the spring may be designed after the French 
model or the German. The former resembles the coil of a watch-spring, and 
is very elastic and clinging; the latter almost exactly fits the outline of the 
body in its state of repose : it is almost inelastic, and very hard. The French 
is always pressing inwards, even when the wearer is at rest ; the German 
scarcely presses at all when the abdomen is soft, but resists with power when 
any expulsive force makes the abdomen swell. The best shape for the spring 
is one which forms a medium between the two. The pad should be of mod- 
erate dimensions. For the adult it should not exceed two and a half inches 
in length, and two inches at the widest part. Its superior edge should follow 
the upper line of the spring, which falls a little from the shoulder or bend, 
where it lies in contact with the hip. The inner surface should be directed 
slightly upwards. The proper shape for the pad, and the materials of which 
it should be constructed, may be varied to accommodate particular cases. The 
wearer generally discovers after a while which kind of pad is most free from 
annoyance ; that pad, however, is the best which maintains perfect and unin- 
termitting retention of the hernia. Every pad should. have attached to it two 
studs, one near its junction with the spring, and another at its lowest point. 
To the upper one the transverse strap, passing from the free end of the spring, 
is attached ; the lower stud is used with the thigh strap, which should be al- 
ways worn. It is loosely fastened on to the spring of the truss near its 
shoulder, and should fall along the hollow beneath the buttock. In the erect 
posture of the wearer this strap should be moderately tight ; it prevents the 
pad from shifting, and should never be discarded." The pad may be pre- 
vented from fretting the skin by covering it with fur, or by the interposition 
of some soft substance. 

Trusses for ventral, umbilical, and femoral hernia are also constructed. In 
the case of crural or femoral hernia " the spring should fall somewhat sud- 
denly from the point where it passes around the hip, and lie along the fold of 
the groin (Poupart's ligament). The pad should be rather small and convex. 
The cross-strap should fasten high up on to the shoulder of the spring, in order 
to keep the pad well down on the thigh. The thigh strap should start from 
near the pad, and return, after encircling the thigh, to the pad itself." In 
a large hernia, or one which has become irreducible, a bag truss is indispen- 
sable. Trusses are also in use for the support of prolapse of the worn I) or 
rectum, and constructed of various forms by different makers. See Hernia. 

Tubercular Meningitis. See Meningitis. 

Tuberculosis is a name applied to a form of fever which is accompanied 
by the formation of small bodies called tubercles in various tissues ; when they 
are deposited in the membranes of the brain, they give rise to the disease 
known as tubercular meningitis, or acute hydrocephalus. 

Tumors. Tumors or new growths are divided by pathologists into two 



TUR 767 TUR 

main groups; one of innocent or benign growths, the other of malignant 
growths. The latter are distinguished by the following common characters : 
rapidity of growth, tendency to infiltrate and to replace the tissues of the 
affected part, tendency to recur after removal by operation, tendency to mul- 
tiply locally and to infect other and remote parts of the body, and tendency to 
destructive and progressive ulceration, inducing fatal exhaustion through pain, 
continuous discharges, and occasional loss of blood. To any tumor presenting 
these so-called characters of malignancy, the term cancer was applied by pa- 
thologists of a past generation, but at the present time, in consequence of the 
extensive use of the microscope in pathological research, there is a tendency 
to classify tumors with regard more to minute structure than to clinical char- 
acters. The tumors constituting the malignant differ much in consistency and 
in minute structure, but the great majority of them have been referred to one 
of the following two great divisions : that in which the growth is composed of 
some form of connective tissues, and that in which it is made up in great part 
of cells resembling in character those found in the epidermis, on mucous mem- 
branes, and in the ultimate lobules of secretiug glands. To the former divis- 
ion belong tumors that are called sarcomata or Meshy growths ; to the latter 
belong the true cancers or carcinomata. Structurally the two are distinct ; 
with regard to clinical characters and malignancy, their resemblance is very 
close, the chief distinctions in these respects being the facts that cancer almost 
invariably, and sarcoma seldom, affects secondarily the lymphatic glands, and 
that the latter usually appears at an earlier period of life. See Cancer. 

Innocent or benign tumors may occur in almost any part of the body, and 
they may vary in chai-acter from so simple a growth as a wart up to forma- 
tions which may endanger life or require some serious surgical operation for 
their removal. It would be useless to attempt in a work like this any useful 
classification of tumors, as any properly devised system would be unintelligible 
to the ordinary reader. The question with most people who find a tumor is 
forming is as to its being of a cancerous nature or not, and this can only be 
answered by obtaining the advice of a medical man. Much harm is done by 
the reckless way in which patients, to get rid of their malady, fall into the 
hands of those who pretend to cure them, while too often they only hasten on 
the fatal termination. The great majority of small tumors are harmless in 
character, and often cause inconvenience rather than any other distress, but in 
all cases proper surgical advice must be taken before recourse is had to re- 
moval. 

Turkish Bath. See Bath. 

Turmeric is the underground stem of a plant (curcuma) growing in Cey- 
lon. It contains a substauce, bright yellow in color, which alkalies readily 
turn brown. A solution of this material in alcohol, or paper smeared with it, 
may be used as litmus, or as a test for alkalies. 

Turmeric itself is something of a stimulant, and is used as a condiment. It 
is turmeric which gives the bright yellow color to curry powder, into whose 
composition it enters. 

Turpentine is a mixture of oil and resin obtained from various species of 
pine, and mainly produced in America. This substance is separated by distil- 
lation ; the oil of turpentine passes over, the resin is left behind. Turpentine 
as it flows from the tree is of a pale yellow color, about the consistence of 
honey ; but gradually, by exposure, becomes harder, the oil passing off and 
the resin remaining behind. 

Oil of turpentine, which is alone used internally, is a colorless fluid, with 



TYM 768 TYP 

the peculiar odor and taste of the ahove liquid ; the resin is semi-transparent 
and yellow. The preparations of oil of turpentine are a confection, an enema, 
a liniment, an acetic liniment, and an ointment. The resin figures in a plaster 
and an ointment. 

Applied to the skin, turpentine acts as a powerful stimulant; if used along 
with heat it may redden the part, or if its vapor he confined even blister it. 
Its liniment is of value for stiff joints and chronic rheumatism. Turpentine 
stupes are valuable applications. A piece of flannel is wrung out of hot water, 
as hot as the hands will bear, turpentine sprinkled on the surface, and so ap- 
plied to the skin. This application is of exceeding great value in inflamma- 
tion of internal organs near the surface, as in slight peritonitis and pleurisy. 

Internally, turpentine may be given either as a stimulant or for destroying 
worms. Often turpentine is given as a stimulant to the kidneys, hut it may 
produce much irritation in the urinary tract. It is also valuable for arresting 
haemorrhage, especially if that is partly due to debility. It is frequently given 
as an enema, when it not only moves the bowels, but also acts as a stimulant 
to the system at large. When swallowed, turpentine may likewise act as a 
purgative, but it is common to combine it with castor oil. It is perhaps the 
most valuable remedy for tape-worms we possess, provided the patient is not 
made sick by the dose. If retained, it speedily causes the worm to be ex- 
pelled dead. The dose of oil of turpentine as a stimulant and diuretic is half 
a drachm or a drachm ; to destroy worms half an ounce is given. 

Tympanites is the term given to flatulent distension of the abdomen. 
The exact origin and nature of the gases which cause the bowels to swell up 
and resound like a drum has been often made the subject of speculation, but 
not very often of careful investigation. Undoubtedly in certain diseases a 
period often comes when the bowels, from no very ostensible cause, swell up 
from wind, which apparently has been secreted by their walls. This com- 
monly occurs only in very exhausting diseases, or in which there is great pros- 
tration. In typhoid fever, and in peritonitis of whatever origin, it is found 
and dreaded. It is as a rule of very evil omen. When tympanites does occur, 
the best application outside assuredly is turpentine in the form of stupe ; many, 
too, prefer to give turpentine, internally, but that is a question to be settled in 
each individual case. Stimulants as a rule are first given, and sometimes pass- 
ing a long tube up the rectum carefully and gently may enable the gases to 
escape, and so afford unspeakable relief to the patient. In the last resource 
the bowels must be punctured with a fine hollow needle or trocar. 

Tympanum. See Ear. 

Typhlitis means an inflammation of the caecum. (See Intestines.) It 
may be caused by eating nuts or some other indigestible food, which sets up an 
irritation when lodged there. There is much pain, a little fever, some vomit- 
ing, and constipation. Hot fomentations should be applied, an anodyne given, 
i and the bowels should be opened by enemata. 

Typhoid Fever is a continued and infectious fever, caused chiefly by the 
influence of bad drains and sewer-gas, lasting an uncertain period of from lour 
to six weeks, and sometimes followed by a relapse. It is also known by the 
names low, enteric, gastric, pythogenic, drain, cesspool, bilious, infantile, re- 
mittent, and slow nervous fever, also as abdominal typhus fever. 

History : It seems to have been known from the earliest times, and cases sim- 
ilar to it have been mentioned by Galen and Hippocrates. In the eighteenth 
century numerous authors in America, England, France, and Germany have 
described this disorder under various names, nor was it until nearly the mid- 



TYP 769 TYP 

die of the present century that its true character and clinical history was fully 
shown, for hefore this many looked upon it as a kind of brain fever or malig- 
nant fever, or as typhus fever. Typhoid fever is always endemic in the Brit- 
ish Isles, but seems to be most common in England, more common in Ireland 
than in Scotland, and more common on the west coast of Scotland than on the 
east coast. The admissions to the London Fever Hospital show the following 
influence of race : — 

1 in every 670 of the Irish inhabitants in London. 
1 " "1208 of the English 
1 " 1906 of Foreigners " " " 
1 " 2338 of the Scotch " « ' 

This should be contrasted with similar facts in the article on Typhus, where 
it will be seen that the Irish were most always attacked by that disease. 

Causes : Among the predisposing causes are sex, age, mode of prevalence, 
months and seasons, temperance and moisture, idiosyncrasy, mental emotion, 
and fatigue, residence in an infected locality, overcrowding and deficient ven- 
tilation, occupation, and station of life. (1.) Typhoid fever appears to attack 
one sex as readily as the other ; of 2432 collected cases, 1211 were males and 
1221 were females. (2.) The disease is chiefly met with in youth and adoles- 
cence. Of 1772 cases admitted into one of the fever hospitals during ten 
years, the mean age was 21.25 years; that for males being 21.45, and for fe- 
males 21.06. The mean age of 3456 cases of typhus fever was found to be 29.33. 
Of the above cases of typhoid more than one-half (52 per cent.) were between 
fifteen and twenty-five years of age, and one-fifth were under fifteen. Less 
than one-seventh were above thirty, and only 1 in 68 exceeded fifty. Persons 
under thirty are nearly twice as liable to typhoid fever as those above thirty, 
because there are so many more persons alive of the previous age. Age has a 
very different effect in typhus fever. (3.) Typhus and relapsing fevers are 
every now and then epidemic ; typhoid seems endemic amongst us, and the 
number of cases does not vary greatly from year to year. (4.) This fever is 
most common in the autumn and winter ; of 2432 collected cases, 315 were in 
the spring, 435 in the summer, 994 in the autumn, and 688 in the winter. (5.) 
It is most common after a dry and hot summer, and unusually scarce in sum- 
mers and autumns which are cold and wet. (6.) It does not appear that intem- 
perance, fatigue, and mental emotions predispose to this disease. (7.) Some 
people, owing to what is called a peculiar idiosyncrasy, are more liable to it 
than others. (8.) While in typhus fever overcrowding and deficient ventila- 
tion play an important part, this does not seem to be the case in typhoid fever ; 
all classes are alike subject to it when exposed to the exciting cause. (9.) 
New comers in an affected locality take the fever more readily than the or- 
dinary residents in the place. (10.) There is no clear evidence that occupa- 
tion has much influence ; those who work in sewers are, however, very subject 
to it. (11.) No station in life is exempt from this insidious malady; rich as 
well as poor are attacked by it. The exciting causes are contagion and sponta- 
neous degeneration. Numbers of cases go to prove that those nursing the sick 
from this disease very frequently catch it, and they probably do so from the 
emanations of the stools. Whenever any drainage soaks from the surface into 
a well used for drinking purposes, or when sewer gases escape into a house by 
a leaky pipe, or when the traps are out of order, or when one drinks foul and 
stagnant water into which any drainage from manure can enter, then arise the 
conditions which excite the disease. Very few houses are properly drained, 
and whenever a storm occurs and the sewers are suddenly flushed, the gases 
49 



TYP 770 TYP 

escape upward into the waste-pipes of the houses along the route and overcome 
the resistance of the traps, so that a most noxious smell arises whenever the 
pan of a water-closet is raised. It is of the utmost importance that all water- 
closets should be outside the house ; that the waste-pipe should not communi- 
cate with the main sewer unless there be first a communication with the open 
air, so that the backward pressure will never cause the gases to regurgitate 
into the house ; that just beneath the pan of a water-closet the waste-pipe 
should communicate with the open air and be carried up above the house-top ; 
that a cistern with a continuous supply of water should be supplied close to and 
above each water-closet, and' that the cistern for the drinking water should he 
quite distinct from the other cisterns. In small places the dry-earth system 
should be adopted, and care must be taken that no leaking from an old cess- 
pool can escape into the well for drinking purposes. 

Symptoms : The onset of typhoid fever is always very gradual and insidious ; 
it begins with feeling out of sorts, aching pains in the limbs, headache, loss of 
appetite, and chilliness ; for many clays the sufferer is able to go about and 
think that there is not much the matter. Sometimes there is diarrhoea, or 
some intestinal disturbance ; then the pulse is quicker, the skin hot, and the 
tongue red and dry. The nights are disturbed and restless, and he does not 
care for any exertion. At the end of the first week, or often later, he takes 
to his bed, and it is found that he is feverish, has no appetite, is thirsty, and 
his bowels are generally relaxed. The urine is scanty and high colored ; there 
is still more restlessness at night ; there is no stupid, heavy expression as in 
typhus, nor are the eyes suffused ; on the contrary, the face is often pale and 
the cheeks have a pink flush, and the eyes are clear and bright. Between the 
seventh and the twelfth day the peculiar eruption appears on the chest, abdo- 
men, and back, and it consists of a few slightly raised, rose-colored spots, which 
disappear on pressure under the finger and fade away in two or three days ; 
but in the mean time others appear, so that several crops are noticed, and fresh 
ones may be seen every day ; these spots are never petechial. If now the 
hand is pressed over the right side of the abdomen there may be a feeling or 
expression of pain, and one may also feel a gurgling under the fingers. About 
the middle of the second week delirium comes on, at first slight and only no- 
ticed at night, and then more constant, intense, and noisy. The tongue is dry, 
red, and glazed, and often cracked in various directions ; in children, however, 
it may sometimes remain moist and white the whole time, and in very young 
cases also you sometimes see no rash at all. As the diseases advances the 
patient loses flesh and strength ; he lies prostrate and perhaps unconscious of 
what is going on around, and if it end fatally he will become quite insensible, 
have a markedly high temperature, and fumble at the bed-clothes. If the dis- 
ease progress favorably the amendment is very gradual, and for this the tem- 
perature is a pretty good guide. The temperature rises from the first, but not 
so suddenly as in typhus and relapsing fevers ; at the end of the first week it 
may be 104° or 10>°, being generally highest towards evening ; it keeps high 
with slight oscillations for about twenty-one days, and then a fall may often 
be noticed in the morning, although it rises again at night ; these daily varia- 
tions are very marked and may cover three or four degrees ; at about the thir- 
tieth day, or a little later, the symptoms are decidedly less severe in ordinary 
cases ; the tongue cleans ; there is less prostration and delirium, and a general 
improvement is manifested. But then a relapse may ensue, and the tempera- 
ture will again rise, and the patient go through a second attack, but this is 
much shorter than the first. 



TYP 771 TYP 

Complications : Typhoid fever is a very dangerous disease, because there 
are so many accidents to which patients are liable. Diarrhoea may be pro- 
fuse, and exhaust the patient, but as a rule diarrhoea is not a very bad symptom, 
and should be left alone, unless very profuse. Bleeding from the bowels, when 
it occurs in any large quantity, is a very dangerous sign ; it is clue to the ulcer- 
ation of the intestines. Bleeding from the nose is not often a bad symptom. 
Perforation of the bowel is very likely to occur between the twenty-fifth and 
thirty-second day, and even later, and this may be brought on by any error of 
diet ; it is attended by collapse and is very fatal. Inflammation of the perito- 
neum, either with or without perforation, adds greatly to the danger. Bron- 
chitis and pneumonia may supervene and increase the general mischief. Some 
cases are mild, others very severe, and there is perhaps no other fever which 
varies more in its forms, nor about which so much anxiety and uncertainty 
must exist with regard to a successful issue ; nor is one safe until recovery is 
fully established. In many cases it is most difficult to be certain of the nature 
of the case in the first week. It is most likely to be mistaken in children for 
acute tuberculosis ; or it may be looked upon as the so-called gastric fever or 
gastric irritation ; or it may resemble the symptoms of arsenical poisoning. It 
may be as well to say here that there is no such disease as gastric fever ; it 
either means typhoid fever, or it is a disturbance of the stomach and intestines 
from poisoning or eating unripe fruit. Whenever three or four cases occur 
together this fever may be suspected, and if any one die of similar symptoms 
within a week or two, and the cause is not clearly made out, an examination 
of the body should be made, for many cases of arsenical poisoning have in this 
way been overlooked. In typhoid fever the main appearances after death are 
ulceration of the bowels, and chiefly so near the caecum and towards the end 
of the ileum, with enlargement of the spleen and mesenteric glands. 

Treatment : As regards ventilation, good nursing, cleanliness, and quiet, and 
with respect to disinfectants, etc., nothing more need here be said than is laid 
down in the article on Typhus Fever, and it need not be repeated. Yet there 
are some special points of importance. The diarrhoea need seldom lie checked 
unless one is purged more than twelve or fifteen times a day, and then a little 
starch injection may be given ; if there is much bleeding it may be requisite to 
give turpentine. It is a mistake to give medicines containing acids, as they 
often increase the purging and the bleeding. In fact, there is no medicine 
which can cure the fever. The diet must be very light, and no solid food 
should be taken under six weeks or two months, because, in consequence of 
the ulceration of the bowels, the coats are very thin and liable to burst. Eat- 
ing an orange or a piece of potato, or drinking an effervescent draught, will 
cause distension of the bowel and rupture it, just when the patient is otherwise 
doing well ; the greatest precautions should be taken during the third and 
fourth weeks, as then it is most liable to occur. . Milk must form the main 
article of diet, and then an egg or two may be beaten up in it, or a custard 
may be given, and beef-tea ; then a small piece of mutton and sole, and so on, 
gradually, to more solid food. If there is much distension of the bowels, hot 
flannels, on which is sprinkled a little turpentine, will be found very useful. 
For information as to disinfection, see Sanitary Regulations. 

Typhus. This is a highly contagious fever, attacking people of all ages, 
which occurs in an epidemic form, and generally in periods of famine and des- 
titution. It has been known at different times under various names : thus it 
has been called pestilential fever, petechial fever, brain fever, putrid continual 
fever, camp fever, jail fever, etc. 



TYP 772 TYP 

History : It is a disease which has been known in very early times ; cases 
closely resembling it were recorded by Hippocrates two thousand years ago. 
During the first fifteen centuries of the Christian era numerous epidemics have 
occurred in different parts of Europe, and have been more or less accurately 
described by Greek, Latin, and Arabian writers. In the year 1489 no fewer 
than 17,000 of the troops of Ferdinand, then besieging Granada, were 
destroyed by a fever which seems to have been typhus. In 1508, and again 
in 1528, it appears to have raged in Italy. In 1550-54, during a season of 
great scarcity, and a consequent crowded state of the large towns, a petechial 
fever prevailed in Tuscany, and carried off more than 100,000 persons. In 
1566 it appeared in Hungary, and thence spread over Europe. Over and over 
again it prevailed during that century in various parts of Europe, and during 
the Thirty Years' War (1619-48) it committed dreadful ravages. In the 
spring of 1643, while the Earl of Essex was besieging Reading, this fever 
broke out among the troops of the parliamentary general and those of Charles 
I. The Great Plague of London in 1665 was preceded and followed by a con- 
tinued fever, which was probably typhus. In 1708 the first recorded epidemic 
occurred in Ireland, and again in 1718-21 and in 1729-31. In 1728 there 
had been a succession of three bad harvests ; food rose to a great price, and 
there was much distress and poverty in the country. In 1780 an out- 
break of typhus occurred among the Spanish prisoners at Winchester, of 
whom 268 died in three and a half months ; but before that time it had fre- 
quently appeared in England. In the first fifteen years of this century 
typhus committed great ravages in the army of Napoleon I., and among the 
population of those parts which had been desolated, and where famine and 
misery prevailed. The first great outbreak in England that has been well 
recorded was in 1803, and again in 1817-19. The previous winters had been 
extremely severe, and there had been a complete failure of the harvest and 
potato crop ; the working classes were out of employment, and there was much 
distress in the land ; then the poorer classes migrated to the large towns, and 
overcrowding and uncleanliness prevailed; it was under these circumstances 
that the fever raged so widely. The next epidemic was in 1826-28; it broke 
out chiefly in the large towns, and in a time of great commercial distress; the 
demand for labor was diminished, and provisions were very dear. It began in 
Dublin in May, 1826, and subsided there in May, 1827. In Glasgow and 
Edinburgh it reached its height in 1828, but it was not so bad in London. In 
1836 and in 1843 there were also severe epidemics, the last being chiefly con- 
fined to Scotland. In 1846 there commenced a most severe epidemic in Ire- 
land, after a failure of the potato crop ; it began in Ireland and Glasgow at 
the close of 1846; at Liverpool in January, 1847 ; at London and Edinburgh 
in March; and at Manchester in April, 1847. It reached its height in the 
summer and autumn of 1847, but did not subside until 1848. The Irish were 
those chiefly affected ; of 473 cases in the Edinburgh Infirmary, 379 were 
Irish ; in 1847, 75,000 Irish emigrated to America, and of these 10,000 died. 
The number of cases of typhus fever in Ireland probably exceeded a million ; 
in England the number was estimated at 300,000; in Liverpool alone 10.000 
people died of this disorder ; and it also raged in Manchester, Birmingham, and 
Preston to a less extent ; in Edinburgh it was calculated that one in nine of 
the population suffered from it. In 1856 typhus again increased in London ; 
then there was a marked cessation until 1861, when it became epidemic once 
more; and the last epidemic was in 1864-65. 

Causes: In the individual, sex and aire have no influence in determining an 



TYP 773 TYP 

attack ; nearly equal numbers of both sexes catch it, and children, as well as 
adults and old people, are liable to it, but more cases have it after fifteen than 
before. Of 3456 cases admitted into the London Fever Hospital nearly one- 
half of the cases were thirty years of age or upwards, one-eighth were fifty or 
upwards, while less than one-sixth were under fifteen. Depressing mental in- 
fluences, overwork, and anxiety render the system more liable to contagion ; 
those who are badly fed, and those who suffer from loss of a harvest, people 
who have suffered the hardships of war, of civil strifes, and commercial distress 
are often its chief victims. Overcrowding, dirt, and bad ventilation are im- 
portant predisposing causes to this affection. Typhus is chiefly met with in 
cold and temperate climates, but not in the tropics. The chief cause of typhus 
is contagion, or the transmission of the disease from one person to another ; 
the other causes only render the system more liable to the action of the poison. 
Nearly all the evidence goes to show that typhus is essentially a disease that 
is caught by a healthy person coming in contact with one previously affected, 
and it is easily caught during convalescence. It is very rare for a person who 
has had the fever once to have it a second time. To show how contagious this 
fever is, the following history will show : The fever first appeared in a family 
residing on the ground floor, and consisting of a father, aged 54 ; a mother, 
aged 40; and six children, aged respectively 16, 14, 12, 10, 8, and 5 years. 
These eight persons lived and slept in two rooms, which together contained 
only 1378 cubic feet of space, making only an allowance of 172.5 cubic feet to 
each individual. Each of the two rooms was furnished with a door, one win- 
dow, and one fireplace ; but the windows were seldom opened. The whole 
family had long been destitute, and the father had been out of employment for 
some time. No history of contagion could be traced, and they were the first 
cases in the court thej r dwelt in or in the vicinity. Soon after cases broke out 
in the next house ; the mother's sister came to attend upon her, and she caught 
it, giving the fever to her husband and child, and all three died. A third sister 
came to nurse the last one from a neighboring street ; she likewise caught the 
fever, and also her husband, who afterwards died. 

In the year 1869, 4281 persons died in England and Wales from typhus 
fever ; before this time these cases were classed under the head of continued 
fevers, with typhoid and simple continued fever. The total deaths from these 
three forms of continued fever in the years 1860-69 were as follows : — 

Year. Deaths. | Year. Deaths. 



1860 . 13,012 

1861 15,440 

1862 18,72! 

1863 18,017 

1864 20,106 



1865 23,034 

1866 21,104 

1867 16,862 

1868 19,701 

1869 18,389 



The numbers of course vary with the prevalence of an epidemic, but the an- 
nual mortality is very great. 

Symptoms : It is difficult to say how long the disease may be incubating in 
the system before it appears, but the period is certainly not constant, and seems 
to vary from a few hours to several days. The onset is marked by a severe 
headache, loss of appetite, and languor, and aching of the limbs ; the invasion 
of the symptoms is not so sudden as in relapsing fever, but much better 
marked than in typhoid fever. For three or four days the patient gets worse, 
being unable to go about, and feeling chilly and prostrate; he then is worse at 
night and restless ; the skin is hot, the tongue coated ; there is thirst and some- 
times vomiting ; by the third day of the disease most are obliged to take to 



TYP 774 TYP 

their bed, while this is not the case in typhoid fever, which is a much more 
insidious disorder. There is a general aspect of a typhus case, which an ex- 
perienced person will at once recognize : the patient lies prostrate on his back, 
with a dull and weary, if not stupid, expression ; the eyes are suffused and 
watery, and a dusky flush overspreads the face. As the disease progresses, the 
eyes are half shut and the mouth open ; he lies moaning and unable to move 
himself or answer questions; the lips and teeth are dry and covered with 
sordes, and look black ; the mouth is dry ; the tongue dry, brown or black, 
and marked with cracks. The temperature rises from the first, and reaches 
103° or 104° Fahr. by the middle of the first week; the highest temperature 
reached in the fever is seldom less than 105°, although it may be higher, but 
the higher the point reached the greater is the danger ; the fever may slightly 
abate in favorable cases about the ninth or tenth day ; no marked fall, how- 
ever, takes place until the end of the second week, and generally on the four- 
teenth day, when defervescence may take place suddenly, and the normal 
temperature (08.4°) he reached in twenty-four hours, but more commonly it 
takes two or three days for the descent to be accomplished. The temperature 
generally is highest of an evening: when defervescence occurs, the temperature 
always goes below the normal line so as to mark 97° or even 96°, and in 
a few days it becomes natural. This fall is a very good sign, and then the 
patient is generally out of danger. A very high temperature (106° or 107°) 
is a sign of serious gravity. In mild cases the fever begins to leave on the 
twelfth day in many cases. The pulse is generally 120 in a minute, but is 
very easily compressed under the finger ; the heart sounds in very severe cases 
are feeble, and the first sound may even be inaudible. A rash appears in 
nearly every case, and is very characteristic ; sometimes it looks as if there 
were a general mottling just beneath the skin, or distinct spots may appear of 
small size and purplish color ; they are irregularly rounded, at first may dis- 
appear on pressure, but soon become petechial ; oftentimes the two kinds occur 
together, but sometimes separately. The rash appears on the fourth or fifth 
day, rarely later; it comes on the back of the wrists first, in the arm-pits, and 
over the epigastrium ; then it more or less covers the trunk ; it seldom comes 
on the face and neck ; the rash has something of a measly look, but the other 
symptoms are much more severe than are seen in measles ; the rash lasts a 
variable time, but generally until the fourteenth or fifteenth day. No solid 
food can be taken, but the patient is always thirsty. The bowels in some 
cases are confined; in others they are open too much. There may often be 
heard rattling or wheezing noises in the chest, and the more so when the 
face is very dusky. The nervpus symptoms are well marked : restlessness, 
loss of sleep, and confusion of thought first come on; then headache, giddiness, 
a buzzing in the ears, and deafness ; in most cases there is delirium, and the 
patient is beset with horrid fancies. In bad cases he lies picking the bed- 
clothes, twitching his hands, and muttering to himself or moaning ; or he may 
be quite unconscious, with wide-open eyes, staring vacantly. Loss of the 
power of swallowing and insensibility are very bad signs, and generally pre- 
cede death. The urine is passed involuntarily, as well as the motions in most 
cases, so that great cleanliness has to be observed. 

Duration: The duration of typhus may be from three to twenty-one days, 
but about fourteen or fifteen days is the average time ; if a case live more than 
this time, it will generally recover. The termination in recovery is sometimes 
quite rapid, and the tongue will clean, the temperature fall, and the delirium 
cease in a day or two, but generally the improvement is more gradual and lasts 



TYP 775 TYP 

over three or four days. Unlike typhoid fever, there is no relapse, so that 
when once the temperature has come down the best hopes may be entertained ; 
neither is there liablity to peritonitis or perforation of the bowel, as in typhoid 
fever. 

Mortality : The death-rate varies with the epidemic, being generally great- 
est at the commencement. Of children under ten years of age about 5 per 
cent, die ; of those over sixty years of age, 66 per cent, die ; the older the pa- 
tient the greater is the danger; between thirty and forty, 21.5 per cent, die; 
between twenty and thirty, 15.6 per cent, die ; between ten and twenty, 8.6 per 
cent. die. 

Habits of intemperance increase the danger in those attacked ; bulky people 
die more frequently than thin ones ; black people more than white ; and those 
who are overworked and have mental worry, etc., have the disease with the 
most severity. 

Treatment : The patient must be placed in a well-ventilated and large room, 
so that draughts will be avoided ; he should have his bed so situated that the 
light from a window will not fall on his face, as this is annoying ; all curtains, 
carpets, and bed-hangings should be at once removed ; the bed should not be 
too soft, and a draw-sheet or mackintosh must be put under the patient. He 
should not be allowed to exert himself at all, but try and husband all his 
strength. The greatest cleanliness must be observed, and all excreta removed 
at once, and Condy's fluid or chloride of lime should be mixed with them ; 
any soiled linen may be put in a tub of water in which is some Condy's fluid. 
Bed-sores are very liable to form on the back, and so the nurse must always 
be on the lookout and try and prevent them coming by smoothing the sheets, 
drying the patient, and rubbing brandy or balsam of Peru over the part; 
better still, to have a water-cushion or a water-bed. The skin may be sponged 
down with tepid water, the nurse sponging and drying one part at a time, so as 
to prevent any undue chill to the surface from exposure ; this relieves the pa- 
tient and partly removes that disagreeable smell so common from the skin in 
typhus cases. None but the nurse and doctor should see the patient ; all noises 
must be stopped and great quiet enjoined ; at night-time, there may be a small 
light in the room, but placed so as not to disturb the patient. Milk must be 
the chief article of diet, and is best given cold ; an egg or two may be beaten 
up in it, and three or four pints of milk may be given in the twenty-four hours ; 
this must be done regularly every two hours in equal quantities, and more 
especially must this be done at night or in the early morning when the prostra- 
tion is the greatest. Beef-tea and broths, jellies, extract of beef, custards, etc., 
may be given if the patient can take them and wants them, but in very bad 
cases they will not do so. For drinks in the early stage, lemonade, cold tea, 
soda water, etc., may be given, but do not let them have too much effervescent 
drink ; when very bad the nurse will have plenty to do to get the milk down. 
Stimulants are very useful, but the quantity must vary with each case, and be 
left to the medical mon's judgment ; brandy is the best stimulant, and may be 
given with iced milk ; too much must not be given at first, as it causes oppres- 
sion and inability to take nutrient food ; but afterwards, in the stage of great 
prostration, its proper and careful administration may save the patient's life. 

Albumen is often present in the urine in these cases, but calls for no special 
treatment. Much care must be taken that there is no retention of urine in the 
bladder in these cases, as that organ is very liable to be paralyzed. When the 
crisis is passed and the tor.gue cleans, some boiled mutton or a sole may be 
given ; also jellies, light puddings, custards, etc. The stimulants may then be 



ULC 776 ULC 

diminished, and beer given if preferred. If, however, convalescence be retarded 
by bed-sores, or by the formation of abscesses, the stimulants must be contin- 
ued and solid food given sparingly. In some cases the mind is childish for 
some time after recovery. A trip in the country, plenty of good food, and fresh 
air will complete a cure. For the prevention of typhus spreading, isolation 
must be adopted, and if a case occur in a crowded court it should be removed 
to a fever hospital ; for the measures to adopt with regard to disinfecting the 
clothes, room, etc., see Sanitary Regulations. 

U. 

Ulcers. Ulceration consists in the gradual disintegration and separation 
of tissues, the healthy nutrition of which has been disturbed by local inflam- 
matory changes, by impoverishment or poisoning of the blood, or by an injury 
to one or more of the nerves of the affected region. In this process the de- 
stroyed tissues break down into minute particles, or undergo liquefaction ; in 
gangrene, to which ulceration is closely connected, the open sore is formed by 
the separation of the dead tissues in sloughs or large and visible masses. Ulcer- 
ation may attack any organ or tissue ; it is often met with in hone, and some- 
times in teeth ; the tissues most disposed to it are the skin, mucous membrane, 
and connective or areolar tissue. Nerves and blood-vessels resist longer than 
other tissues the ulcerative process, and may, in cases of rapidly increasing and 
sloughing ulcers, be seen isolated in the midst of discharge and slough. The 
cornea is a frequent seat of ulceration, which too often causes blindness or 
serious impairment of vision, by resulting in opacity or perforation of the 
membrane. Within the body ulceration very frequently occurs in some part 
of the alimentary canal. Ulcer of the stomach, ulcer of the duodenum, alter 
severe burn, typhoid and tubercular ulceration of the small intestine, syphilitic 
and dysenteric ulceration of the colon and rectum, and fissure or painful ulcer 
of the rectum are all well-known affections. The favorite seats of ulcers on the 
snrface of the body are the legs ; here the ulceration is generally due to local 
irritation and obstruction in the circulation. Ulcers, when present in parts of 
the body above the knees are usually dependent upon some constitutional 
affection, such as syphilis or scrofula, or are connected with some form of can- 
cer. The face is often attacked with obstinate and spreading ulceration, of 
which the most common examples are epithelioma, lupus, and the rodent ulcer. 
Ulcers vary much in their form and appearance, in their rate of increase, and 
in the severity of the symptoms to which they give rise. Some, as the slough- 
ing and phagedenic idcers, spread very rapidly, and are attended with bad 
general symptoms ; others, as the so-called callous ulcers, observed on the legs 
of old people, undergo very little change, and usually cause very little pain, 
and rarely any constitutional reaction. Some are quite indolent, and others 
give rise to excruciating pain ; there is also much variety in their shape, the 
general tendency, however, being to form round or oval ulcers. These differ- 
ences generally disappear when the ulcer takes on healthy action and begins 
to cicatrize ; a healthy granulating surface is then presented, which closes by 
contraction, and the formation of a gradually extending zone of delicate scar- 
tissue at its edges. Some ulcers, and especially those formed in cancerous 
affections, obstinately resist local treatment, and continue to increase in size 
and invade surrounding tissues, until the patient sinks from pain and ex- 
haustion. 



ULC 777 ULC 

The following remarks apply only to ulcers formed on the surface of the 
body. For information concerning the ulcers of internal organs, the reader 
is referred to articles on Typhoid Fever, Dysentery, Phthisis, etc. 

The Inflammatory Ulcer is met with generally in front of and on the lower 
half of the leg, and is usually due to slight injury, such as a grazed or broken 
shin. As a rule, the patient is either a plethoric individual, whose health has 
been impaired by excesses in diet, or one advanced in years, and exhausted in 
consequence of hard work and insufficient nourishment. The sore is small 
and circular and usually single ; its base is covered by small granulations of a 
brownish-red color, from which there is a profuse discharge of thin and acrid 
ichor ; the edges of the sore are sharply cut, and the surrounding skin is hot 
and red. The patient complains of severe burning pain in the ulcer and over 
the inflamed skin. The development of this troublesome and painful affection 
is favored and in many cases caused by negligence on the part of the patient, 
or in consequence of inability to discontinue active work. A slight abrasion 
on the skin of an unhealthy individual suffering from congestion of the liver, 
piles, and distension of the veins of the lower extremities will almost certainly 
degenerate into a painful and inflamed ulcer if the part affected be not kept at 
complete rest for a few days. The prevalence of the inflammatory ulcer 
among the laboring classes is no doubt clue to the frequent occurrence in in- 
dividuals of this class of wounds and slight injuries to the lower limbs, and to 
the necessity under which they lie of continuing work and active exercise, 
even though suffering from acute pain. 

The treatment of inflammatory ulcer should consist of complete rest of the 
affected limb. The patient should remain in bed with the limb elevated on a 
pillow. The ulcer should be dressed with a light bread poultice, warm fomen- 
tations, or a weak lead lotion. When the pain has subsided, and the ulcer 
presents the appearance of a healthy granulating sore, water dressing, or a 
weak solution of sulphate of zinc, should be applied, and the limb be bandaged 
from the toes, as far as the middle of the thigh. Local applications alone are 
quite useless. The patient must remain in bed, or in the recumbent position, 
until the ulcer has changed into a rapidly-closing and healthy sore. 

The Irritable Ulcer. This name is applied to any small sore which has an 
unhealthy appearance, obstinately resists treatment, and gives great pain when 
touched at a certain point of its surface. According to some, the acute pain 
in this affection depends upon the exposure of a nerve on the surface of the 
ulcer. This pain is always limited to one sj>ot, the rest of the raw surface be- 
ing free from tenderness. This variety of ulcer may be much relieved by a 
poultice or poppy-head fomentations. The only effectual means of cure, how- 
ever, is division of the exposed nerve, by making a small incision across its 
track at a short distance above the painful spot. 

The Chronic, Callous, or Indolent Ulcer is of frequent occurrence among 
old and debilitated individuals, and in most instances affects the lower part of 
the leg. It is usually of considerable extent, and in some bad cases completely 
encircles the limb. The surface is smooth and glassy, is much depressed below 
the surface, and is surrounded by hard and white edges. The skin surround- 
ing the ulcer is thick and callous ; the leg below the ulcer is hide-bound as it 
were, and the foot is often swollen. This ulcer, though large and formidable 
in appearance, is generally free from pain and remains indolent, except when 
much irritated. The hard edges then rapidly sink down, and a large and pain- 
ful sloughing ulcer is formed. 

The essential point in the treatment of chronic ulcers is to establish healthy 



ULC 778 ULC 

and active granulations, and at the same time to reduce the thickening and in- 
duration of the parts around, so that these may yield to the contractile force 
of the scar -tissue formed over the granulating surface. The patient should 
keep in the recumbent position, and take good diet and a moderate amount of 
alcoholic stimulants. The ulcer should be poulticed, and afterwards, when its 
surface is moist and bathed by a' purulent discharge, should, together with the 
surrounding hard skin, be strapped and bandaged. By this treatment an in- 
dolent ulcer of an oval shape and not very large will generally, in the course 
of a month or six weeks, be completely closed. In cases, however, where the 
ulcer is very old and large, and involves a considerable extent of the circum- 
ference of the limb, although considerable improvement may be produced, and 
the raw surface be much reduced, it will seldom be possihle to make the limb 
sound. There is always a tendency for the scar formed over a chronic ulcer 
to break down and to slough whenever the patient commences to walk about 
again and to take active exercise. The general idea that it is dangerous to 
close an old indolent ulcer is not an unfounded one, as the cicatrization of a 
chronic ulcer in a person of advanced age is often followed by symptoms of 
constitutional disorder and slight apoplectic strokes. In cases of this kind it 
is often thought necessary to establish a drain upon the system by making an 
issue or a seton wound. 

The Varicose Ulcer is met with in the lower extremity in connection with 
distended and varicose veins. It generally commences as a small simple or 
inflammatory sore, and then, in consequence of the congested state of the limb, 
persists and acquires the characters of an indolent ulcer. The varicose ulcer 
is seldom single ; usually one may observe about the ankle two or more torpid 
ulcers of oval shape and varied size. The surface of each ulcer is smooth 
and a brownish-red color, and the edges are hard and somewhat elevated. The 
skin around and between the ulcers is generally swollen and red, and some- 
times raw, in consequence of a chronic eczematous eruption ; the foot is 
swollen, and about the ankles are unnatural swellings, caused by distension of 
the superficial veins ; the veins of the leg are much swollen and varicose, and 
the small subcutaneous veins form large purple patches of an arborescent ap- 
pearance. A prominent cord, formed of one or more varicose veins, may gen- 
erally be seen passing upwards from the superior margin of each ulcer. A 
vein is sometimes laid open by the extension of a varicose ulcer, and bleeding 
takes place, which persists and causes much trouble and alarm, so long as the 
patient remains erect, and no means are applied locally in order to arrest the 
flow. As soon, however, as the patient is placed on his back and the lower 
limb is elevated, the bleeding is arrested. In cases of this kiud a small pad of 
lint or linen rag should be placed over the bleeding point, and be retained 
there by plaster and a few turns of a banrlage. 

The varicose ulcer may usually be much rednceil in size, or even completely 
closed, by rest in the recumbent position, by the application of mildly stimulat- 
ing lotions to the raw surface, and by firm bandaging of the affected leg. The 
ulcer, however, will generally break out again if the patient becomes careless 
and takes active exercise without taking measures to afford support to the 
varicose veins. A banrlage ought to be applied every morning, and be carried 
from the toes to the middle third of the thigh, or, what is a much better plan, 
the limb should be encased in an elastic stocking. In cases where several large 
and obstinate ulcers exist in collection with an extremely enlarged and varicose 
state of the veins of the leg and thigh, it will be necessary for the patient, be- 
fore he can obtain any relief, to submit to a surgical operation, by which the 
larger superficial vessels may be obliterated. 



UMB 779 URI 

Strumous or Scrofulous Ulcers usually result from the enlargement and sup- 
puration of a lymphatic gland, or from the bursting of a small subcutaneous 
abscess. They are generally multiple and closely clustered, and most fre- 
quently affect the neck. They are very irregular in shape, and often run to- 
gether. The individual ulcers are small, and show no tendency to increase 
much in size ; the edges are irregular and formed of thin and undermined skin 
of a pink or light purple color. The surface of each ulcer is composed of large 
pulpy granulations, from which there is constant discharge of thin yellow pus. 
In old and severe cases there is much thickening of the surrounding integ- 
ument. These ulcers are usually associated with enlarged glands, pustular 
eruptions on the scalp and face, and with other manifestations of the morbid 
disposition known as scrofula. 

In these cases no relief can be obtained except by a proper constitutional 
treatment. (See Scrofula.) Local treatment should consist in the applica- 
tion of mildly stimulating lotions, such as a weak solution of tincture of iodine, 
or a lotion containing blue stone (two grains to one ounce of water). 

Umbilicus, the central spot of the abdomen, mai-ked by a depression ; it 
is now and then protruded in infants, and may require a pad and bandage to 
keep it in its place: it is commonly called the navel. 

Urates, or Lithates, from the common deposit in the urine known as 
sand or gravel. They are usually of a pink or drab color, and consist of uric 
acid in combination with potash, soda, and ammonia. They often appear after 
an ordinary cold, in many cases of fever, and from too much drinking. In such 
cases the urine is often more acid and more scanty than usual. See Urine. 

Urea. See Urine. 

Ureter, a narrow tube passing down from each kidney into the bladder, 
and allowing of the passage of the urine. 

Urethra is the tube which allows of the passage of the urine from the 
bladder. It is liable to be hurt by accident or disease, and may be the seat of 
stricture, so that one cannot pass water readily. See Stricture. 

Uric Acid is one of the constituents of healthy urine ; it now and then 
forms the nucleus of a stone or calculus. It is found in excess in the blood in 
cases of gout. See Urine. 

Urinals. These should be thoroughly clean and amply supplied with run- 
ning water. Night and morning they should also be well flushed clown. It is 
usual to have some chloride of lime placed about, so as to remove any noxious 
odors. Great pains should be taken at all times to remove any accumulation 
of fluid. It is desirable that the walls should be made of glazed tiles rather 
than metal, wood, or slate, and the roof should freely communicate with the 
open air. 

Urine. This is a secretion which is constantly going on from the kidney, 
and in this way a large quantity of water and various inorganic and organic 
matters are continually being taken from the blood; and it is important that 
this should be the case, for if these materials were retained they would be pro- 
ductive of serious consequences. Urine is generally of a light amber color, of 
an acid reaction, turning blue litmus paper red, of a peculiar odor, and saline 
taste. Its specific gravity on the average is 1020, pure water being taken as 
1000; but this will vary with the time of day, and with the amount of liquid 
food absorbed into the system. The quantity of urine passed during the 
twenty-four hours varies a good deal, but on an average may be estimated at 
forty to fifty ounces. An average healthy man excretes about fifty ounces, or 
24,000 grains of water in a day. In this are dissolved 500 grains of urea, and 



URI 



780 



URI 



from ten to twelve grains of uric acid, 
sition of healthy urine : — 



The following table shows the compo- 



Water 956.80 

Urea 14.23 

Uric acid .... 0.37 



S 



Organic matters, 29.79 



Inorganic matters, 13.35 



- Alcoholic extract . 

Watery extract . 

Vesical mucus . . 

Chloride of sodium 

Phosphoric acid . . 

Sulphuric acid 

Lime 

Magnesia . . . 

Potash 

[ Soda 



12.53 

2.50 
0.16 
7.22 
2.12 
1.70 
0.21 
0.12 
1.93 
0.05 



In 100 parts of 

solid matter. 

33.00 

0.86 
29.03 

5.80 

0.37 
16.73 

4.91 

3.94 

0.49 

0.28 

4.47 

0.12 



In addition the urine contains carbonic acid, oxygen, and nitrogen in a 
gaseous form, but very small quantities of the last two substances. Urea is 
a nitrogenous product, and nearly all the nitrogen which daily enters the 
blood in such food as the proteid compounds passes off in the urine after be- 
ing used up in the system. By taking an animal diet the urea is increased in 
amount, and diminished by living upon a vegetable diet. When uric acid is 
not properly eliminated by the kidneys it will be retained in the blood, and it is 
always present in that fluid in cases of gout. In many cases the constituents 
of the urine, instead of passing away in a soluble form, may become deposited 
in the solid state on their way from the kidney ; at first very small, they may 
increase in size, and form what is commonly known as a stone or calculus. 
Stones are chiefly formed in the bladder, but they are met with in the kidney 
as well. (See Obstructions, Stonk.) Uric acid or urates and phosphates 
are the substances most commonly forming the greater part of a stone. In 
ordinary cases there is no sediment in the urine, but merely a faint cloud of 
mucus. Often, however, when one has a cold, or has had an excess of beer, 
or from various causes, there may be a pink or drab sediment when the urine 
cools. This is composed of urates, or uric, acid in combination with the alka- 
lies, potash, soda, and ammonia, which are daily passed in the urine. This 
sediment is of slight practical importance, and will disappear by drinking 
plenty of bland fluids, as tea, water, etc. The color of urine varies much ; 
when a small quantity is passed it is of a high color ; when plenty is voided 
it is paler. This is seen in cases where a person has had two or three glasses 
of hot gin and water. This fluid rapidly runs through the kidneys, and the 
urine is then almost colorless and of low specific gravity. A large quantity of 
urine daily passed, associated with great thirst and dryness of skin, should 
make one suspect that diabetes is present. When a stone is present in the 
bladder, or when the patient suffers from stricture, the urine may be ammo- 
niacal and smell disagreeably. There will, most likely, be also a deposit of 
phosphates. Retention of urine is said to occur when the urine is secreted by 
the kidneys, but not voided from the bladder. It is at once relieved by pass- 
ing a catheter. Suppression of urine is of much more serious import, and is 
due to mischief in the kidneys, and if not relieved will soon cause death by 
poisoning the blood. This often forms the last stage of Bright's disease ; and 
commencing with drowsiness, and often convulsions, passes through stupor 
into coma and death. The urine is of immense importance to the physician in 
finding out the state of a patient, and in making out clearly the nature of 
many disorders. Albumen, pus, blood, and sugar are the four impurities most 



URT 781 UTE 

commonly met with in the urine in cases of disease. Albumen may be known 
by heating a small quantity of urine in a test-tube, and adding nitric acid, 
when a white, flocculent precipitate will come on. The patient is then said to 
be suffering from albuminuria. Albumen may be present in cases of Bright's 
disease, emphysema, chronic bronchitis, heart disease, most of the fevers, and 
chiefly in those which take on a malignant character, and in several other dis- 
orders. (See Albuminuria.) Pus gives a greenish-yellow deposit in urine, 
and it turns very tenacious when heated with a solution of potash. It may 
be caused by disease of the kidney or bladder, or by an abscess bursting into 
the bladder. Paralysis of the bladder in cases of paraplegia, a stone in the 
bladder, and old-standing strictures are the conditions most liable to favor the 
formation of pus in the urine. Blood is present in the urine in cases of acute 
Bright's disease, in heart disease, many fevers, blood poisoning by turpentine, 
cantharis, etc. (See Hematuria.) Sugar is present in the urine in case of 
diabetes ; but the importance of this as a symptom varies much with the age 
of the patient, being far more dangerous in young than in old people. Elderly 
persons and those who are consumptive now and then pass slight amounts of 
sugar without its producing any symptoms. See Diabetes. 

Urticaria. See Nettlerasi-i. 

Uterus. The uterus, or womb, is situated in the pelvis. Tt is chiefly 
composed of muscular fibres, which increase enormously in size in cases of 
pregnancy, and aid in bringing forth the child into the world. It contains a 
narrow cavity about two inches and a half in length, and it is lined by a mu- 
cous membrane. From this membrane is secreted the fluid which comes away 
at the ordinary monthly periods. On either side of the uterus is an ovary, 
which at certain times is connected with the womb by means of the Fallopian 
tube. The uterus is liable to many diseases ; a polypus or a fibroid tumor 
may grow in its walls, or project into its cavity. The symptoms will probably 
be occasional haemorrhage, or bleeding in excess, pain in the back, and per- 
haps difficulty in passing water. The uterus may become bent upon itself, 
and sometimes cause distressing symptoms of pain, difficulty in micturition and 
defecation, and excessive menorrhagia. Sometimes there is ulceration of the 
womb, accompanied by leucorrhoea. After delivery the uterus does not 
always return to its normal size, but is larger and heavier than usual. Sub- 
involution is then said to have occurred; menorrhagia is then very likely to 
supervene, and. the patient feels weak, and is unable to undergo much exer- 
tion. Prolapse or procidentia of the uterus comes on in those who have to 
stand about much, and who get about too soon after their confinement. The 
common symptoms of disease of the womb are pain in the back, and generally 
across the loins, of a bearing-down character, weight or discomfort in the pelvis, 
difficulty in micturition and defecation, with menorrhagia or leucorrhoea, and 
inability for walking or any exertion. Cancer of the womb is known chiefly 
by the excessive pain, a profuse and often fetid discharge, occasionally menor- 
rhagia, and a marked cachexia. 

Treatment : Many diseases of the uterus occur in nervous women, and the 
constant pain and inability to go about much are apt to produce a sense of de- 
pression and melancholy, and to fix the patients' attention too much on their 
disorder. And this is perhaps intensified by their coming under the care of 
medical men, who, devoting themselves to a special line of practice, are apt to 
estimate unduly the local malady, instead of looking at the constitution and 
general health of the patient. Most affections of the womb are to a great ex- 
tent curable. Rest in the horizontal position, a moderate amount of out door 



UVU 782 VAC 

exercise without causing fatigue, wearing an abdominal belt, and the use of a 
cold or tepid hip-bath will do much to alleviate any diseased condition that 
may be present. In cases of prolapse, pessaries are very useful, but nothing is 
more to be condemned than a mere mechanical treatment of these affections. 
The patients' attention should be diverted from their malady by having some 
light employment, as needle-work, fancy-work, etc., by cheerful companion- 
ship, and by reading useful books — by anything, in short, which prevents 
them thinking too much about their complaint. Most women improve much, 
and may quite recover, when the child-bearing period is passed. Riding and 
driving seldom do much good, as they are attended with so much jolting, and 
often aggravate any pain. Tonics and astringents must now and then he 
given, to improve the general health and alleviate any excessive haemorrhage. 
The chief thing to be done, however, is to improve the physical health of 
women during girlhood, in allowing them out-door exercise and more freedom 
in running about ; in altering any absurd fashions of dress, as tight-lacing, 
etc., so as to develop the chest and not compress any internal organs ; in 
teaching them to swim and ride ; in preventing them from keeping late hours 
at balls and parties, and from breathing impure air; in changing the artificial 
system of education in the present day ; in allowing them to read sensible 
books, and not inferior literature ; and, finally, by letting them learn the 
elementary principles of health and diet, so as to enable them to become intel- 
ligent and efficient wives and mothers. In cases of cancer of the womb, 
nothing can be done beyond alleviating any symptoms that may arise, and in 
rendering a painful disease as easy as possihle to be borne. 

Uvula. This is a muscular prominence covered with mucous membrane, 
which projects from the centre of the soft palate, hanging down like a tongue. 
It may be relaxed in cases of ordinary sore-throat, or destroyed in some cases 
of syphilis, or it may be habitually too long, and cause a tickling cough. In 
such cases the end may be snipped off with advantage. See Sork-throat. 

V. 

Vaccination is a process by which a peculiar specific disease, known as the 
cow-pox or vaccinia, is introduced into the system with the view of prot?cting 
it against an attack of small-pox. 

The cow-pox is a disease which never occui's spontaneously in man, but it 
may be readily communicated to him by inserting some of the matter into the 
system. Vaccinia, or the cow-pox, is not always prevalent in this country, 
but occurs casually and sometimes appears almost as an epidemic. When af- 
fecting the cow, the rash appears as a small vesicle or blister, and comes out 
on the teats and udder. The disease runs its course in a precise and definite 
manner, and lasts about three weeks. About four days after the invasion of 
the disease the animal may become slightly indisposed, and small red papules 
or pimples appear on the teats or near the udder. These soon become vesicu- 
lar, and the top of the pimple becomes raised and pellucid, as if a little blister 
were present; this is due to the epithelial covering of the skin heing raised by 
the effusion of some clear lymph, so that the spot has a pearly look. When 
these vesicles are well developed, the margin is raised and there is a central 
concavity, or cup-like depression ; at first the skin around is of a natural color, 
but about the eighth or ninth day a pink blush or areola is seen around the 
vesicle, which extends gradually, so that in two or three days more the areola 



VAC 783 VAC 

forms a, zone half an inch wide, and there is some thickening and hardening of 
the skin around ; at the same time the vesicles lose their pellucid, pearly look, 
and become more opaque. By the twelfth day the lymph or fluid in the vesicle 
becomes more turbid, and the whole becomes drier, and a crust begins to form ; 
many vesicles burst, and as their contents escape they become dry and form 
scabs ; the scabbing is complete in sis or eight days, and from the twentieth 
to the twenty-fourth day these crusts fall off spontaneously and leave slight 
depressions or pits behind, which remain permanent. 

Such is a short account of the cow-pox, and it will be seen presently that the 
disease, when given to man, runs a precisely similar course. When cows af- 
fected in the above manner are milked, the vesicles burst, and the lymph which 
exudes from them is often found to produce sores of a definite and similar 
character on the hands of the milkers, and they, in their turn, are the means of 
causing the disease to spread to other animals in the dairy. Amongst the dairy 
districts in the fertile vales of Gloucestershire, England, there existed, more 
than a century ago, a popular notion that milkers who were thus infected with 
the cow-pox were incapable of taking the small-pox. This singular fact at- 
tracted the notice of Edward Jenner in the year 1768, who at that time was 
an apprentice to a surgeon at Sodbury, near Bristol. At an eai'ly age he 
satisfied himself, by inoculating with small-pox several people who had had 
the cow-pox, that this notion had in it the elements of truth, and by dint of 
perseverance and accurate reasoning he at length disclosed to the world that 
discovery which has made the name of Jenner for all time illustrious, and 
saved thousands of his fellow- creatures from a painful death or a life-long dis- 
figurement. He confeived the happy idea of giving man the cow-pox by in- 
oculation, and then of transmitting it to others by inoculation from one human 
subject to another. Thirty years afterwards (a. d. 1798), he published an 
Inquiry into the Causes and Effects of the Variole Vaccinas ; and in this work 
he established the following propositions: (1.) That this disease (cow-pox), 
casually communicated to man, has the power of rendering him insusceptible 
of small-pox. (2.) That the specific cow-pox alone, and not other eruptions 
affecting the cow which might be confounded with it, had this protective 
power. (3.) That the cow-pox might be easily communicated to man when- 
ever it was requisite to do so. (4.) That the cow-pox, once engrafted on the 
human subject, might be continued from individual to individual by successive 
transmissions, conferring on each the same immunity from small-pox as was 
enjoyed by the one first infected direct from the cow. 

It is but seldom now that a child is vaccinated directly from the cow, al- 
though it is an open question whether it is not advisable every few years to 
obtain matter directly from that animal, as it is possible that lymph from the 
human subject may deteriorate by time. Great as was the discovery of Jenner, 
it met with great prejudices in his day ; some looked on small-pox as a scourge 
to humanity which Providence occasionally sent as a beneficent warning for 
its sins, and they thought an attempt to stop its ravages would be an impious 
endeavor to thwart the divine will. 

Others objected that any matter from an inferior animal like the cow should 
be allowed to enter the human system. 

Many similar foolish statements were made to prejudice the people against 
vaccination, and years elapsed before it came into repute. As has been the 
case in every other scientific advance, ignorance and credulity have ever op- 
posed what afterwards has proved to be a vast benefit to humanity. 

As soon as Jenner had found that there was truth in the popular notion, he 



VAC 784 VAC 

endeavored to trace the origin of this singular disease in the cow. In the first 
place, he observed that it only occurred in certain dairies, and, next, that men 
were employed in milking ; then he learned that these men had charge of the 
farm horses ; and, finally, that when the complaint called " the grease " was 
prevalent amongst the horses, then cow-pox was also most common. Thus he 
inferred that the disease was communicated to the cows by men who had 
dressed the heels of horses affected with " the grease." This, however, has 
since been shown not to be strictly correct. Yet the path to discovery was 
beset with difficulties ; it was observed that some of those who were casually 
infected with the cow-pox were not protected from the small-pox ; after much 
perseverance Jenner found that this depended on the time when the disease 
was communicated, to the milker. When the vesicle is thoroughly matured, 
and when the lymph or matter in the vesicle has become by the tenth or 
eleventh day opaque and turbid, it is apt to produce a severer local sore than 
from the clearer and thinner matter taken on the eighth day, yet the latter 
conferred more protection. 

In this way Jenner arrived at the conclusion that individuals could become in- 
fected with the cow-pox ; and further, that when so infected they were safe from 
the small-pox ; it was, in fact, substituting a mild disease for a dangerous one. 
An important point still remained to be solved, namely, could the disease be 
transmitted from one human being to another, and if so engrafted did it retain 
its protecting influence ? This question was set at rest in the year 1796. On 
the 14th of May in that year the first human being was vaccinated. " On that 
day matter was taken from the hand of Sarah Nelmes, who had been infected 
by her master's cows, and inserted by two superficial incisions into the arms 
of James Phipps, a healthy boy of about eight years old. He went through 
the disease apparently in a regular and satisfactory manner ; but the most 
agitating part of the trial still remained to be performed. It was needful to 
ascertain whether he was secure from the contagion of small-pox. This point, 
so full of anxiety to Dr. Jenner, was fairly put to issue on the first of the fol- 
lowing July. Variolous matter, immediately taken from a pustule, was care- 
fully inserted by several incisions, but no disease followed." 

The symptoms seen in man after vaccination closely resemble those which 
have been described as occurring in a cow affected with vaccinia. If a child 
be vaccinated with pure vaccine lymph taken from the arm of another child, 
nothing will be seen locally during the first two days, but at the end of the sec- 
ond or on the third day, a small red pimple appears, which gradually increases 
in size, and on the fifth or sixth day it has become a vesicle or little blister, of a 
pearly color, with well-defined raised edges, while the centre is depressed and 
concave. On the eighth day the vesicle has become perfect; it is round and 
plump, and the edges are more defined and pellucid, while the centre is more 
concave. About this time also a red blush or areola is seen round the vesicle, 
and this continues to spread for a zone of from one to three inches; the skin 
looks red and angry, and becomes hard and painful from an affection of the 
tissue of the skin. When this areola appears, the child generally presents con- 
stitutional symptoms; sometimes they are very slight and pass by unnoticed; 
others may be peevish and restless, and have some derangement of the bowels 
or enlargement and inflammation of the glands in the arm pit. 

On or about the tenth day the areola begins to fade, the vesicle dries in the 
centre, while the lymph gets opaque and turbid, so that by the fourteenth or 
fifteenth day a dark brown scab is formed, which dries, blackens, and falls off 
between the twentieth and twenty-fifth day ; a cicatrix or scar is left, which 



VAC 785 VAC 

becomes permanent, is generally circular, and marked with minute pits. Such 
are the stages through which the vesicle passes, but it is important to note that 
only on the eighth day is the vesicle in perfection, and it is then only that lymph 
should be taken. Thus, if the child be vaccinated on a Monday, matter should 
be taken on the following Monday, but not later, as after that time the lymph 
is not so protective. It happens occasionally that parents are much alarmed by 
skin eruptions occurring after vaccination, and they often impute it needlessly 
to the fault of the surgeon for introducing bad matter ; this is a great mistake, 
for in some children any constitutional disturbance will bring out an eczema- 
tous eruption, as is indeed often seen when they are teething. No alarm need 
be felt on this score, as the mischief is soon cured, and it depends upon some 
peculiarity in the child's constitution. At times a rose-colored rash may appear 
on the body, or a crop of papules or vesicles ; these are generally very transi- 
tory, and disappear when the scab falls off the arm. The shape of the scar, 
and also its size, will depend upon the way in which the vaccination is per- 
formed ; some make one puncture in three or four places on the arm, about 
an inch from each other ; others scratch or scarify the skin ; and some make 
punctures very close together, so that when the vesicles form they coalesce 
or run together, and form a large irregular scab. All these methods are 
equally efficacious, and are adopted according to the fancy of the operator. 
The course of the vesicle in the soft, smooth skin of a child is more character- 
istic than in an adult who has not before been vaccinated. If the lymph inserted 
be taken direct from the cow, the course may be accelerated or retarded ; 
sometimes the vesicle is delayed only for a day or two, and it has been said to 
lie dormant in the system for many weeks ; if now the child be again vacci- 
nated, the original vesicles will resume their course, and the two will run on to- 
gether. Should the child be incubating measles or scarlet fever, the areola may 
not form until these diseases have gone. Mere delay in the appearance of the 
symptoms will not hinder the protective influence, so long as the red areola 
appears before the child is exposed to small-pox. When acceleration of the 
symptoms occurs, the vaccination is generally useless and spurious ; if any doubt 
exist, the child should be vaccinated again after a short interval. The impor- 
tant rule to remember is this — "that if there is any deviation from the per- 
fect character of the vesicle and the regular development of the areola, the 
vaccination is not to be relied on as protective against small-pox." 

If the arm becomes much inflamed, a little cold cream spread over the red 
surface will give relief ; the child should not be allowed to rub the places, and 
any source of irritation should be avoided. As a rule, the regular phenomena 
of vaccination occur only once in a life-time ; if lymph is introduced into the 
system of a person who has once been successfully vaccinated, spurious effects 
result ; a papule will at first form, to be followed by a little vesicle ; this is 
surrounded by an angry red areola, which may cause great irritation and itching. 
The symptoms begin early, and arrive at their height on the fifth or sixth day, 
when they begin to decline ; on the eighth day the scab generally forms and 
soon falls off. Severe constitutional symptoms are more common in cases of 
revaccination than in primary cases, and in a very few exceptional cases ery- 
sipelas has supervened, while in others the lymph has acted as a poison and 
caused death by pyaemia. 

Every child should be vaccinated in early infancy ; out of 20,590 deaths from 

small-pox in England during the six years 1856-61, no less than 5010 were in 

children under one year of age, so that there is great risk of catching small-pox 

if any delay occurs ; this observation more especially applies to those living in 

50 



VAC 786 VAC 

large towns, where the danger of infection is greatest, and it is still more need- 
ful in periods when an epidemic of small-pox is raging. Plump, healthy, well- 
fed children should therefore be vaccinated before they are three months old ; 
they are then free from the disturbances often caused in the system by teething. 
But there may be reasons why vaccination may be delayed ; the child may be 
suffering from acute disease, as measles, or scarlet fever, or bronchitis, or from 
mal-nutrition and diarrhoea ; the general health should in such cases be first 
attended to, and then the operation may be performed. For similar reasons 
delay may take place if any skin eruption be present ; herpes, eczema, and 
intertrigo, or the chafing which is often seen in the folds of the skin, have an 
injurious influence. 

Should small-pox, however, be near at hand, discretion must be used, and it 
will be needful to perform vaccination in spite of these circumstances ; all such 
cases must therefore be left to the judgment of the medical man in attendance. 
No age is too early for vaccination if there is direct exposure to small-pox, and 
many infants have been saved who have been operated upon immediately after 
birth. The incubation of small-pox lasts twelve days, and the time needful for 
the development of the areola in vaccination is only nine days; hence it is ob- 
vious that, although a person has been exposed to, and has actually imbibed the 
poison of, small-pox, yet, if he be vaccinated within the first three days imme- 
diately following the reception of the infection, its protective influence will be 
felt in modifying the disease. Hence, then, we have this fact of great impor- 
tance — that if the vaccination can be got to the stage of areola before the 
small-pox appears, life may be safed ; the loss in such cases of a single day may 
be most disastrous. Lymph should always be taken from healthy children, 
and from well marked vesicles, just before the areola commences, or at any rate 
within a very few hours. After the eighth day the vesicle may yield more 
lymph, but it is weaker and not so protective ; if on the eighth day several 
small punctures are made in the pellucid, pearly vesicle all round the circum- 
ference, minute drops of clear lymph will readily exude. Care should be taken 
not to draw the slightest trace of blood, nor to use any pressure in squeezing 
out the lymph ; this simple operation is unattended with any pain to the child. 

It is best for lymph to be inserted from the arm of one child to the arm of 
another, but as this cannot always be done, it is usual to adopt various means 
for preserving the lymph. For this purpose ivory points may be dipped into 
the lymph, and when the latter dries upon it the point may be kept until re- 
quired for use, or the fluid may be preserved in capillary glass tubes, from 
which air can be excluded, and this is a valuable and efficacious measure. In 
very rare cases children may be insusceptible to the influence of cow-pox ; a 
few cases fail to take the first time, but are successful on a second trial ; those 
incapable of taking cow-pox are probably incapable of catching small-pox. 

If people are successfully vaccinated they are, as a rule, forever protected 
against small-pox ; yet there are some cases in which some persons are liable 
to it, but even then they take it in a very mild and modified manner ; very rarely 
indeed does it leave any marked disfigurement or prove fatal. It was never 
maintained by Jenner that those who were successfully vaccinated were abso- 
lutely safe from an attack of small-pox ; but just as some who have had small- 
pox once may now and then have a second attack, so those who have once suf- 
fered from cow-pox may in like manner have the small-pox at some future 
time. These cases, however, occur so seldom, and when they do happen are 
so mild and harmless in their manifestations, that vaccination, when well per- 
formed, may be considered a most effectual safeguard against small-pox. Jenner 



VAC 



787 



VAC 



himself saw cases of this kind, and in his own writings he has thus stated his 
opinion of the value of vaccination : " Duly and efficiently performed, it will 
protect the constitution from subsequent attacks of small-pox, as much as that 
disease itself will. I never expected it would do more, and it will not, I believe, 
do less." To have its due protective influence, the operation must be properly 
performed, and the phenomena must develop themselves in a due and regular 
manner. Experience has shown that, in order thoroughly to infect the consti- 
tution, a certain amount of local affection is as essential as a perfect character 
of the vaccine vesicle. The benefit derived from vaccination may be seen in 
the faces of the children of the poorer classes : fifty years ago one child out 
of every three was marked with small-pox, while now hardly one in forty can 
be found to have any traces of that disease. From ignorance and carelessness 
there will always be a good many persons in a community who are unvacci- 
nated, and this will be more especially the case when there has been no epidemic 
of small-pox for some time ; apathy and indifference are then felt for the opera- 
tion, and when an epidemic again appears these are the first to fall victims to 
their rashness. Parents in this respect are really to blame. It is not uncom- 
mon to find that in a family of four or five some have been vaccinated and some 
have not, and when small-pox appears the death or disfigurement of those who 
are unvaccinated is a proof of the dangers of delay and a strong argument in 
favor of the simple operation. 

Accurate records are kept of the state of health of the boys at the Royal 
Military Asylum, Chelsea, England, and it has been shown that 5774 boys 
were admitted into that institution in the course of the forty-eight years ending 
December, 1851 ; of these, 1950 had on admission marks of small-pox, and 
3284 either had marks of vaccination or were vaccinated on admission. Of the 
former class, 6.15 per thousand, and of the latter 7.06 per thousand, con- 
tracted small-pox subsequently during their residence in the asylum. These 
cases all occurred before the legislature made vaccination compulsory, and it 
shows that one boy in every three had smalbpox. Those who now think 
lightly of vaccination, or take steps to oppose it, should reflect on the ravages 
caused by small-pox in the early part of this century. A similar result has 
been arrived at by Dr. Balfour, of the army medical department, with regard 
to the mortality of the British troops at different times. In the ten years end- 
ing 1846, the average annual admission of cases of small-pox into the various 
hospitals was 22 out of every 10,000 men ; this number of late years has been 
considerably reduced, as will be seen by the following table, taken from a 
paper by Dr. Balfour on the subject : — 





Number of Troops in 
the United Kingdom. 


Cases of 
Small-pox. 


Deaths. 


Per 10,000. 




Cases. 


Deaths. 


1859 
1860 
1861 
1862 


71,715 
85,443 
88,955 
78,173 


175 
140 
51 

64 


9 
4 
4 


24.3 

16.8 
5.9 
8.1 


0.97 
1.05 
0.45 
0.51 



Inquiries have also been made as to the protection enjoyed by individuals in 
civil life who were closely exposed to the contagion, either by living in the 
same house or even in the same room, and in some cases sharing the same bed, 



VAC 788 VAC 

with the infected case. "At Norwich, out of 215 unprotected members of 
families so circumstanced, 200 contracted small-pox and 4(3 died; while of 91 
vaccinated, only two took the disease, and these both had it in its modified 
form." At Chelsea the result of a similar inquiry showed that out of 757 in- 
dividuals in infected families 526 persons were unvaccinated, and of these all 
but seven took the small-pox, while of the 231 persons who were protected by 
vaccination only 27 contracted the disease. These facts alone will suffice to 
show the great benefits which arise in a community from a due and efficient 
system of vaccination. 

Similar benefits, too, are observed in those cases in which small-pox may be 
contracted subsequent to vaccination, and where the disease appears in so mod- 
ified a form as to be disarmed of all its terrors. It was observed years asjo, 
before people were protected as the great majority are now, that the mortality 
of natural small-pox was seldom below 20 per cent., and often amounted to 30 
and even 40 per cent, in very severe epidemics ; the death-rate from those who 
have been vaccinated is generally 3, 4, or 5 per cent., and is rarely known to 
exceed 7 per cent. In Bohemia, where observations have been made for 
twenty-one years on four millions of people, it has been found that the death- 
rate among vaccinated persons who contracted small-pox was only 5.625 per 
cent., while the death-rate among non-vaccinated persons who had small-pox 
was 29.8 per cent. At the small-pox hospital, in London, observations have 
been made with the greatest accuracy for a long series of years ; more than 
15,000 cases have there been treated, and it has been found that while 37 per 
cent, of the unvaccinated die, the mortality amongst those who have been pro- 
tected by vaccination is only 6.5 per cent. It is not enough to know that a 
person has been vaccinated ; it is also essential to know how it has been done. 
Mr. Marson's observations at the small pox hospital show that " the degree of 
modifying power is in the exact ratio of the excellence and completeness of 
the vaccination, as shown by the cicatrices." The following table, taken from 
the same source, will show the value of these remarks : — 





Classification of Patients Affected with Small-pox. 


Number of Deaths per 

Cent, in each Class 

Respectively. 


1 




37.0 


•J. 

3. 


Stated to have been vaccinated, but having no cicatrix . . . 
Vaccinated — 


23.57 
7.73 




b. Having two vaccine cicatrices 

c. Having three vaccine cicatrices 

d. Having four or more vaccine cicatrices 

(1.) Having well-marked cicatrices 

(2.) Having badly-marked cicatrices 

(3.) Having previously had small-pox .... 


4.70 
1.95 
0.55 
2.52 

8.82 
19.0 



Hence will be seen the importance of having the operation thoroughly well 
performed; the immunity enjoyed is in direct proportion to the number of 
well-formed scars upon the patient's arm. 

In all countries the influence of vaccination has been felt. In an epidemic 
which occurred many years ago in the Mauritius, the mortality among the non- 
vaccinated was 42.7 per cent., while it was only 7 per cent, in those who were 
protected. So also in Ceylon, 4.5 per cent, died amongst those who were non- 
vaccinated, while oidy 1.6 per ceut. died of those who had satisfactory marks 



789 




Fie. oxlvi. ll Fig, cxeviii. 

Fig. csxvii. 



Fig. cxlix. 



PLATE XXVII. 



VAC 791 VAC 

of vaccination. The death-rate from small-pox, in many countries, has been 
reduced to one-tenth part from what it was at the end of the last century. In 
Sweden, where the average death-rate from small-pox was 2050 out of every 
million of inhabitants, during the forty years 1810-50 it was but 158. In 
Westphalia it has been reduced from 2G43 to 114; in Bohemia and Moravia, 
from 4000 to 200; in Copenhagen, from 3128 to 28G ; while in Berlin it has 
been reduced from 3422 to 176. Nor is the benefit conferred on this country 
by the discovery of vaccination much less marked ; although here we have 
been until quite recently much more backward than some of the European 
nations in the preservation of the national health. Yet, with all these facts 
showing what vaccination will do in the way of protection, it would seem that 
a large per cent, of children old enough to attend at an infants' school are even 
now unvaccinated. It is to be hoped that with the spread of education and 
intelligence this disgraceful state of affairs may be altered. It is among the. 
young non-vaccinated portion of the population that the chief mortality occurs. 
If every infant were carefully and successfully vaccinated, small-pox would in 
a few years have a fair chance of being stamped out. 

Reuaccination. Whenever an epidemic of small-pox is prevalent, a panic 
takes place among the people, and every one is in a hilrry to be revaccinated ; 
now, although it is no doubt of great importance that those who have been im- 
perfectly vaccinated in infancy should again resort to this operation for further 
safety, it certainly is not wise to give way to panic, for at such times so great 
is the application for fresh lymph that the demand exceeds the supply, and 
vaccinations are hastily and insufficiently done ; it follows from what has been 
said before that those who have four or more perfect cicatrices on the arm are 
free from danger for the rest of their lives ; those, on the other hand, who 
have one or two marks, and these perhaps not very perfect ones, should cer- 
tainly be revaccinated when they attain the age of puberty, and the operation 
should be done with as much care as in the case of an infant. The matter 
should be taken from an infant's arm, and in no case whatever from the arm 
of a person who has been successfully revaccinated, as the lymph then is not 
sufficiently protective. A popular notion exists that the human constitution 
changes every seven years ; there is, however, no proof whatever of the truth 
of this assertion, and it seems pretty clear that a second vaccination about the 
age of puberty is all that is required. If, at the second operation, the arm 
rises, and all the usual phenomena appear, it is probable that the effect of the 
first operation had worn off, and the patient was liable to a modified attack of 
small-pox ; if, on the other hand, no effects follow the second time, it is a sign 
that the original vaccination remains efficacious, and that no danger need be 
feared even when small-pox is prevalent. It is the custom at the small-pox 
hospital to vaccinate every attendant and nurse when they first enter, and after 
an experience of thirty years it is important to note the fact that not a single 
case of small-pox has arisen among them. Although a certain small proportion 
of those who have been thoroughly vaccinated in infancy do take small-pox in 
a modified form after they are grown. up, yet after effectual revaccination such 
a case hardly ever recurs. In Wiirtemberg, out of 14,384 soldiers who have 
been revaccinated, only one case of small-pox broke out during a period of five 
years. There can be no doubt that, on the outbreak of an epidemic of small- 
pox, all the persons in the house should be carefully examined, and those who 
have no cicatrices, or at least but imperfect ones, should at once be vaccinated, 
and not only those in the house, but others who live close to and have recently 
mixed with them, as is the case in a crowded court or alley. If this were suffi- 



VAC 792 VAR 

ciently done, there would be no occasion for a pauic, and an epidemic of small- 
pox would probably be at once stamped out. 
Vaccinia. See Vaccination. 

Vagina. The anatomical name for the female passage, and necessary to 
be explained because it sometimes occurs that in states of disease applications 
or injections are ordered to be applied to this part of the body, which is men- 
tioned only by this term. Sometimes a slight membrane exists at the entrance 
to this passage, which prevents the proper and natural monthly discharge. 
When this is discovered it should be at once removed, and it is well if such an 
accident should be perceived and remedied in infancy, before any evil conse- 
quences can result from it. 

Valerian is the root of a well-known plant, the Valeriana officinalis. The 
best plants grow in dry soils. The root consists of a kind of stock or head, 
whence numerous rootlets are given off. The color is light brown, the odor 
peculiar and characteristic. The roots contain valerianic acid and an oil. This 
oil contains two substances, valerole and valerianin, neither of very great im- 
portance. Valerole, by exposure, is slowly converted into valerianic acid. 
The preparations of valerian are an infusion, a tincture, and an ammoniated 
tincture, in which aromatic spirit of ammonia replaces the ordinary spirit. 

Valerian acts as a powerful stimulant. It is mostly given in nervous dis- 
eases, especially in those of hysterical subjects, as well as in chorea and such 
like affections, as an antispasmodic. The value of valerian is not quite clear; 
some esteem it highly, others rather scout its efficacy. The ammoniated tinct- 
ure is the best form of the remedy. The dose is a drachm. 

Valerianic acid, though contained in valerian, is prepared from a totally 
different substance. Fusel oil, which is a waste product in the distillation of 
most forms of alcohol, though more abundant in some than others, tends, when 
kept, to pass by oxidation into valerianic acid. This may be done at once by 
chemical means, sulphuric acid and bichromate of potass being employed. The 
acid is then neutralized by carbonate of soda, and valerianate of soda is pro- 
duced. 

Valerianate of soda is hardly ever used itself in medicine, but is employed 
in the manufacture of another salt, valerianate of zinc. This salt occurs in 
fine scales, with the odor of valerianic acid. It is not readily soluble in water. 

Valerianate of zinc is commonly esteemed a valuable nervine tonic, though 
some prefer to give sulphate or oxide of zinc along with the ordinary tincture 
of valerian. It has been given in nervous affections, as chorea, epilepsy, and 
hysteria. It has also been given with advantage along with quinine in neu- 
ralgia. A valerianate of quinine is now made. The dose of valerianate of 
zinc is from three to five grains or more. 

Valves are usually folds of membrane which guard certain orifices; they 
are met with in the course of the veins, and play an important part in the 
proper action of the heart. See Heart. 

Vanilla. A delicious and fragrant orchidaceous plant growing in the West 
Indies, whose fruit, in the form of a long pod. is highly prized, on account of 
its delicate flavor, by confectioners, cooks, and chemists. 

Varicella. A technical name for chicken-pox or glass-pock. 

Varicose Veins. See Varix and Veins. 

Varicla. A technical name for small-pox. 

Varix. This consists in dilatation and a convoluted state of the veins, due 
in most instances to an obstruction of the current of blood towards the heart. 
It occurs very often in the lower part of the rectum, where it constitutes 



VAR 793 VAR 

haemorrhoids ; and in the affliction known as varicocele, the veins of the testicle 
are thus affected. The most frequent seats of varix, however, are the lower 
extremities, a condition being there established which is commonly termed that 
of " varicose veins." 

In a well-marked case of " varicose veins " the inner surface of the lower 
limb, from foot to groin, is studded with a number of soft, bluish swellings, 
varying in size and shape, and which are formed by a tortuous and dilated con- 
dition of the large saphena vein, which extends along the whole length of the 
limb. These swellings become more prominent when the patient stands up, 
or after constriction of the knee or thigh. The skin covering the tumors is 
generally thin and distended. This condition gives rise to stiffness and aching 
pain in the affected limbs, and even slight exercise is soon followed by a sense 
of fatigue. The skin about the ankles is puffy and is marked by purple patches 
of small veins, arranged in an arborescent form, etc. The feet are generally 
cold, and the toes of a bluish color. The skin of the leg is generally dry and 
itches very much ; it is very often red and inflamed, and the seat of an eczem- 
atous eruption. In old people, and in case where the varicose condition is 
of long standing, large ulcers may form on the lower third of the leg, constitut- 
ing the so-called varicose ulcers. An occasional serious result of varix is thin- 
ning and giving way of the skin over a distended vein and haemorrhage, which, 
so long as the patient remains in the erect position or allows the leg to hang 
down, continues, and may speedily become fatal, but which may be readily ar- 
rested by placing the patient on his back, elevating the limb, and applying 
slight pressure with a pad of lint and a bandage over the bleeding point. 

The predisposing causes of varix are an inherited tendency and debility, due 
to old age, overwork, or long illness. It is believed by some that the disten- 
sion of the veins is occasionally preceded by a gouty condition of the blood. 
The chief exciting cause is obstruction to the venous circulation, applied either 
directly to the lower limb, as in the case of wearing tight garters, or indirectly, 
as in disease of the heart, congestion of the liver, or constipation, with over- 
loading and distension of the large intestine. Varix may be caused by the 
pressure upon the veins of the pelvis of tumors, or of the pregnant uterus. 
Pursuits necessitating much standing or walking very often give rise to the affec- 
tion. It has been stated that cooks and soldiers are the people most especially 
prone to the formation of varicose veins. The subjects of varix in the lower 
extremities, when old or debilitated, should be invigorated by good diet and 
medicinal tonics, such as quinine and preparations of iron. In cases where 
the patients are of middle age, and are full-blooded, it will be necessary to ad- 
vise temperance and restriction of -diet, and occasional free purgation, in order 
to relieve a congested liver and a distended rectum. In early stages of the af- 
fection much may be done to prevent the further development of the varix, 
and all its troublesome results of eczema, ulceration, etc., by removing all likely 
causes of obstruction to the venous circulation. The patient should avoid, as 
far as may be possible, standing or walking ; the limb for a period of six weeks 
or two months should be kept elevated ; the skin should be well rubbed with 
the hand night and morning, and during the day an elastic stocking should be 
worn, or the limb should be bandaged from toe to groin. Many operations 
have been devised for the purpose of producing permanent obliteration of the 
distended veins. Of these, the safest and the one most commonly practiced 
consists in the application of needles and twisted sutures — tying the veins. 
These operations rarely produce a permanent cure, but are often of great ser- 
vice in cases where severe varix has resulted in painful eczema, or extensive 



VEI 794 VEI 

and obstinate ulceration. In cases of old and severe varix, very little can be 
done to produce any abiding relief. 

Veins. These are vessels distributed through all parts of the body and 
through which the blood returns to the right side of the heart, after it has sup- 
plied the different organs and tissues. In addition to this widely distributed 
or systemic venous set, there are two special sets of veins, the pulmonary and 
the hepatic. The first serves to carry blood from the heart to the lungs ; the 
second collects the blood from the minute or capillary vessels ramifying in the 
walls of the stomach and intestines, and carries it to the liver. The veins of 
the systemic set commence by minute branches, which, as they travel towards 
the heart, are found to increase in size and diminish in number, until at last 
the blood is conveyed to the right auricular chamber of the heart by two large 
veins, the superior and inferior venae cava?. The veins of the heart open di- 
rectly into the right auricular chamher of the systemic veins. There are two 
kinds, the deep and the superficial veins. The first accompany the arteries of 
the limbs and trunk, and are deeply situated ; the latter are placed immediately 
under the skin, and are prominent and readily visible, especially in old and thin 
persons. On tightly binding a handkerchief or bandage around the arm be- 
tween the elbow and shoulder, the return of the venous blood to the heart from 
the parts below the constriction may be prevented. The superficial veins of 
the upper extremity become distended with blood, and their branches and large 
trunks may be seen extending from the fingers upwards. From the results of 
this experiment, Harvey was led to the conclusion that the blood in the veins 
passes towards the heart, and that the veins commence in small branches, which 
gradually pass into larger and less numerous vessels as they pass upwards to- 
wards the heart. Most veins are provided with valves or small folds of the in- 
ternal membrane, which project into the interior of the vessels. The usual ar- 
rangement of these valves is thus : two folds are placed at directly opposite 
points of the interior of a vein, their free margins are concave and their at- 
tached margins convex ; where there is a free current of blood towards the 
heart, each fold is driven outwards, and is applied closely to the inner surface 
of the walls of the vein, so that the channel remains free. If, however, the 
current of blood is obstructed, or has a tendency to flow backwards from the 
heart, these folds are driven inwards and come together in the centre of the 
calibre of the vein, and thus prevent any further regurgitation. These valves 
are most numerous in the veins of the lower extremities ; in the largest and 
smallest veins they are absent. 

Wounds in the Veins. An incised wound of a vein is much less serious, even 
when the vessel is large, than a similar injury of an artery. In the former 
injury there is an even stream of dark-colored blood, the flow of which can be 
readily arrested by pressure below the wound. From a wounded artery, on 
the other hand, there is a profuse How in jets of bright red blood, which, when 
the vessel is large, cannot be arrested save by completely closing the vessel 
above and below the wound. F^ven where a large vein has been completely 
divided, as in amputation of a limb, the flow of blood usually soon ceases, 
although the vessel does not contract. Arteries, both large and small, do con- 
tract when cut through, but still not sufficiently to obstruct the bleeding. An 
artery never becomes permeable again after it has been wounded, and the blood 
is carried along the enlarged collateral vessels. A wound in the walls of a vein, 
when properly treated, closes by adhesion, and the calibre of the vessel remains 
free. In former times, when the operation of bleeding was often performed, 
and persons were bled habitually at certain seasons of the year, the incision at 



VEI 795 VBI 

the front of the elbow was repeatedly made at the same spot and into the same 
vein. 

Inflammation of one or more veins, or phlebitis, may be acute or chronic. 
The most frequent causes of acute inflammation are incised or punctured wounds 
of veins, irritation of the surrounding tissues, or the application of a ligature. 
In some rare cases inflammation attacks veins without any appreciable cause. 
Acute phlebitis occurring in a healthy individual, who is submitted to suitable 
and careful treatment under good hygienic conditions, usually runs a favorable 
course, and terminates in complete and speedy recovery ; but when it attacks 
a " bad patient," and one who has been debilitated by previous disease or in- 
sufficient nourishment, it constitutes a very serious affection, in consequence of 
a tendency to the formation of diffused abscesses in the affected part, of the 
intense constitutional reaction, and of the very probable occurrence of pyasmia. 
The following are the symptoms of ordinary acute phlebitis attacking the su- 
perficial veins of a limb. Intense pain over the starting-point of the inflamma- 
tion, and tenderness and redness of the skin along the course of the inflamed 
vessels ; the limb is swollen and cedematous, and its surface is marked by a 
pale diffused blush ; the patient suffers from more or less inflammatory fever, 
and complains of general uneasiness, headache, and nausea ; the pulse is high 
and strong, the skin hot, and the tongue dry at its centre and of a bright red 
color at its tip and edges. As the acute symptoms subside the course of the 
inflamed veins is marked by hard cords, which remain for a long time after 
convalescence. In bad cases of phlebitis, abscesses form about the affected veins 
and the whole limb becomes red and much swollen ; the constitutional symp- 
toms take on a typhoid character and there is much prostration ; finally, py- 
emic symptoms come on, as pain and swelling of one or more joints, jaundice, 
a cough, and shortness of breath, to which the patient succumbs. In chronic 
phlebitis the symptoms, both local and constitutional, are much less severe, 
although they last for a long time and give rise to much trouble and anxiety. 
The affected limb is stiff and painful, and its movements are interfered with. 
There is much oedema of the parts from which the inflamed vein proceeds, and 
considerable induration along the branches and trunk of the affected vessel. 

The treatment of acute phlebitis should consist in the administration of 
tonics, and occasionally sedatives in order to relieve pain. The part affected 
must be kept at perfect rest, and if the veins of the lower limb be inflamed the 
patient should be kept in bed. Warm fomentations should be applied over the 
inflamed region, and care be taken to guard the patient from draught. Cool- 
ing lotions or cold applications of any kind ought to be avoided. The patient 
should be allowed a generous diet. When suppuration takes place the surgeon 
generally considers it necessary to make early and free incisions, not only to 
relieve suffering, but also to prevent diffusion of the suppurative process. In 
chronic inflammation with much thickening of veins, the affected limb should 
be kept at rest as much as possible, and be supported by a firmly applied flan- 
nel bandage. 

Air, Entrance of, into Veins. In the records of practical surgery have been 
reported several instances of sudden death or of alarming prostration during 
the course of cutting operations on the neck and arm-pit. The history of these 
cases may be briefly summed up : during the removal of a tumor in either of 
the above regions, a distinct gurgling or hissing sound is suddenly heard, and 
the blood at the bottom of the wound becomes frothy from admixture with 
bubbles of air. The patient either dies at once, or falls into a deadly faint, 
complaining of great oppression over the heart and of a sensation of impending 



VBN 796 VEN 

sudden death. There are some few instances of tardy recovery from this con- 
dition, but death either immediate or delayed for two or three hours is the 
usual result. The phenomena observed before death in these cases, and the 
post-mortem examination, together with the results of physiological experiments 
on animals, indicate very clearly that the alarming symptoms just described 
are due to the entrance of air into veins, and its transmission to the right side 
of the heart along the vessels whose proper function it is to return black venous 
blood to this central organ. It is easy to account for this introduction of air 
into a wounded vein. When the chest is expanded in the movement of inspi- 
ration, a vacuum is formed within this large cavity, which is filled up by a 
downward rush of air through the windpipe, and by a rush of blood in a sim- 
ilar direction, through the jugulars and other veins of the neck. If during an 
operation, as for instance the removal of a tumor, one of these veins be 
wounded, and the gap thus formed be kept stretched for a short time, a deep 
inspiration, as it suddenly withdraws the blood from the lower part of the 
opened vessel, might cause a sucking in of external air in considerable quan- 
tity through the wound. The immediate cause of death is a failure in the sup- 
ply of arterial blood to the brain, from the arrest of the circulation, but whether 
this arrest be due to distension of the heart with air, to inaction of the valves 
of the heart in consequence of the presence of air, or to a stoppage of the flow 
of blood through the lungs in consequence of the admixture of air-bubbles, is 
still a matter of speculation. 

Venesection. The operation of venesection, or bleeding from a vein, is 
one of comparative rarity nowadays, although in some cases it is of undoubted 
value. The veins selected are generally those at the bend of the elbow, and of 
these the median cephalic is to be preferred, as there is less danger of wounding 
the brachial artery, than in operating on the median bacilic, which lies immedi- 
ately over that vessel, although most blood can be drawn from it. The opera- 
tion is thus performed : The patient lying down or sitting, a tape or narrow 
bandage is fastened firmly round the arm above the bend of the elbow, suffi- 
ciently tight to arrest the flow of blood in the veins, but not to stop the pulse 
at the wrist. The surgeon next takes the patient's arm and extends it, and 
fixes the hand under his left arm-pit, if he is operating on the right arm, and 
vice versa if on the left ; next, by gently rubbing the part, he causes as great 
an afflux of blood as possible to the vein, which he keeps up with his left 
thumb, at the same time that the four other fingers seize the limb, and by be- 
ing placed behind it make tense the skin. Then the surgeon takes the heel 
of the lancet between his thumb and forefinger, and steadies his hand by mak- 
ing a point d'appui on the surface of the limb with his other fingers. The 
opening of the vein is to be made by a simple puncture, and obliquely to the 
direction of the vein. Immediately after the puncture, the blood squirts out 
with greater or less rapidity, and its flow is facilitated by making the patient 
grasp a stick or a roller bandage. When the necessary quantity of blood has 
been withdrawn, the bleeding at the point is arrested by placing the left thumb 
upon it, and at the same time removing the bandage from the arm. After clean- 
ing the part, a compress of lint, maintained in place by the application of a 
figure of 8 bandage (see Bandages), and fixed by a pin, complete the pro- 
ceeding. 

If the external jugular vein in the neck is selected as the point to bleed 
from, the operation is as follows : The patient lying down, the vessel — which is 
directed obliquely from before backwards, across the middle of the sterno- 
cleido- mastoid muscle — is compressed a little above the clavicle. The punc- 



VEN 797 VBN 

ture, made in the middle of the neck, ought to to be large enough, and made 
in a direction across the fibres of the superficial skin-muscle, the platysma, else 
the wound will close immediately the puncture is made, and the blood will 
escape into the sub-muscular tissue. The bleeding is arrested by a well-adapted 
compress. 

Venereal Diseases. The history of these diseases is involved in much 
obscurity, but there is no doubt that they have been the result of licentious 
venereal intercourse from the earliest ages. They are usually spoken of under 
the term " the venereal disease," and this may be again divided into gonor- 
rhoea, chancre, and syphilis. By some writers it is maintained that all three 
forms of this disease are produced by one poison, whilst others maintain that 
syphilis alone is due to a specific poison. 

Gonorrhoea is an acute inflammatory process going on in the lining mem- 
brane of the urethra. This is at first attended with pain in making water, and 
the passing of a clear watery mucus from the urethra. This heals up at first, 
but the discharge returns, having a turbid and puriform character. The at- 
tack is attended with more or less feverishness ; other symptoms may follow 
— excoriations, swellings, or even abscess may occur. 

Treatment: Gonorrhoea may get well of itself. The discharge subsides, the 
inflammatory symptoms disappear, and the discharge becomes of a mucous 
character, and is then called a gleet. It is usual, however, to have recourse to 
remedies. It is recommended in the early stages to try and arrest the disease 
by what is called the. abortive treatment. This consists in applying nitrate of 
silver in solution by means of a syringe to the inflamed urethra. This should 
not, however, be attempted by the patient himself. If no opportunity exists 
of applying this treatment, the patient must be treated according to general 
principles. Rest must be enjoined, the diet must be low, the parts should be 
supported, antimony in small doses should be given, as also mild aperients ; 
leeches may sometimes be necessary, and a hip-bath administered. The in- 
flammatory stage being over, less stringent measures may be adopted, and 
various stimulating agents, such as copaiba and cubebs, may be given. As 
the patient recovers, should the discharge continue, injections of sulphate of 
zinc should be employed. 

Sometimes the gonorrhoea virus affects the eyes. The treatment must be 
the same as in an ordinary case of ophthalmia. See Ophthalmia. 

Warts sometimes accompany gonorrhoea. The best method of removing 
them is by knife or scissors, and touching the exposed parts with nitrate of 
silver, or some other escharotic. 

One of the evil consequences of gonorrhoea is stricture of the urethra. This 
disease may come on independent of gonorrhoea in the form of what is called 
spasm of the urethra. In this condition the muscular coats of the urethra 
contract, and, rendering the passage narrower, the urine either flows slowly or 
not at all. It is brought on by exposure to cold, the effects of a debauch, the 
presence of irritation about the anus, or the action of cantharides. The symp- 
toms often retire as quickly as they come on by the use of chloroform, a hip- 
bath, fomentation, some form of sedative by the mouth, or a gentle purgative. 
Tincture of muriate of iron may be subsequently given with advantage. See 
Stricture. 

The inflammatory action of gonorrhoea may produce stricture. The same 
symptoms may occur, and there may be difficulty of making water or suppres- 
sion altogether. In such cases the symptoms are alleviated by the ordinary 
treatment. Should an abscess outside the urethra cause the stricture, the ab- 



VEN 798 VEN 

scess should be opened. In all cases where the urine is not passed the, catheter 
must be employed, and for this purpose medical aid should be sought. 

The third and most difficult form of stricture is that when the canal is nar- 
rowed by chronic structural change. This constitutes true or organic stricture. 
The symptoms of this form of stricture may for some time escape notice. 
The urine is passed in an attenuated stream, sometimes twisted, or scattered, 
or dribbly. Sometimes there is pain and uneasiness in the bladder when it is 
full. There is an increased tendency to micturition, and the water passes 
away frequently involuntarily after micturition. There is also often a gleety 
discharge. 

The treatment of such cases is simple, but must always be conducted under 
surgical superintendence. It consists mainly in inducing the absorption of the 
enlarged tissue by the introduction of instruments called bougies. At first a 
small-sized bougie is introduced, and subsequently larger ones, till at last the 
urethra acquires its natural size, and allows the urine to flow naturally. 

The second form of venereal diseases are those sores which form on the 
organs of generation, either after impure intercourse, or independent of it. 
They never assume the appearance of the true chancre with indurated edges, 
and are easily cured by external applications. Oxide of zinc ointment, the 
black wash, and other simple dressings may be applied externally, whilst cool- 
ing medicine may be given, and rest enjoined. 

A third form of venereal disease is that produced by a specific virus where- 
by a sore is formed which is called a chancre. Such sores exhibit various 
characters, but they are reduced to two heads : those which are not followed 
by subsequent effects, and those which are. The treatment of the first class 
of sores should always consist of an attempt to cure them at once by the 
abortive treatment. This should be effected by means of fusing nitric acid, 
the acid pernitrate of mercury, potassa fusa, or chloride of zinc. The surface 
may be then dressed with lint. Water dressings may be afterwards applied. 

The second form of sore, which is really the symptom of a formidable dis- 
ease, is characterized as "a superficial erosion situated upon an indurated 
base." The sore has a regularly oval or elongated form, sometimes not bigger 
than a millet seed, and rarely attaining the size of a shilling. The surface 
presents a pearly gray aspect without granulations. The general surface is 
usually cup-shaped, as if scooped out by means of a gouge. The induration 

• of the base and margins of the sore are its great characteristics. The time of 
the incubation of this sore has been put down at from ten to forty days. No 
treatment of this sore can prevent the development of constitutional symp- 
toms. The treatment consists in the same methods as those recommended for 

• the simple sore. The great mass of medical men, however, recommend some 
form of mercurial treatment. Mercury is given internally, and the sore itself 
is treated with mercurial ointment. These sores may proceed in their course 
and produce sloughing and phagedenic sores, demanding in their treatment the 
most special care. 

Such sores are frequently attended with bubo, the result of irritation of the 
absorbents. The treatment of a syphilitic bubo requires the same general 
treatment as an ordinary abscess. See Abscess. 

Although the primary sore may be healed, the true specific chancre is fol- 
lowed by certain general symptoms which are called secondary and tertiary. 
The syphilitic poison in these cases pervades the whole system, and certain 
well-known symptoms follow. In the course of a few days or weeks a state of 
the system comes on in which there is sallowness of the countenance, more or 



VEN 799 VER 

less emaciation, a sense of lassitude and muscular debility, headache, with pal- 
pitation, and other signs of disturbance of the heart's action, oedema of the 
lower extremities, and a tendency to bleeding at the nose. Following these 
symptoms are a variety of affections of the skin known as syphilitic eruptions. 
These eruptions have a copper color, a rounded form, a tendency to desqua- 
mate, and have no irritative quality. 

The treatment of such cases should consist of an attempt to relieve the sys- 
tem of the accumulated syphilitic virus. For many years the only general 
remedy for this state was considered to be some of the preparations of mer- 
cury to the extent of salivation. Although it has been shown that the con- 
stitutional symptoms may be cured without mercury, a large number of sur- 
geons still recommend this treatment. Others have recommended chlorate of 
potass, iodide of potassium, sarsaparilla, and a hygienic or tonic treatment. 
!No one, however, should presume, when suffering under the various phases 
of these diseases, to attempt to treat themselves, but apply to the nearest intel- 
ligent practitioner, who does not advertise his powers of curing these diseases 
by some secret treatment or vaunted remedy. 

Ventilation. This is a subject of much importance to public health, but 
one which is often much neglected. By ventilation one must understand a 
due supply of fresh air in the twenty-four hours, so as to allow plenty of oxy- 
gen to enter the lungs and properly aerate the blood. But it is a bad thing if 
there is too much draught with the ventilation, as in this way the patient is 
often cold, and this may do harm. For this reason the poor, who huddle to- 
gether in winter in a small room, prefer a stifling atmosphere with a warm 
temperature to a ventilation which in their case is generally accompanied by a 
draught. Again, in the wards of a hospital it is usual to have the windows 
open to let fresh air in, but this is sometimes bad for cases of bronchitis and 
Bright's disease, as the cold air blowing upon the patients increases their mal- 
ady. To obviate this, there should be a corridor running parallel with each 
ward, and supplied with plenty of windows on each side ; the one set, com- 
municating with the open air, should be opened, while those communicating 
with the ward are closed, and vice versa ; in this way, by repeating the process 
several times a clay, enough fresh air will be brought in the room without too 
much draught being felt. Li workshops, factories, etc., this entry of fresh air 
is very important, as a room soon becomes contaminated when many are 
working in it. An ordinary fire and the usual crevices of a window or door 
are agents in promoting a current of air through a room ; the smaller a room 
the oftener the air has to pass through it to sustain a proper amount of purity. 
Each person should have at least 800 cubic feet of space with a due current of 
air. A bedroom should have the windows open for the greater part of the 
day, so as thoroughly to aerate it. See Respiration and Lungs. 

Ventricle. This name is applied to a cavity ; thus there are ventricles in 
the brain and in the heart. See Brain and Hkart. 

Veratria is a powerful alkaloid which exists in several vegetable sub- 
stances, but is itself mainly obtained from sabadilla seeds. The jn'ocess for 
obtaining it is complicated, but essentially consists in the separation of the al- 
kaloid by means of alcohol, and afterwards purifying the product thus obtained. 
The pure veratria is crystalline and almost insoluble in water, but freely so in 
alcohol. Its taste is powerfully acrid, and it is excessively irritating to mu- 
cous membranes, especially the nose. From this cause it gives rise to violent 
sneezing when applied to the nostrils. There is an officinal preparation of 
veratria not much used, namely, the ointment of veratria. 



VER 800 VER 

Veratria acts very powerfully on the skin, and still more so on mucous 
membranes, producing irritation on these, but afterwards sedative effects. The 
true use of veratria is not yet quite clear. 

Veratrum Album, or AVhite Hellebore, contains veratria, and owes 
its influence to that substance. The root stock of the plant is employed, but it 
is no longer officinal. It is generally seen in sections an inch or two long, 
with the rootlets projecting from it. The color is yellowish-brown, lighter 
within, and it has an exceedingly acrid and bitter taste. White hellebore used 
to be employed mainly in the form of vinum veratrise, white hellebore wine. 
This substance when swallowed gives rise to much vomiting and purging, and 
was at one time largely used, as was black hellebore, in the treatment of 
mania. It gave rise to much disturbance of the alimentary canal, and greatly 
reduced the patient's strength, but did no good. It has fallen completely into 
disuse, as has the black hellebore ; but another veratrum, which, however, is 
said to contain no veratria, has come into general use, especially in America, 
where it is a native. See Veratrum Viuide. 

Veratrum Viride, or Green Hellebore, is known as Indian poke, and 
is said to have been long in use among the aborigines of North America. 
The root stock, which is thick and fleshy, is the part used. It gives rise to 
tingling, and has a peculiar acrid taste like others of the class. Jts only prep- 
aration is the tincture. This is an excessively powerful preparation, given 
even in small doses ; repeated at moderate intervals it produces much sickness 
and great prostration of strength. Even doses of a few drops of the tincture 
will in a short time give rise to these sensations. It acts apparently specially 
on the heart, which it controls ; not long after it has begun to take effect, the 
pulse gets small and the strength is greatly diminished. It does not purge 
when given as tincture, but produces vomiting. Its effects have been compared 
to those of colchicum, but though analogous they do not coincide. In America 
the drug has been largely given in inflammations, especially of the lungs. It 
seems to do good in rheumatism, but does not cut short the attack. 

In pneumonia, green hellebore has been employed with benefit. It lowers 
the temperature, and seems to favor the local changes necessary to recovery. 
The remedy requires careful handling. 

Verdigris is an acetate of copper, a product which results from the action 
of some fermenting substance on copper. It is more dangerous as a poison 
than valuable as a remedy. Not unfrequently its presence in badly-cleaned 
copper cooking utensils has given rise to somew T hat serious results. Some- 
times, but very rarely, it is applied externally ; internally, it is never used. 
It has been mixed with honey and applied, by means of a camel's-hair pencil, 
to some half-vitalized body, as wart?, for the purpose of destroying them. 

Vertebra. See Spine. 

Vertigo, or Giddiness, is that peculiar sensation wherein we seem to be 
standing quite still, and objects running round us. This commonly causes loss 
of balance, and the individual may fall down. In a good many cases he is able 
to recover himself without falling, especially if he can lay hold of anything to 
steady himself with for a moment. In most cases giddiness depends on an in- 
sufficient or improper supply of blood to the brain. Thus, in giddiness after 
a severe illness, in attempting to stand upright, we see imperfect blood supply. 
In other instances the blood supply is impure from containing too much alco- 
hol, or the products of imperfect food metamorphosis. In old people, when 
the vessels become hardened and unyielding, as well as incapable of due re- 
silience, we often find giddiness a permanent symptom. 



VES 801 VIS 

Thus it is seen that vertigo is rather a symptom than a malady, and a symp- 
tom, too, of very varying significance, for sometimes apparently over-fullness of 
the vessels gives rise to a kind of giddiness. If, for instance, the face is flushed 
and the head hot, it may be desirable to give some purgative medicine, whereas 
the kind referred to first of all as occurring in convalescence is best remedied 
by a glass of wine. The subsequent management depends on the same prin- 
ciple. Where there is weakness, good food and exercise are the best rem- 
edies ; in the other, saline purgatives, with some diuretic. 

Not unfrequently vertigo depends upon or foreruns brain disease, and such 
brain disease may be very intractable in character. Headache is commonly 
associated with such vertigo. Thus the symptom of giddiness, taken by itself, 
may teach us nothing beyond directing attention to the case which, if care- 
fully studied, will gradually reveal itself to the skillful practitioner. 

Vesica. An anatomical name for the bladder. 

Vesical Calculus. See Stone. 

Vesicant. Any remedy, as Spanish fly, acetic acid, etc., which can raise a 
blister on the skin. See Blisters. 

Vesicle. A small blister on the skin, containing a little clear fluid within. 
It is seen in cases of eczema, herpes, and erysipelas ; also when a blister is 
applied. 

Vibices are patches of haemorrhage, which occur in the skin in cases of 
purpura ; they are also known as ecchymoses ; when v'ery small, they are called 
petechias. See Petechia. 

Village Hospitals have been established of late years in many parts of 
the country. They generally are fitted up in a suitable manner, and placed in 
a healthy situation, while around there is a garden where the convalescents 
can sit or walk about, A trained nurse looks after the patients, while a ser- 
vant does more or less of the domestic work. These hospitals rarely contain 
more than four or six beds. They are very useful in case an accident should 
occur in the neighborhood, in relieving the patient from being carried several 
miles to the nearest town ; also in case any epidemic breaks out, when the 
patients can be isolated at once. One or more medical men in the neighbor- 
hood attend every day to look after the invalids. 

Villi are small prominences on the inner or mucous lining of the intestinal 
canal, which take an active part in the absorption of the food. See Intes- 
tines. 

Vinegar, as employed in medicine, is only a dilute form of acetic acid. It 
is used as a refrigerant and as a solvent for some medicinal substances yielding 
their properties more readily to vinegar than to alcohol. The officinal vinegar 
is made from malt ; that in most common use is made from wine. It really mat- 
ters little which is used. Vinegar and water is a favorite local application 
for cooling, but it is not nearly so efficacious as spirit and water. 

Violets, the plant of the Viola odorata, is no longer officinal. The root 
was at one time used, but recently only the petals have been. These were 
used to prepare a syrup, which was a beautiful preparation, but rather useless. 
The root had more active properties, especially emetic. 

Viscera. This is a name applied generally to any of the internal organs ; 
thus the liver, kidneys, and spleen, etc., are spoken of as the abdominal vis- 
cera. 

Vision. The eye is the organ of vision, and by it we perceive those phe- 
nomena which reveal to us objects in the world around us. The eye is a nearly 
circular body, placed safely in a bony cavity called the orbit, and acted upon 



VIS 802 VIS 

by certain muscles, so, that we can direct our gaze in any direction we please. 
In front of the eye is a circular window called the cornea, which enables light 
to enter ; behind this is a circular ring of muscular fibres, called the iris, which 
is variously colored in different people ; in the centre of this ring is an open- 
ing called the pupil, and this corresponds to the centre of the eye. and allows 
of the transmission of light. Now the iris, being muscular, can contract or 
dilate, and thus the size of the pupil will necessarily vary. When the light is 
very strong the pupil contracts, so as to let in less light, and, conversely, in the 
dark the pupil expands, so as to allow as much as possible to enter. Placed 
behind the iris, but close to it, is a transparent double convex lens, and further 
behind is the retina, a delicate membrane made up chiefly of nerve-fibres, and 
when the rays of light fall on this membrane they excite in the brain the sen- 
sation of vision. The retina is concave, and at the back of the eyeball ; the 
greater part of the eye is filled up in the centre with a transparent gelatinous 
substance known as the vitreous body, while between the cornea and iris is a 
similar clear substance known as the aqueous humor. Thus it will be seen 
that in health there is a clear, transparent passage for the rays of light to pass 
into the eyeball, so as to fall upon the sensitive surface of the retina ; and 
further, this passage is guarded by the iris, which, by contracting or dilating, 
may diminish or increase the quantity of light entering. Now the use of the 
double convex lens is to bring the rays of light to a focus on the retina. Par- 
allel rays, or those proceeding from a distant object, are in this way brought 
to focus, while non-parallel rays are more or less deflected from their previous 
direction. The position of the lens can be slightly altered at will, and this is 
of much use in determining the size and clearness of an object ; the eye, in fact, 
accommodates itself to various distances, or otherwise anything afar off will 
appear dull and blurred. This is the case in some diseases. If, for example, 
we look at two objects, one of which is at the distance of a yard from the eye, 
and the other at two yards, when we fix the first the other becomes dim ; 
while if we fix the second, the other in turn becomes indistinct. Errors in the 
apparatus for this accommodation of vision give rise to the affections known 
as myopia and presbyopia, or short-sight and long-sight. The usual cause of 
short-sight is too great a convexity of the lens, so that the focus is formed in 
front of the retina, and not upon it. It may be remedied by slightly concave 
glasses, which, by their diverging power, correct the want of accommodation, 
and. throwing the focus further back, cause the image to be formed on the 
retina. Working at a microscope, and constantly looking at small objects, as 
reading and writing, tends to produce myopia. It is common in the case of 
young'people, but diminishes with age. Presbyopia, or long-sight, is the op- 
posite condition. The eye can see distant objects very well, but those which 
are very near badly. This is because the lens is not convex enough, and does 
not allow a proper convergence of the rays of light upon the retina. It is cor- 
rected by using convex glasses according to the degree to which the patient is 
affected.' It generally occurs in old people. People are color-blind when 
their retina will not perceive some of the rays of light. Light is made up of 
three primary colors, and when overlapping in the spectrum are known as the 
colors of the rainbow. When mixed, white light is produced ; now each color 
has a different velocity, for light is supposed to be made up of imponderable 
particles traveling at a vast speed through space. The eye can only see those 
colors which have a certain velocity, and in ordinary persons these colors are 
red, blue, and yellow, with their compounds, — green (blue and yellow), 
orange (red and yellow), and purple or violet (red and blue). In some cases 



VIS 803 VIT 

the retina may not be able to see one or other of these colors. The bluish 
tinge seen in solutions of quinine and horse-chestnut is called fluorescence, and 
is due to the fact that extra rays of the spectrum are then made visible to the 
human eye. The special sense of sight is carried on by the optic nerve, and 
if this is diseased, more or less blindness will ensue. A cataract, or disease of 
the lens, and opacities in the cornea cause blindness by preventing the light 
entering the eye. The mischief may in some of these cases be removed. We 
may see flashes of light without any rays of light entering from the outer 
world. Any sensation which will stimulate the retina in a way similar to 
what ordinary light does will cause a flash to appear before the eyes. A gen- 
tle current of electricity passed through the temples will give the appearance of 
summer lightning. In dreams, and in some diseases of the brain, flashes of 
light may also appear. When an eye is exhausted by looking too long at a 
bright color, another color, called the complementary color, will appear on re- 
moving the gaze. This is due to the retina being tired for a short time, and 
a false impression is therefore conveyed to the brain. Thus, on looking at a 
scarlet object with a fixed gaze, a green one will appear on looking away, and 
every one who has gazed at the sun a short time will have observed a black 
disk on the pavement when he looks down again. There are an immense 
number of optical delusions, which in sensible people arc corrected by the ex- 
perience of the other senses, but which in foolish and emotional people may 
lead to extravagances and erroneous impressions. See Eye. 

Vision, Double, may be produced at will in perfectly healthy eyes. 
" If a person hold the two forefingers in a line from his eyes, so that one may 
be more distant than the other, by then looking at the nearest the more dis- 
tant will appear double." (Dr. Arnott, Elements of Physics, vol. ii.) It 
occurs, moreover, as a frequent disorder of vision, either dependent upon 
changes in the nervous, transparent, or muscular structures of the eye, or 
arising without any intrinsic morbid changes, and in sympathy as it were with 
some disease affecting a near or remote organ of the body. Thus affections 
of the stomach, worms, toothache, headache, and chronic affections of the 
brain are often associated with double vision, which ceases after the subsi- 
dence of the pi-imary malady. There are two kinds of double vision : In 
the first, the patient sees double, treble, etc., witli one eye alone. This is 
called polyopia. In the second kind the patient sees double with both eyes 
open — diplopia, or double vision. 

Double vision may be produced through long-continued exercise of the eye 
in reading or writing by a bad light, and by straining the sight in reading 
small type. In cases of this kind the disorder is usually transitory, -and may 
be speedily relieved by resting the eyes or closing them for a short time. 

In recent squinting, due to irritation in the stomach or intestines, or to 
some severe affection of the brain, the patient sees double. In ordinary con- 
genital or long-acquired squinting of one eye, double vision does not generally 
occur, as the patient, by habit, has learnt to use only the sound eye. 

Vitiligo. A technical name for white patches on the skin, caused by loss 
of pigment, or the usual coloring matter, at that spot. 

. Vitiligoidea. A name given to certain yellow patches which now and 
then are met with round the eyelids and elsewhere on the skin. See Xan- 
thelasma. 

Vitreous Body. The name given to a 'gelatinous semi-fluid substance 
which fills up the central portion of the eye. It is quite transparent, and allows* 
of the transmission of light. See Eye and Vision. 



VIT 804 WAL 

Vitriol. See Sulphuric Acid. 

Voice is the product of the vocal cords, situated in the larynx, at the upper 
portion of the windpipe. Outwardly in males this part is indicated by a pro- 
jection commonly called " Adam's apple." These vocal cords are' membranes 
extending from hack to front of the larynx, and are capable of adjustment, so 
that a greater or less portion of the surface may be allowed to vibrate. The 
deep grave notes of the voice are apparently produced when these are relaxed 
to the uttermost ; the shrill, high notes when only a small portion is in vibra- 
tion. A series of muscles regulate these movements, which, after a time, be- 
come quite automatic. The motive power is air ejected from the chest gradu- 
ally, but little sound and no voice can be produced during inspiration ; it is 
by expiration alone, under ordinary circumstances, that sound is produced. 

Voice may be lost from various causes. The condition is termed aphonia. 
Thus voice is often lost in hysterical people, in whom a smart electric shock 
will generally bring it back speedily enough. It may be lost in disease, as in 
ulceration of the larynx, or in malignant disease of the same. In these cases 
the nature of the malady is decided by examination with the laryngoscope, 
and the remedy will of course depend on the nature of the malady. 

Vomiting means the ejection of the contents of the stomach upwards, in- 
stead of into the bowel. The act is a complex one, and seems due to two 
factors, namely, contraction of the walls of the stomach itself, and contraction 
of the abdominal walls, the contents of the abdomen tliceby in their turn 
pressing on the stomach itself. The causes of vomiting are very various : irri- 
tation of the stomach itself, whatever be its cause, will give rise to ejection of 
its contents ; but vomiting occurs in many other maladies. When gall-stones 
or small urinary calculi are passing there is usually sickness and vomiting ; in 
Bright's disease there is vomiting too, and in the maladies of the brain among 
children vomiting is an invariable symptom. 

To arrest vomiting, ice is a capital remedy ; prussic acid, too, in very small 
doses of two or three drops, is a favorite remedy with some. Bismuth ia 
good, especially with small doses of opium. In all cases the quantity of the 
remedy used should be small. Bulky preparations will most probably be re- 
jected. 

Voyages are frequently undertaken as a means of health, especially in 
young persons with delicate chests, and often are attended with most beneficial 
results. We shall only lay down one or two rules as to their selection, but 
these are important : Voyages should never be undertaken by any too deli- 
cate to stand a little knocking about. Sometimes people are sent away who 
die on their voyage, and whom it was positive cruelty to send abroad. A 
short voyage is useless. The time for sailing should be late autumn, after the 
equinoxes. Some few private stores should be taken, but these will suggest 
themselves. The first rule is the guide to everything else. 

W. 

Walking, as a means of exercise, is invaluable to people in sufficiently 
robust health to undertake it. It should never be allowed to be carried so far, 
however, as to produce more than a sufficient degree of fatigue to make it 
pleasant, and should never be indulged in to the foolish extent it is by some 
young men. The great thing in walking is the boot. That should not be too 
heavy ; strong, with good thick, broad soles and low heels. Walking-boots 



WAR 805 WAR 

should always be made to lace ; what are called side-springs are an abomina- 
tion. A few nails are a decided improvement. 

Warming. Most large institutions and churches, etc., are now warmed by 
means of hot water, which circulates in pipes through the building and radiates 
heat. A furnace in the -basement heats the water, which then rises in the 
pipes, while the cooler water descends to the boiler to be in turn re-heated, and 
so a continual current is set up. An ordinary room may be heated by a stove 
or an open fire ; the latter is much to be preferred. A room should not be 
more than 65° Fahr., for beyond this point the heat is relaxing. 

Warts, or, as they are scientifically termed, verruca}, are papillary tumors, 
the varieties of which depend upon their locality. The most common are 
those situated about the hands or fingers, or sometimes on the face, and more 
rarely on other parts of the body ; they chiefly affect young persons, and their 
structure is hypertrophied papilla?, closely adherent to each other, and covered 
with thick cuticle. A somewhat scarce variety occurs upon the scalp occasion- 
ally, and almost invariably in women after adult age, although it has been met 
with in males, and from its presence and form gives great pain and incon- 
venience in brushing the hair. A third variety is occasionally met with be- 
neath or at the side of the finger or toe nails. These originate beneath the 
skin and protrude beyond the free margin of the nail. They are generally 
very painful and troublesome. Warts of a peculiar nature, arising from vene- 
real causes, are met with under the foreskin and between the labia, and are 
liable to rapid propagation from their close contact with neighboring parts. 
Such warts are undoubtedly contagious. 

In some persons warts appear to be hereditary, and the period of life up to 
the time of puberty seems to be that in which these growths flourish. They 
sometimes appear curiously, suddenly, and as suddenly disappear. It is very 
probable that the poison of decomposing animal matter is, under certain condi- 
tions, capable of exciting these warts. This is partly inferred from the fact 
that those engaged in the manipulation of dead and morbid tissues are fre- 
quently affected by them. As a rule, warts do not materially increase in size, 
supposing that they do not entirely disappear, although occasionally, owing 
to some permanent source- of local irritation, they may ''take on" a semi- 
malignant character (see Tumors), especially those occurring about the 
face. 

The treatment of simple warts, such as occur on the fingers or scalp, is very 
simple. The best method consists of their destruction by the glacial acetic 
acid, which may be either dropped upon them or painted thickly over them 
with a brush, care being taken to apply a little oil or glycerine to the tissue 
contiguous to the wart, so as to avoid blistering it. Lunar caustic, tincture of 
the perchloride of iron, a drop of pure nitric acid, or the acid nitrate of mer- 
cury, are all good and frequently efficient remedies. The scalp warts are often 
most effectually treated by ligaturing their bases with a loop of silk or thin 
silver wire, and allowing them to drop off. Venereal warts of a not very gen- 
eral character are best treated by snipping them off with scissors, or by the 
application of powdered oxide of zinc, or equal parts of powdered savine and 
diacetate of copper. In the case of rapidly growing warts, and those which 
are evidently degenerating in their appearance, excision of the growth and of 
the integument from which it grows is the advisable treatment. 

The variety noticed as growing from under the nails of the fingers or toes is 
best treated by pulling out the papillae constituting its bulk by forceps, sepa- 
rately. 



WAS 806 WAT 

Wasting Diseases. Wasting is a very common symptom in many dis- 
orders. In the adult it is observed in all severe cases of fever, but then they 
reoover their weight during convalescence. In cancer and consumption it is a 
most marked symptom, also in many cases of disease of any internal organ ; it 
is chiefly noticed also in those who are liable to degeneration of their tissues. 
(See Degeneration.) It is clearly impossible to enumerate all the causes of 
wasting, or to give any account of the symptoms associated with it, as it is 
common to so many varieties of disease. In children, in whom very few 
symptoms can be observed, wasting is a valuable indication of mischief. It 
may arise from insufficient nourishment, or over-feeding, or from unsuitable 
foods (see Diet), or from chronic diarrhoea, which more or less exhausts the 
child (see Diarrhcea), or from chronic vomiting, generally depending on 
some gastric disturbance, or from the child having rickets (see Rickets), or 
from the presence of worms in the intestinal canal (see Entozoa). Inherited 
syphilis, consumption, and tuberculosis will also cause much wasting. A part 
may waste from want of use, and so it is common to see a wasting of an arm 
or leg in cases of paralysis. See Tabes Mksenterica. 

Water. "Water is a compound of hydrogen and oxygen, in the proportion 
by weight of two parts of the former and sixteen of the latter. Ordinary 
water is too well known to require a full description. It should be clear, col- 
orless, and deposit no sediment on standing, nor on evaporating a drop on a 
glass slide. Covering a large portion of the -earth's surface, it is invaluable to 
man in many respects ; in the form of ice in the arctic regions it forms a 
bridge of communication between distant places ; in its liquid state it supplies 
animal and vegetable matter with the means of sustenance ; it supplies man, 
also, by means of the seas and rivers, with means for communication with for- 
eign lands ; in the ocean and in lakes and rivers are also contained myriads of 
fish and other products which are useful as food ; as steam it is useful as a 
motor power in economizing labor, advancing civilization, and improving the 
condition of man. It occurs in various forms : ice, hail, dew, hoar-frost, rain ; 
snow and hail are but various kinds of water. On evaporation from the sur- 
face of the earth it forms clouds, which, when they condense, give back the 
water to the thirsty earth. 

Properties. Pure water is only known to the chemist, for all the ordinary 
kinds of water contain either gaseous, saline, or organic matters. It freezes at 
32° Fahr., or at zero on the Centigrade scale, into a number of crystalline 
forms. It evaporates at all temperatures, and boils at 212° Fahr. or 100° 
Centigrade, under the ordinary atmospheric pressure at the sea level. Above 
39° Fahr. water expands by heat ; below this point it expands gradually, thus 
differing from most fluids, which contract by cold ; it is due to this fact that 
pipes burst in a house in the winter, and that a jug may become broken when 
ice forms. Sea-water, however, contracts regularly on lowering the tempera- 
ture. The density of water at 60° Fahr. is taken as unity (1.000), and it is the 
standard by which the specific gravities of all solids and liquids are compared 
in this country ; the barometric pressure at the time should be noted to insure 
accuracy; the mercury should stand at 30 inches or 7oO millimetres. (See 
Barometer.) A cubic inch of pure water weighs at 60° Fahr. in air 252.456 
grains. Nearly all ordinary compounds contain water, and therefore shrink on 
exposure to heat, for then the water is driven off. Nearly all crystallized bodies 
contain water, and when heated become powdery. There are various kinds of 
natural waters, namely, rain water, spring, mineral, river, and sea-water. 

Main water is never really absolutely water, as it contains gases which it 



WAT 807 WAT 

absorbs in passing through the air ; melted ice and melted snow are perhaps 
the purest forms of water which can be obtained naturally. The water of our 
lakes contains various inorganic and organic impurities, from the rivers which 
flow into them or the springs which supply them. The beautiful color of the 
Swiss lakes seems due to the floating about of innumerable fine • particles 
brought down by the swift mountain torrents. 

The river water contains less saline matter than spring water, but it also 
contains various organic impurities according to the district through which it 
passes. Near large towns it may contain a good deal of sewage, or refuse 
from manufactories ; it contains also fish-spawn, leaves, silt or mud, according 
to the rapidity of the current. Before, therefore, it can be used for drinking 
purposes, it must be filtered through beds of sand, gravel, etc., so as to remove 
the impurities ; any running stream has a self-purifying power, because it 
continually exposes fresh portions of the water to the air, and so the organic 
matters get oxidized. It is thus very important that for the due supply of a 
large town there should be a rapid current, absence of sewage matters from 
the towns above, and proper filtration, so as to separate inorganic impurities. 
The presence of organic matter may be roughly estimated by putting two or 
three drops of Condy's fluid, or permanganate of potash, into half a gallon of 
water ; if pure there will be a pink tinge ; if impure it will be colorless, or a 
faintly brown precipitate is produced. River and rain water are ordinarily 
known as soft water, because they contain little or no lime ; hence they are 
more useful for washing and other domestic purposes. 

Spring water, although it may look transparent, always contains saline mat- 
ters, and chiefly the lime salts ; hence such water, although very agreeable to 
drink and quite wholesome, is known as hard water, and soap curdles in it and 
does not produce a good lather. Carbonate of lime, common salt, sulphate of 
lime, and carbonate and sulphate of magnesia are the salts most usually pres- 
ent in spring water. They are held in solution partly by the carbonic acid 
which all such waters contain ; this is seen on boiling the water, when the car- 
bonic acid is driven off, and on cooling the water looks turbid, and deposits a 
small amount of sediment consisting of the above salts; to this cause is due the 
fur or incrustation on the inside of kettles and. boilers. Pure water is very 
insipid, and it is to the gases and saline impurities of ordinary spring water 
that its refreshing properties are mostly due. The danger from impure water 
is due to the orgauic matters and those derived from drains, sewers, etc. An 
excess of lime in spring water is said to cause the Derbyshire neck, known 
also as bronchocele or goitre. 

Mineral waters contain iron, sulphur, and various salts, according to the 
nature of the soil through which the water has percolated. Those which con- 
tain iron are called chalybeate waters, of which Cheltenham is an example ; 
those which contain carbonic acid are pungent and effervescent ; artificially 
prepared they are known as soda and seltzer waters. Some have sulphur or 
sulphuretted hydrogen in solution, and are very nauseous, as the Harrogate 
waters. Others contain saline matters, as the springs at Epsom, and hence 
the well-known medicine commonly called Epsom salts. See Mineral 
Waters. 

■ Sea water is largely impregnated with common salt and with chloride of 
magnesium, to which it owes its bitter taste. From the vast surface of the 
seas pure water is constantly evaporating to form the clouds ; into it run the 
contents of myriads of rivers, while the sea itself constantly returns to the 
earth marine plants, fish, guano, kelp, etc., which are useful to man. The 



-WAT 803 WAT 

mean specific gravity of sea water is 1.027, and the quantity of salt it contains 
varies from 3.5 to 4 per cent. Hence it is easier to keep afloat in salt th;in 
in fresh water. The following table shows the composition of the sea water 
of the British Channel: — 

Water 963.74372 

Chloride of sodium 28.05948 

Chloride of potassium . . 0.76552 

Chloride of magnesium 3.66658 

Bromide of magnesium 0.02929 

Sulphate of magnesia ......... 2.29578 

Sulphate of lime 4.40662 

Carbonate of lime 0.03301 

Iodine traces 

Ammonia traces 

1000.00000 

For chemical purposes water is obtained by distillation ; this may be done 
on a small scale by heating water in a glass retort and allowing the vapor to 
pass over into a receiver which is kept cool ; the vapor condenses and pure 
water is obtained ; however, the first and the last portions distilled should be 
thrown away, as the first may contain volatile waters, and the last saline im- 
purities, when the contents of the retort get too low. The specific gravity of 
steam is 0.662, of ice, 0.94; hence ice is lighter, and therefore floats in water. 
Water may be produced when an electric spark is passed through a vessel con- 
taining a mixture of hydrogen and oxygen, in the proportion of two volumes 
of the former and one of the latter ; a slight explosion occurs and a few drops 
of moisture are produced. Water dissolves many substances, and therefore 
cisterns are best made of slate, and not of lead, as that metal is acted on by the 
water, and may give rise to colic and lead poisoning if swallowed. Iron pipes, 
and not lead pipes, should be used for the conveyance of water for the same 
reason. 

"Water-beds, or Water-cushions, are very useful in many cases of fever, 
paralysis, and long-standing disease ; they aid in preventing any undue press- 
ure on a part, and so prevent the formation of bed-sores ; they are also of 
great comfort to a patient, and enable one to rest much better than on an or- 
dinary bed. 

Water-brash is a common symptom in indigestion. It is caused by the 
rising up in the oesophagus, or gullet, of a watery fluid secreted by the glands 
of the stomach. See Indigestion. 

Water Closets are inventions of which no one has any particular reason 
to be proud. With a show of cleanliness they combine essential nastiness and 
a good deal of real danger. In large towns their use can hardly be dispensed 
with ; in the country, with imperfect drainage and water supply, they are an 
intolerable nuisance. Earth should always be used instead of water in country 
.places ; it is preferable in every way. To keep water closets moderately safe, 
the first thing is to have the sewers ventilated ; otherwise, they ventilate them- 
selves into the house by means of the water closets. A pipe should therefore 
lead from the house sewer to the highest point of the building. From time to 
time the pipes and traps ought to be examined, to see that the former are 
entire and not leaking, and that the traps are in working order. A portion of 
disinfectant, fluid or solid, should be used at least once every day. The best 
is carbolic acid, in powder or in solution. With these precautions the water 
closet system may be worked with no very great risk, but the best thing is to 
get rid of them wherever possible. 



WAT 809 WEI 

Water on the Brain. See Hydrocephalus. 

Wax is the cera of the Roman physicians, and is a peculiar substance oc- 
curring in the textures of plants, and sometimes on their surface. It is also 
formed by animal organisms, and in the largest quantity by the common bee. 
It is obtained for use after the honey which the waxen cell incloses has been 
expressed, and is fused in boiling water and strained. This is the yellow wax 
of commerce, and the cera of the London Pharmacopoeia. The white wax 
of the shops, cera alba of the Pharmacopoeia, is made by bleaching the com- 
mon yellow wax, and exposing it to the air. It is largely used in the prepa- 
ration of plasters, ointments, and cerates, and also by dentists and mechanical 
surgeons in taking moulds or models of any part of the body. 

Waxy Degeneration of the liver, or kidney, or spleen. See Degenera- 
tion. 

Weaning. When a child, having been suckled for 'some months, is taken 
from the breast and fed on ordinary food it is said to be weaned. As a rule, 
the poor suckle their infants far too long, and this is attended with injury to 
themselves and to the child. Most children should be weaned between nine 
and ten months old. The transition between the breast-milk and solid food 
should not be too sudden. See Diet. 

Weight. The average weight of the human body may be taken at 154 lbs. 
Such a body would be made up of muscles and their appurtenances, 68 lbs., 
skeleton, 24 lbs. : skin 10| lbs. ; fat, 28 lbs.; brain, 3 lbs.; thoracic viscera, 
2i lbs ; abdominal viscera, 11 lbs.; blood, 7 lbs. About five pounds more 
blood will remain in the tissues and will not drain away, and therefore it is 
reckoned with them. The female weighs less .than the male. The following 
is the weight of the chief internal organs : — 

Male. Female. 

Brain 48-53 oz. 40-45 oz. 

Heart 10 " 9 " 

Lungs „ 18-20 " 15-18 " 

Liver 50-60 " 45-50 " 

Kidney . I 5-5^ " 4^-5 " 

Spleen 4-6 " 4-6 " 

These are but averages ; a great variation in the weight of people is met 
with, depending on their age, stoutness, sex, height, and mode of living. 

Weight and Height. Within the last few years public attention has been 
drawn to the fact that weight is as important an indication of the general con- 
dition of the human body as any other evidence, and many physicians make 
a practice of weighing their patients periodically at each consultation. The 
habit of being weighed has almost become an amusement, and in railway sta- 
tions, shops, and many places of recreation weighing machines are to be seen 
in constant request, and little cards inscribed with the " correct weight " are in 
the possession of most persons we see. It will easily be seen, however, that to 
know the correct weight of an individual without reference to height is of 
little advantage, but if a standard be ascertained as to the proper proportion 
which weight should bear to height, then we know how much a person ought 
to weigh and can treat him accordingly. One of the earliest efforts made to 
obtain anything like a fixed relation between weight and height was that of 
Dr. Boyd, who weighed a certain number of inmates of the Marylebone work- 
house. He took the weight and height of 108 persons suffering from consump- 
tion, and found they measured 5 feet 7 inches, and weighed 90 lbs. He then 
measured and weighed 141 paupers not in ill health, and found their average 
height was 5 feet 3 inches, and they weighed 134 lbs. This subject attracted 



WEI 



810 



WEI 



the attention of the late Dr. John Hutchinson, and he determined to take the 
height and weight of persons of all classes of the community. In this way he 
collected the height and weight of upwards of 5000 persons. This list, how- 
ever, included persons who exhibited themselves as giants and dwarfs, and other 
exceptional cases. He therefore reduced his instances to 2650 persons, all of 
whom were men in the prime and vigor of life, and included sailors, soldiers, 
firemen, policemen, draymen, gentlemen, paupers, and pugilists. This group 
of cases was intended to make one class a set-off against another, so as to get a 
fair average. The following is the result of Dr. Hutchinson's observations : — 



Height. 
Ft. In. 
5 1 
5 2 
5 3 
5 4 
5 5 
5 6 



Weight. 


Height. 


lbs. 


Ft. In. 


. 120 


5 7 


126 


5 8 


133 


5 9 


139 


5 10 . 


142 


5 11 


145 


6 . 



Weight. 
lbs. 

148 
155 
162 
169 
174 
178 



Of course the result of these observations can only be considered as approx- 
imate, but they are sufficient to show that among a set of healthy men there is 
a healthy standard of height and weight. In examining this table, Dr. Lan- 
kester found that for every inch increased in height we have five pounds more 
in weight, and this rule holds good for all practical purposes. Starting with a 
person 5 feet in height, who, according to the assumed law, should weigli 115 
lbs., we obtain the following results : — 



Height in In. 


Height in Ft. 


Weight in Lbs. 


Height in In. 


Height in Ft. 


Weight in Lbs. 


Inches. 


Ft. In. 


Lbs. 


Inches. 


Ft. In. 


Lbs. 


60 


5 


115 


69 


5 9 


160 


61 


5 1 


120 


70 


5 10 


165 


62 


5 2 


125 


71 


5 11 


170 


63 


5 3 


130 


72 


6 


175 


64 


5 4 


135 


73 


6 1 


180 


65 


5 5 


140 


74 


6 2 


185 


66 


5 6 


145 


75 


6 3 


190 


67 


5 7 


150 


76 


6 4 


195 


68 


5 8 


155 









Although this law is approximately good for a certain number of cases, even 
above and below this table, it is practically found, and especially in the case of 
children and growing persons, that there is a wide difference of weight at 
heights below 5 feet. Attention may also be drawn to the fact that there will 
constantly occur in the community instances of persons where either the mus- 
cular or bony systems are excessively developed, and who, consequently, weigh 
more or less than their height. Dr. T. K. Chambers, in his essay on corpu- 
lence, calls especial attention to the researches of Mr. Brent on the assumed 
weights of the statues of antiquity. In order to get at this, Mr. Brent im- 
mersed in water accurate copies of these statues, and by ascertaining the 
quantity of water they displaced he calculated their heights. Dr. Chambers 
has taken the pains to reduce the absolute weights of these statues to assumed 
heights, and thus compared the heights and weights of these statues of antiq- 
uity with Dr. Hutchinson's modern man. Without giving the whole of the 
heights and weights we preseut the series at the assumed height of 6 feet. 
Thus ; — 



811 




PLATE XXVIII. 



WEI 



813 



WEI 



Bronze Tumbler . . . . 
Hutchinson's Man . . . 
Dying Gladiator . . . . 
Theseus (British Museum) 

Hercules 

Farnese Hercules . . . . 



Height. 



Inches. 


Lbs. 


72 


158 


72 


178 


72. 


196 


72 


210 


72 


234 


72 


259 



On this table Dr. Chambers remarks : " Of the statues here selected, the 
Bronze Tumbler may be taken as the type of extreme lightness and activity, 
the Dying Gladiator of robust strength ; Theseus and the smaller Hercules as 
the sculptor's idea of a hero, where bodily strength must be equal to that of 
any possible man. The Farnese Hercules exhibits a development of muscle 
greater than is ever known to exist in the human species." Dr. Chambers 
also gives the height and weight of certain celebrated prize-fighters, the result 
of Mr. Brent's observations, which makes it obvious that in certain cases the 
great weight depends on muscular and osseous development. The conclusion 
we come to with regard to all these weighings and measurings is that all ordi- 
nary departures from the average height and weight of the body deduced from 
Dr. Hutchison's tables are clue to an increase or decrease of the fat or adipose 
tissue of the body. Thus, taking the composition of a human body weighing 
154 lbs. and measuring 5 feet 8 inches, it will be found to contain 12 lbs. of fat. 
It is then mainly due to the diminution or increase of this substance that human 
beings vary in weight, and it is important to find out whether this fat be of any 
use or value in the system, and whether the indications afforded by the weigh- 
ing scales should not afford some suggestions for caution in diet and regimen. 
Besides exerting a primary influence on the growth of the body, fat subserves 
many other purposes and is essential to animal life. When there is too little de- 
posited for the purposes of life, then serious disease has already commenced, or 
may set in ; whilst, on the other hand, a redundancy of this deposit may seri- 
ously interfere with the functions necessary to life. It is from this point of 
view that the value practically of a knowledge of the height and weight of in- 
dividuals becomes apparent. When the weight of a person is much below 
his height, then it may be suspected that some disease has set in, which may 
go on to the destruction of life. One of the earliest symptoms of consumption 
is a tendency to loss of weight. Long before any symptoms are present of 
tuberculous deposits in the lungs, this loss of weight is observable in persons 
afflicted with consumption. At this stage of the disease, a large amount of 
evidence renders it probable that the fatal advance of this disease may be pre- 
vented. This fact has been admitted by the practice 'introduced during the 
last thirty years of administering cod-liver oil and fatty substances to those who 
are threatened with consumption. In fact, it may be stated generally that, 
wherever the weight is much below the height, suspicion should be aroused 
and the indication regarded. The other side of the question should not be for- 
gotten ; in certain families and individuals there is a tendency to develop adi- 
pose tissue unduly. However free from fat may be the food, what little it con- 
tains is arrested in the tissues of these individuals and they become "fat" — 
that is, they weigh more than their height. Sometimes this is deposited all over 
the system so as not to be an obvious obstruction to the functions of life ; but 
it can be well understood that when two men of equal stature, say 5 feet 



WEN 814 WET 

8 inches, have to carry one 154 pounds and the other 168, the latter will bs at 
disadvantage. This arises- from two causes. The heavier man carries in the first 
place greater weight, and in the second place his heart has to project into the 
tissues of the body a larger amount of blood in order to keep him alive. For 
every pound a man weighs above his height his system is at a disadvantage, and 
he suffers in various ways. When fat is equally distributed about the body, then 
no immediate disadvantage is felt ; but when fat is accumulated in particular 
parts of the body, interfering with the functions of particular organs, then its 
evil influences become speedily apparent. When persons weigh much above 
their height it is obviously a matter of importance that they should, as much as 
possible, relieve the tax on their muscular and circulating system by diminishing 
their weight ; but this must be done with caution. The sudden withdrawal of 
accustomed articles of food is unwise, and it is far better gradually to lessen the 
fatty portions of diet than to go to extremes. When looked at carefully, there 
can be no doubt that the relation of height and weight is very important as 
regards health and the chances of life. Whenever the weight is below the 
height there is a fair suspicion of scrofulous or tuberculous disease, and when 
the weight is greatly in excess of the height there is a tendency to those sud- 
den impairments of muscular and circulating powers which may lead to pre- 
mature and sudden death. See Bantingism. 

Wens are encysted tumors, most frequently met with on the scalp or eye- 
brows. The origin of these tumors is in obstruction or imperfect congenital 
development of the sebaceous follicles dilated by the accumulation of their con- 
tents. If existing on the scalp they are generally multiple, and the cyst wall 
strong and tough, and at first but loosely adherent to the surrounding tissues. 
If irritation be set up by continuous pressure or friction, the cyst wall becomes 
intimately adherent to the»e tissues. The contents vary from being merely an 
accumulation of the natural sebaceous secretion to several forms of its perver- 
sion. Sometimes they are semi-fluid or honey-like, sometimes atheromatous, 
sometimes steatomatous or fibrinous, occasionally purulent. Hairs or eyelashes 
are frequently met with in their cavity, and in encysted tumors, which exist in 
the ovaries, hair, skin, teeth, or bones are met with. The treatment of such 
tumors consists in their removal : if very small, evacuation by pressure is suffi- 
cient; but, if large and unattached, a simple incision through the integument 
and down upon the cyst wall, with the subsequent enucleation of the entire cyst 
and its contents. Supposing the tumor to be very large, and its cyst wall thin 
and adherent, removal must be effected by regular dissection. It must be borne 
in mind that, unless the entire cyst or bag is removed, there is every probabil- 
ity of the tumor returning. These tumors may occur in the neck, and a some- 
what favorite locale is just under the angle or symphysis of the lower jaw. 
Those occurring on the eyelids (tarsal tumors) have extremely thin walls, and 
it is rarely necessary to dissect them out, as by eversion of the eyelid and rup- 
ture of the sac from the under surface all deformity from cicatrix is avoided, 
and the result is all that is required. (See Eyelids.) It is well to remark 
that these wens should be removed by a surgeon as soon as they are noticed, 
as the scars increase in size, and are horribly unsightly if situated in any prom- 
inent place, and their removal is safe and generally unattended with any great 
pain. 

Wet-nursing. A term used in those cases where, on the death of the 
mother, or because she is incapable of suckling her infant, another woman who 
lias been recently confined is employed for the purpose of giving the child 
sustenance. It is better to have a wet-nurse than to bring the child up by hand 



WET 815 WHI 

or by bottle. Precautions should be taken to see that the wet-nurse is in good 
health at the time. 

Wetting the Bed. This troublesome accident, so frequent to children and 
so well known to nurses, requires careful attention, and should not always be 
treated as an avoidable habit and punished accordingly, though it is often 
necessary, when a child is of sufficient age to understand, to create habits of 
self-control by severe measures. In the first place, however, pains should be 
taken to ascertain whether the irritable condition of the bladder be not pro- 
duced by the too alkaline condition of the water, or by the presence of worms in 
the rectum, which cause great irritation in the surrounding nerves, and so in- 
voluntarily lead to the discharge of the water. If after all precautions have 
been used to discover a local cause for the habit, none seems to exist, the oc- 
currence of it must be treated as a fault, especially if it occur in the day-time, 
when indolence and indifference alone can account for such an uncleanly prac- 
tice. Frequently, however, in young children, it will be found to cease alto- 
gether after a few doses of suitable medicine to allay one or other of the causes 
of irritation. 

Wheals are red and white marks on the skin, which are seen in cases of 
nettle-rash, and in some forms of indigestion ; tepid water will generally relieve 
the tingling, but the treatment must be directed to the cause. 

Whey. The watery part of milk, or serum, as it is called ; the part which 
separates when curds are made. It is a wholesome and pleasant drink, and in 
cases of cholera or fever is very often beneficial. 

White Blood Corpuscles are rounded, often granular cells, which are 
seen in the blood with the aid of a good microscope. (See Blood.) They are 
in excess in cases of leucocythgemia and lymphoma. 

White Softening of the Brain. See Cerebral Softening. 

White Swelling. See Knek-joint. 

Whitlow, called also Paronychia, is a very common and, if neglected, 
serious affection. It signifies an abscess of the fingers, and it may arise from 
various causes, and has various localities and intensities. The simplest form is 
one which is limited to the surface. The finger is swollen, inflamed, and in- 
tensely painful, and the integument generally vesicates. This form frequently 
begins by inflammation of the matrix of the nail, which nail may be eventually 
shed. The treatment consists of poultices, fomentation, and attention to the 
state of the bowels. A more serious form of the disease is one which affects 
the deeper structures, and attacks the subcutaneous areolar tissue, and this 
much resembles a boil, and the swelling, tension, and pain are very considerable. 
The affected parts should be freely incised to evacuate pus, and this proceeding 
must be followed by fomentations and poultices. In the case of a painful tip 
to a finger, which is very painful and does not seem inclined to suppurate, it 
should be well rubbed with lunar caustic. 

The worst form of whitlow is the tendinous whitlow or thecal abscess ; and 
the disease originates in the deep fibrous tissue of the finger, or in the perios- 
teum or bone. It is characterized by the most excruciating pain from the very 
outset of the disease. Pus forms early, and the constitution is affected with 
frequently severe inflammatory fever. If this state of things be permitted to 
continue, there is no relief for the symptoms until nature has evacuated the 
pus herself ; but then the joints are disorganized, the tendons have sloughed, 
the bones become carious or necrosed, an:l if recovery takes place it is with 
stiff, useless digits, requiring amputation. The treatment of such cases consists 
in the early and free evacuation of the pent-up matter by a deep, vigorous in- 



V/HO 816 WHO 

cision doion to the bone. The pain at the time is most acute, but the relief is 
instantaneous, and in all probability a useful finger is retained. These thecal 
abscesses not unfrequently spread into the palm of the hand, forming palmar 
abscesses, or may extend underneath the annular ligament, and the matter bur- 
row up into the tendinous sheaths of the muscles of the fore-arm. In opening 
sucli abscesses in the palm, the incision should be made over and down upon 
the metacarpal bone, taking care to avoid wounding the digital artery or palmar 
arch. 

The subsequent treatment of thecal abscesses consists in poulticing, fomen- 
tation, and the administration of tonics, and in taking care that stiffness of the 
fingers be avoided after the free incisions, and when the tissues have become 
healthy, by early passive motion and inunction of ointment, such as creasote 
or resin. All dead skin is to be carefully removed. Their most frequent causes 
are the inoculation of decaying animal or vegetable matter, and the effect of 
such on a somewhat low state of health. It must be borne in mind that the 
discharge from them is contagious. 

Whooping-cough is a disease of great frequency in childhood, and a large 
proportion of infant mortality is due to this cause. It belongs to that class of 
disorders which is called zymotic. It is contagious, but differs in this respect 
from other contagious diseases, that whereas they are communicable by a third 
person who may all the time be unaffected, this is not so with whooping-cough, 
and this fact has some practical importance in a children's hospital. A ward 
for measles and scarlet fever should be kept quite separate from the main build- 
ing, and all the nurses, etc., should also be distinct ; but for cases of whooping- 
cough it is enough if other children are kept from going into the ward, while 
the nurses, etc., may go about without spreading the disease. Whooping-cough 
is known in different parts as hooping-cough, chin-cough, kink-cough, and per- 
tussis. It may be defined as a disorder in which a convulsive cough consists 
of a long series of short and forcible expirations, and then a deep and loud in- 
spiration, and repeated more or less frequently during each paroxysm; it lasts 
several weeks, occurs once in a life-time, and is most common in childhood. 

Whooping-cough has been known since the middle of the seventh century, 
and has always of late years been prevalent in this country ; it seems to be 
most fatal in those years in which measles are also prevalent. No disease 
kills more children under one year of age than whooping-cough ; nearly sev- 
enty per cent., of all the cases occur under two years of age, and not more 
than five per cent, of the deaths are recorded as above five years of age. 

Symptoms : The earliest is a common cold or catarrh, accompanied by a 
cough ; there is also a slight amouut of fever, restlessness, and sometimes run- 
ning at the eyes and nose. The couijh in a few days becomes more trouble- 
some, and some glairy fluid may be brought up from the chest ; in a week or 
ten days, but oftener later, the child will begin to have the characteristic 
whoop ; the cough comes on in paroxysms, and is more frequent by night than 
by day ; each paroxysm begins with a deep and loud inspiration, followed by a 
succession of short and sharp expirations, again followed by a deep inspiration 
and the repeated expiration ; this may go on several times, and last one or two 
minutes, according to the severity of the case. Just before each attack comes 
on, the child clings to its nurse or mother; it sits in an erect position ; during 
the paroxysm the face is flushed, the veins in the head and face are promi- 
nent, the eyes suffused and watery, and generally there is some glairy fluid 
expelled frpm the mouth, or vomiting may come on. After the paroxysm the 
child will rest for a time and appear pretty well until the next attack cornea 



WIL .817 WIN 

on. In bad cases there may be twenty and thirty paroxysms a day, and 
several fits of coughing besides, without the whoop being heard. In ordinary 
cases there are from four to ten spasmodic attacks in the twenty-four hours. 
These symptoms last for three or four weeks, and then the cough abates in 
severity and frequency, and finally ceases altogether ; even when there is no 
whooping, the child may continue to have a troublesome cough for some time. 
In most cases there is some bronchitis attending this complaint, and this is 
shown by the hurried breathing, rise of temperature, and by hearing rattling 
noises over the chest. The more mischief there is in the lungs, the greater is 
the danger to the child. Convulsions are a sign of bad import, and this is gen- 
erally the way in which such cases die. Whooping-cough cannot be made out 
until the characteristic whoop appears, and then there can be no difficulty in 
recognizing the disease. 

Treatment ; In all cases it is best for the child to keep in the house as soon 
as the malady has declared itself ; in a very mild case it need not be kept in 
bed, but it should be in a room of a warm and even temperature, and pro- 
tected from draught ; it can then be allowed to play about as it likes. If there 
is any lung affection, it must be put to bed and hot linseed-meal poultices 
placed round the chest. Other children must not be allowed to come near it 
unless they have had an attack previously, in order to prevent communicating 
the disease. The child must be fed in the usual way, but solid food should 
be given sparingly. Where the infant is emaciated, and has some other dis- 
ease, as rickets, etc., the treatment proper for that disease may be continued. 
Steel wine is very valuable in cases of whooping-cough, and more especially 
when there is no fever, and during convalescence ; it may also stop the diar- 
rhoea which is now and then present. If there is any prolapse, of the bowel, 
the part should be sponged lightly with a solution of sulphate of iron, and at 
once returned. This is often due to the excessive diarrhcea, and steel wine 
must be given internally. Numberless remedies have been tried to cure whoop- 
ing-cough, but none have succeeded. Iron, alum, zinc, sulphuric acid, etc., 
have all failed to do much. The most hopeful remedy is belladonna if given 
in large doses and the symptoms be watched ; children can bear more of this 
drug the younger they are, but it is a dangerous remedy, and can only be given 
with the greatest care. Warm clothing must be worn, and. during convales- 
cence a nourishing diet, moderate exercise in the air when fine, a tepid bath in 
the morning, and a tonic, as steel wine or cod-liver oil, must be enjoined. 

Willow. The bark of the willow is sometimes- used in medicine, but only 
to produce its active principle, salicine. See Salicine. 

Wind in the Stomach. The presence of wind in the stomach is so often 
productive of excessive inconvenience and alarm, at every age, that a few 
words must be said about it. The original cause of the existence of air in the 
stomach or intestines, in excessive quantity, is indigestion. The food does not 
digest healthily and properly, and large quantities of gas are given off during 
the process which cannot be absorbed, and so the stomach is often inflated and 
oppressed by it. This being the case, the neighboring organs are affected ; the 
extended stomach presses on the lun<rs and heart and causes difficulty of breath- 
ing and palpitation of the heart. Often most distressing symptoms arise from 
this cause, and when the stomach is relieved of the air it contains the symptoms 
abate. During an attack of this sort, which is often misunderstood and sup- 
posed to arise from diseased heart, the first necessity is to relieve the imme- 
diate distress by stimulants, such as peppermint, sal volatile, ether, or brandy, 
which will generally disperse the wind, and consequently remove the pressure 
52 



WIN 818 WIN 

on the other organs ; but a recurrence of the attack can be prevented only by 
careful attention to the digestion itself. It is well to observe whether the at- 
tacks come on after certain articles of food, at certain hours, and when they are 
less frequent. By this observation conclusions may be drawn, and in some 
cases it will be found well not to eat much animal food, to avoid hot suppers, 
possibly to allow long intervals between each meal, so as not to embarrass the 
stomach with one meal too near another. Tea and coffee sometimes impede 
digestion; sweetened drinks or food also may produce acidity and flatulence; 
but these things are matters of experience and observation, and differ greatly 
in various people. "Where the heart is enlarged or irritable, or feeble, this con- 
dition of the stomach producing wind is sure to be disagreeably felt, and often 
to give rise to much alarm. The symptoms are distressing, great oppression 
is felt, and sometimes intermission of the pulse is distinctly perceptible, and 
palpitation of the heart, as well as disturbance of the general circulation, is 
present. As soon as the flatulence is removed by the expulsion of the wind 
from the stomach the distress ceases. We therefore advise all who are subject 
to such attacks never to be without some simple stimulating remedy at hand, 
and not to be alarmed at what may appear to them a very dangerous condi- 
tion of health. The urgent symptoms will usually yield to gentle remedies, — 
movement, rubbing, and so on, — and no occasion for alarm need be appre- 
hended. The main cause of the presence of the enemy is imperfect and incom- 
plete digestion, which requires careful diet and general attention to health. 

Windpipe. This is the main tube, or trachea, which allows of the passage 
of air from the mouth and nostrils into the lungs. It can be felt in the. throat, 
and when pressed gives an uncomfortable feeling of impending suffocation. 
See Lungs. 

Winds are an essential feature of the climate of any region, the prevalent 
wind giving it a character of its own. This has been alluded to in dealing 
with Houses and Climate, and need not be further alluded to here. 

Extreme cold, if dry and still, may be borne much more easily than a higher 
temperature if windy. The continual renewal of the air next the body ab- 
stracts the heat more rapidly in the one case than the other. 

Wine is the name generally given to fermented liquors when no foreign 
ingredient is added to flavor them. Thus the fermented wort of malt is called 
malt wine, when hops are not added. British wines are made from the juice 

■ of various fruits fermented, as currants, gooseberries, elderberries, and others. 
The term wine, however, is more especially applied to the fermented juice of 
the grape. Of all fruits the grape is best adapted for making wine. The reason 
is that the juice of the grape contains tartaric acid, and this acid forms an in- 
soluble salt with potash. Thus the acid of the wine is thrown down in the form 
of an insoluble supertartrate of potash which is called tartar, and when punned 
is under the name of cream of tartar, and when burned is converted into car- 
bonate of potash, or salt of tartar. The acid- contained in other fruits, a> the 

■ citric acid in the orange, the malic acid in the apple and pear, form soluble 
supersalts with potash, are retained in the fermented juice, and render the wine 
so sour that sugar has to be added to cover their acidity. The history of the 
use of the grape for making wine is lost in antiquity. The Bible gives an ac- 
count of the use of wine from grapes at a very early period ; and the Greeks, 
Romans, and other nations of antiquity were passionately fond of wine. 

Wines generally contain more alcohol then beers (see Bki;kj, and less than 
distilled spirits (see Distilled Spikits and Alcohol). The quant ty of 
alcohol varies very much in different kinds of wines ; and in fact the quantity 



WIN 



819 



WIN 



of alcohol is the first element which determines the price of wines. An im- 
port duty is levied on all wines coming into this country. Wines, however, 
are not consumed for their alcohol alone. They contain other ingredients 
which they derive from the grape-juice, which give them taste and flavor. 
Thus, when the fermentation of the grape-juice is not complete, a certain 
quantity of sugar is left, and according to the quantity of sugar wines are said' 
to be " sweet " or " dry." Whilst hocks, clarets, and other light wines contain 
little or no sugar, port, sherry, and champagne always contain a large amount. 
In the case of port and sherry this sugar is added during the manufacture in 
order to enable them to keep and bear exportation. 

At the same time that a large quantity of the tartaric acid contained in the 
juice of the grape is thrown down whilst the " must " is being fermented and 
the wine is in the cask, the whole of the tartaric acid is not got rid of, and a 
certain quantity is retained. In order to get rid of this, the wines of Spain 
are exposed to a process called " plastering," which consists in mixing with 
the grapes a certain quantity of gypsum, or plaster of Paris. The quantities 
of alcohol, sugar, and acid found in one pint of certain of the wines commonly 
consumed will be shown in the following table : — 



Port 

Brown Sherry . . . 
Pale Sherry . . . 

Claret 

Burgundy .... 

Hock 

Moselle ..... 
Champagne . . . 

Madeira 

St. Elie (Greek) . . 
Santorin (Greek red) 



16 

18 

m 

"f 

18* 

17 

16 

16 

16+ 



Sugar. 



Oz. Grs. 
1 2 
360 
80 



1 133 
400 
22 
40 



170 
161 
160 
127 
140 
90 
100 
44 
60 



This table is principally drawn up from Dr. Bence Jones's Analyses, pub- 
lished in his translation of Mulder on Wines. 

From this table it will be seen that it is erroneous to suppose that ports, 
sherries, and madeiras are free from acidity. They do not contain so much 
tartaric acid as the lighter French and German wines, but the taste of the acid 
is covered by the sugar they contain. The sugar in wine is often a very pre- 
judicial agent. As it exists in most wines, it is in a state in which it more 
readily ferments than when in the form of common sugar. Hence patients 
are recommended to take " dry " wines. The fact is, with regard to ports, 
sherries, and madeiras, they can hardly be said to be wines at all. 11 
all made on the same principle — that of adding to the genuine wine 
quantities of sugar and brandy. In short, it may be stated that all thes 
are manufactured by the taking the wine of one brewing, and adding t 
" must" or unfermented juice of a second quantity, and adding the pui e 
distilled from a third portion. 

When the stimulus of alcohol is required in disease, it is no doubt 1 
secure it through pure wines, such as those of France, Germany, or ( 
than in the saccharine compounds presented to us from Spain and Poi ugal. 
If larger quantities of alcohol are required in disease, it is better present 
the form of brandy or whisky. The latter spirit is now sold so pure that it 



y are 
irtain 

• 
it the 



WIN 820 WIN 

may without hesitation be used in the sick-room as a substitute for strong 
wine. A theoretical objection has been urged against the use of spirits and 
water. It is said that the stomach, through the action of endosmosis, absorbs 
the water, and leaves the spirit to act as an irritant on the stomach and sur- 
rounding organs. This is said not to be the case with the alcohol and water 
in wines, when the two are held in a much closer chemical union. 

There are three other qualities in wines which demand some consideration. 
The first is what is called the bouquet and flavor of wines. These things are 
sometimes confounded, but they are really different. The vinous flavor is 
common to all wines, but the bouquet is peculiar to certain wines. The sub- 
stance which gives flavor to all wines is cenanthic ether, and is formed during 
the fermentation of the grape-juice. When separated from the wine, this sub- 
stance is anything but pleasant to the taste and smell. It is composed of an 
acid — oenanthic acid — which forms an ether with the alcohol. 

The bouquets of wines are formed in the same way by some of the acids 
found in the grape-juice after fermentation combining with the ethyl of the 
alcohol, and forming ethers. Many of the bouquets thus formed are well 
known, and they consist of ethers formed by ethyl with acetic, proprionic, 
pelargonic, butyric, caproic, and caprylic acids. As far as we know at present, 
these ethers do not in any way exert medicinal effects on the system. All we 
know is, they are, many of them, most agreeable to the taste, and. act upon the 
tongue as delicious odors of flowers upon the nose. These are the things 
which make one wine more pleasant to drink than the other, and which give 
the highest price to the best of wines. They are not detectable by chemical 
agency, and it is the taste of these bouquets, and nothing else, which gives 
to one wine the value of five dollars a bottle, and another 75 cents, when all 
other qualities are precisely the same. 

Another point in the nature of wines is their coloring matter. Some wines 
are what are called " red," and others are " white." Ports, clarets, burgundies, 
are all red ; whilst some of the wines of Greece, Germany, Hungary, and other 
parts of the world are red also. The red colors of these wines have been 
analyzed with some care, but they do not seem to exert any influence upon 
the system. The most important agent in them is tannic acid, or tannin, which 
exists in some wines to a very large extent. t It is especially present in ports 
and clarets, and less in burgundy. It gives an astringency to red wines which 
is not found in white. The large quantity of tannin in port gives it a tendency 
to deposit a sediment, which is known by the name of " crust," and which is 
found on the lower side of the bottle after keeping. This crust consists of 
oxidized tannic acid, which becomes insoluble, and carries down with it a blue 
coloring matter, and the saline matter contained in the wine. The longer port 
is kept the more of the crust it throws down. By this process port wine loses 
its color and density, and acquires a purer flavor, and its price is proportion- 
ately enhanced. Port wines kept twenty, or thirty, or forty years, demand 
when originally good wines almost fabulous prices in the market. This, how- 
ever, is a mere matter of taste, and such wines have no dietetical or medicinal 
qualities to recommend them. Even the assertion that they may lie taken with 
more impunity than new wines is problematical. They do not seem to contain 
so much alcohol as wines not kept, and may be taken in larger quantities on 
that account. 

The other coloring matters described by chemists are a blue and brown color- 
ing matter. The latter is found in dark white wines as well as in red wines. 
The brown coloring matter is found in port wine, when all the tannic acid and 



WIN 821 WIS 

blue coloring matters are thrown down. The blue coloring matter is derived 
from the skins of the red grapes from which red wines are made. These skins 
are also the source of the tannin. The brown coloring matter is more or less 
present in the skins of red and white grapes'. 

The other matters which give a character to wines are the saline compounds. 
These substances, which constitute the " ashes " of all burned vegetable tissues, 
exist in very varying quantity in all fruits, and are found dissolved in the 
juices of fruits ; hence we find them remaining in the wine after fermentation 
of the juice. The most abundant of these salts is the bitartrate of potash 
(cream of tartar), of which we have already spoken. In addition to this, wines 
contain tartrate of lime, tartrate of alumina, tartrate of iron, chloride of sodium, 
chloride of potassium, sulphate of potash, phosphate of alumina. These salts 
occur in the proportion of from one to four parts in the one thousand of wine. 
They do not make much difference in the flavor or action of wines ; but their 
presence or absence is one of the surest indications of the genuineness of a 
wine. Those who manufacture wines with alcohol and water, and add a cer- 
tain quantity of good wine to give a flavor, do not usually add these mineral 
constituents, which are always the best test of a genuine wine. 

With regard to the medicinal and dietetical use of wines, we may say : — 

(1.) That where they are employed for the sake of the stimulating effects 
of alcohol, it is a matter of indifference which may be administered, remember- 
ing that some wines are twice the strength of others. 

(2.) The bouquets and flavor of wines render them more agreeable to drink 
than any form of mixed spirits or beer. 

(3.) Wines are less likely — especially when administered on an empty 
stomach — to do harm to the coats of the stomach than any mixture of brandy. 

(4.) All sugared wines, as port and sherry, should be interdicted in gouty 
states of the system, and in diabetes, and in dyspepsia attended with wind in 
the stomach. 

(5.) For all dietetical purposes, clarets, hocks, and the dry wines of Greece, 
especially the latter, are to be preferred before all others. 

(6.) Where it is desirable to secure an astringent effect, the red light wines 
are to be preferred to the white. 

(7.) The tartaric acid of wines is not injurious, and does not increase acidity 
in the stomach or the blood. It is an error to suppose, on this account, that 
unsugared wines may not be given where there is a tendency to form lactic 
acid in the stomach or lithic acid in the blood. 

(8.) Where powerful stimulants are required, it is better to give brandy, 
gin, whisky, or robur than even the stronger wines. 

(9.) Pure spirits with water are better than wines manufactured from im- 
purely distilled alcohol, which contains fusel oil, and acts injuriously on the 
nervous system. 

Winter-cough. This is a very common symptom in cases of emphysema 
and chronic bronchitis. It is generally worse every winter, and may go away 
in the summer altogether. Those who are exposed to the weather, as cabmen, 
costermongers, etc., are very liable to it ; also those who are intemperate, and 
those who have heart and kidney disease. The best thing for those who can 
afford it is to keep in the house in bad weather, or seek some milder climate, 
but this can seldom be done. Wearing a respirator, not talking in the open 
air, and avoiding fogs and night air are useful measures. See Bronchitis 
and Emphysema. 

Wisdom-teeth are generally cut between twenty and twenty-five years 



WOM 



822 



WRE 



of age ; they are four in number, two in each jaw, and are placed at the back 
part of the mouth. Sometimes a little discomfort attends their coming through 
the gum. 

Womb. See Uterus. 

Wool. This useful article may either be bought under the name of cot- 
ton wool, when it is very fine and white and soft; or under the name of wad- 
ding, when it has a sort of glaze or thin skin over it, which enables it to be cut 
into lengths, and when opened so that the skin is outside, it forms a valuable 
dressing and protection from the air for burns and scalds, and is also largely 
used as a warm covering for rheumatic limbs and joints, and in cases where 
flannel appears to be too harsh and unyielding a material. 

Worms. Under the head of worms are included those parasites which 
infest the intestinal canal ; they are commonly divided into three classes — the 
tape-worms, the round-worms, and the thread-worms. See Entozoa and 
Parasites. 

Wormwood is the flowering herb of the Artemisia absintliinm, and is the 
flavoring ingredient in the liqueur absinthe. The odor is disagreeable and the 
taste very bitter. The substance contains a bitter principle abstracted by 
alcohol, called absinthine. The plant itself, or an infusion of it, is a powerful 
bitter tonic, and it is said also anthelmintic. The liqueur is said to give rise to 
peculiar affections of the nervous system, different from those of ordinary 
alcoholism. 

Wrecks. A great many lives are lost through shipwreck ; the following 
list shows the number of wrecks for the past twenty years: — 



Year. 


Wrecks. 


Year. 


Wrecks. 


Year. 


Wrecks. 


Year. 


Wrecks. 


1852 


1,115 


1857 


1,143 


1862 


1,488 


1867 


2.090 


1853 


832 


1858 


1,170 


1863 


1,664 


1868 


1,747 


1854 


987 


1859 


1,416 


1864 


1,390 


1869 


2,114 


1855 


1,141 


1860 


1,379 


1865 


1,656 


1870 


1,502 


1856 


1,153 


1S61 


1,494 


1866 


1,860 


1871 


1,575 


Average 


1 ,045 


Average 


1,320 


Average 


1,611 


Average 


1,805 



Thus the whole number of wrecks, strandings, casualties, and collisions re- 
ported during 1871 is 230 below the average of the last five years. Of the 
wrecks in 1871 about one in twelve was attended with loss of life. The fol- 
lowing table shows the deaths from wrecks during the ten years 1861-71 : — 



Year. 


Lives Lost. 


Year. 


Lives Lost. 


1861 


884 


1866 


896 


1862 


690 


1867 


1,333 


1 863 


620 


1868 


824 


1864 


516 


1869 


933 


1865 


698 


1870 


774 



A wreck register is kept by the Board of Trade and issued every year; the 
reader must refer to this for further information. 



WRI 823 WRY 

"Wrist-drop is a symptom occasionally met with in cases of lead-poison- 
ing; the patient is then more or less unahle to raise the wrist, as the extensor 
muscles of the arms are wasted and paralyzed. See Lkad-poisoning. 

Writer's Cramp is a wasting of the muscles of the hall of the thumb, 
caused, as the name implies, by too much using of them ; rest and electricity 
are the best remedies. See Paralysis. 

W^ry-neck. This is a remarkable but not very uncommon distortion of 
the head and neck, which in the majority of cases is congenital. In a well- 
marked instance of this affection the following appearances are presented: the 
entire head is bent forwards and downwards, and is approximated to the tip 
of the shoulder, usually on the right side ; the face is directed forwards, slightly 
upwards, and to the opposite or left side ; the right side of the neck is trav- 
ersed in a direction from above downwards and forwards by a tense and hard 
subcutaneous band, which is formed by the persistent and unnatural contraction 
of the sterno-mastoid muscle — the muscle which in the healthy state may be 
distinctly seen passing from the back of the ear on each side downwards along 
the side of the neck to the upper margin of the breast-bone : the side of the 
face which corresponds to the contracted sterno-mastoid muscle is usually 
smaller than the opposite half; any attempt made to restore the head to its 
normal erect position will always cause severe pain. This distortion, when 
congenital, may be due to some disorder or deficiency in development of the 
foetal nervous system, to uterine pressure associated with an irregular position 
of the child in the womb, or to violence produced during delivery, as forcible 
twisting of the neck by the rough usage of forceps. The congenital wry-neck 
is usually slight and almost inappreciable for some months after birth, but as 
the child grows up and begins to take active exercise, the distortion rapidly 
increases, and soon gives rise to uneasiness and even suffering. 

The most frequent cause of non-congenital forms of wry-neck is rigidity of 
the muscles on one side of the neck in consequence of rheumatic or inflam- 
matory affections. The distortion in some few instances is due to paralysis of 
one sterno-mastoid muscle, the head being drawn to the opposite shoulder by 
the unopposed contraction of the fellow muscle. A condition resembling gen- 
uine wry-neck may be produced by the following causes : disease of the bones 
or joints of the cervical portion of the spine, the retractile action of an. exten- 
sive scar on one side of the neck, extensive scrofulous ulceration along the 
neck, swelling and induration of cervical glands. 

A variety of wry-neck is occasionally met with in which there are incessant 
spasmodic contractions of one sterno-mastoid muscle, approximating the head 
to the shoulder by violent jerking movements. This troublesome affection is 
always acquired, and seldom comes on before the age of twenty-five or thirty 
years. It occurs more frequently in females than in males. After it has 
lasted for a long time great pain is felt by .the patient, in consequence of the 
violent and repeated movement of the head and the vertebral bones in the 
neck, and much debility results from want of sleep. The convulsive move- 
ments in most cases persist during the life of the patient, although they may 
be relieved from time to time by galvanism and by a change of air and scene. 
Subcutaneous section of the lower part of the affected sterno-mastoid muscle 
arrests the spasmodic movements, but these in the course of a month or six 
weeks usually return again with the same activity. Occasionally spasmodic 
wry-neck is a temporary affection, excited by gastric and intestinal irritation or 
congestion of the liver. 

In cases of genuine wry-neck, whether congenital or acquired, cure may 



XAN 824 YAW 

sometimes lie effected by the use of a collar or machine contrived in order to 
keep up prolonged and gradually increasing extension of the contracted sterno- 
mastoid muscle. This kind of treatment is usually associated with frequently 
repeated shampooing of the affected side of the neck. In old and advanced 
cases, however, this treatment will pi'ove ineffectual, and then the last resource 
of the surgeon will be subcutaneous division of the contracted muscle. This 
operation, followed by gradual elevation of the head by means of a collar, 
generally results in permanent cure. 

X. 

Xanthelasma is a disease of the skin in which yellow sliglitly raised 
patches occur on various parts of the body. It is most common around the 
eyelids, but is seen also on the elbows, knuckles, and other parts of the body. 
It is sometimes associated with jaundice, but it is a condition of no practical 
importance, and requires no treatment. It is of very rare occurrence, and 
gives rise to no troublesome symptoms. 

Xanthic Oxide, or Xanthine, is sometimes met with- in the form of a 
calculus, or stone in the bladder; such stones are usually small, but are of 
such rare occurrence as to be looked upon more as curiosities than as possess- 
ing any practical interest. 

Xanthine. See Xanthic Oxidi:. 

Xeroderma, or Ichthyosis, is a form of dry skin sometimes met with in 
children and adults. It is usually congenita], and may occur in many mem- 
bers of the same family. The skin is dry. harsh, and rough. On the face the 
epidermis is usually comparatively smooth ; on the neck it is rough, and has a 
branny appearance ; on the rest of the body, cracks are seen on the skin. 
Such patients do not generally enjoy good health, and are liable to palpitation 
of the heart. 

Treatment: This is usually of but little avail. Olive oil will remove the 
scales and improve the general appearance, while cod liver oil and steel may 
be taken internally for the benefit of the health. 

Y. 

Yaws. This is a skin eruption, rarely, if ever, seen in America ; it is 
common in the West Indies and in Africa. At first there is a slight fever, 
which is soon followed by an eruption of small flat pimples, which increase 
until they have a diameter of half an inch ; new spots appear while the old 
ones are going away. The eruption is greatest and the spots are largest, on 
the face, arm-pits, arms, and groins. In eight or ten days the eruption be- 
comes pustular and a crust forms, beneath which there is a foul, unhealthy- 
looking ulcer ; from this ulcer red granulations spring up. These ulcers 
exist all over the body in different stages at the same time, and often there is 
also ulceration of the throat. The rash may continue from a few weeks to 
seven or eight months; after a time the sores heal and contract, generally 
leaving no scar. Much emaciation and debility, and often dropsy, follow this 
disorder. The disease is contagious, and may be transmitted by inocula- 
tion. 

Treatment: Mild and stimulating ointments may be used locally, while 



YEA 825 YEL 

tonics should be given and a liberal diet. Mercurial preparations have been 
tried, and do no good. 

Yeast, as used in medicine, is chiefly employed in making poultices. 
These are applied to old sores, but are not so useful as charcoal poultices or 
those of chlorinated soda. 

Yellow Fever is an infectious, continued fever, beginning with languor, 
chilliness, headache, and pain in the back ; the countenance is flushed, and the 
'eyes are moist and suffused ; the skin gradually acquires a lemon or greenish- 
yellow color ; there is generally a wandering of the mind, and often delirium ; 
the patient is restless and watchful, or he may pass into a state of drowsiness 
and then coma ; there is an uneasy feeling at the pit of the stomach and 
vomiting, at first of a clear, glairy fluid, and afterwards of a coffee-ground ap- 
pearance ; there may also be irrepressible hiccup, and shrieking or melan- 
choly wailing. 

History : This fever has also been known as the Bulam fever, hasmogastric 
pestilence, and black vomit. Its appearance was first recorded in the West 
Indies in 1647, and since then it has been more or less present up to the pres- 
ent time. In St. Thomas and St. Domingo, as well as in Cuba, the disease 
seems to be permanently located. It has visited the United States, through 
commercial intercourse it is claimed, a great many times. Most of the sea- 
port cities as far North as New York, have been visited by it. In the autumn 
of 1793 it broke out in Philadelphia, and swept off more than 4000 persons 
out of a population of 40,000, of whom one half are said to have fled from the 
city. It appeared there again in 1798, but its ravages were less fatal. In 
1853 it appeared in New Orleans in a more malignant form than was ever 
before known. It is estimated that not less than 9500 persons fell victims to 
this scourge during the season. For several weeks the number of deaths aver- 
aged nearly two hundred per day. In 1876, an outbreak occurred on the 
coast of Georgia, principally at Brunswick and Savannah, which was traced to a 
vessel just arrived from Havana. In 1878 it visited Memphis, and its ravages 
caused such a panic as to attract the notice of the whole country. In 1879 
it again broke out there; but owing to a rigid quarrantine it was prevented 
from spreading, and was finally stamped out by stringent sanitary measures. 

The late Dr. J. M. Woodworth, Surgeon-General to the Marine Hospital 
Service, says of yellow fever : " The weight of scientific evidence seems to war- 
rant the conclusion that yellow fever is produced by an invisible poison capa- 
ble of self-multiplication outside of the human organism, which it enters through 
the air-passages. The poison-germ or miasm is a product of the tropics. In 
this country, yellow fever has prevailed in most of the Gulf and Atlantic 
cities, and in many of the towns along the Mississippi River. In some in- 
stances it has been carried inland with the people fleeing from infected local- 
ities, but it has never shown a disposition to spread epidemically at points 
remote from the continuous water-roads of commerce, or to lodge in high, 
salubrious places. The cities of the Great Lakes have always been free from 
the disease. Yellow fever cannot be said to be endemic in the United States, 
from the fact that in some years it does not appear, though the imported germ 
undoubtedly survives the mild winters. It appears to have about as much re- 
sistance of cold as the banana plant. When the banana stalk is killed down 
by the frost, the yellow fever does not recur until again imported. The germ 
is transmissible. It is capable of being transported in the clothing or personal 
effects of passengers and sailors, but its spread from one city to another is 
chiefly accomplished by vessels, — their damp, filthy holds and bilge-water be- 



YEL 826 ZIN 

ing its favorite lurking-places. Confinement, moisture, and high temperature 
favor the multiplication or virulence of the poison." 

Dr. Maclean, who has had much experience of disease in the tropics, thus 
lays down the differences between yellow and remittent fevers : Yellow fever 
is specifically distinct from remittent fever. Yellow fever is unknown in In- 
dia, where true malarial fevers abound. There is in yellow fever an absence, 
for the most part, of that periodicity which is so characteristic of true malarial 
fevers — that is, the remissions and exacerbations. Men do not pass from re- 
covery to health, as is the case in such a marked degree in yellow fever, after 
which there is no, or very little, evidence of the existence of any cachexy. 
Malarial fevers exist and are destructive at a temperature at which yellow 
fever is at once destroyed. Albuminous urine is almost invariable in yellow 
fever, only occasional in remittent. There is in yellow fever a great deal of 
bleeding from various parts of the body ; in remittent fever, this is generally 
absent. Quinine has a power over the malarial fevers, but not over yellow 
fever. Men suffer from malarial fevers again and again ; second attacks of 
yellow fever are very rare. 

Treatment : The patient should have a hot bath in the first stage, and then, 
going to bed, he should have warm drinks, so as to encourage sweating ; this 
may be followed by a purgative, so as to have the bowels well open. Mer- 
cury need not be given, nor is quinine of any use. The sickness is very dis- 
tressing, but may be relieved by lime-water or by a few drops of chlorodyne or 
chloroform ; creasote and hydrocyanic acid do not seem to be of any use for 
this purpose. Stimulants must be given according to the needs of each case. 
The great objects in treatment are to sustain the vital powers, to moderate the 
febrile excitement, and to check any distressing symptoms that may arise. 

Yellow Gum, or the jaundice of new-born children, comes on two or 
three days after birth, and then the child's skin is of a yellow color, the urine 
very dark, and staining the cloths a deep yellow, while the motions are light. 
It is a simple disorder, which will soon pass away. It is due to the liver be- 
ing engorged, from the lungs not acting properly at first. The child should 
be put to the breast, and the mother's milk is generally sufficiently aperient at 
first to open the bowels ; if not, a little gray powder may be given at bed-time. 
It may be some days before the yellow tinge has quite gone from the skin. 

Yellow-wash. A lotion made by dissolving corrosive sublimate in 
lime-water. 



Zero. See Thermometer. 

Zinc is introduced into the Pharmacopoeia in the metallic form for the prep- 
aration of its chloride. 

The oxide of zinc is made by heating the carbonate. It is a white powder, 
without taste or smell, and turns yellow by heating. Its only preparation is 
an ointment, which is very useful. If given internally in large doses it causes 
vomiting, but is never used with that intention. It is chiefly given as a 
nervine tonic and astringent. ,\i is used, as are all the other preparations of 
zinc ijiven internally, in chorea, epilepsy, hysteria, and neuralgia. Externally, 
the ointment is very useful as an application to raw, weeping surfaces. The 
dose is five or ten grains. 

Calamine is a form of oxide no longer officinal. Its ointment, known as 
Turner's cerate, long had a reputation where now the oxide is used. 



ZYM 82T ZYM 

Chloride of zinc is made by dissolving zinc in hydrochloric acid. A solution 
of it is officinal. "When made into a paste with flour or any similar substance 
the chloride acts as a powerful escharotic. In weaker solutions it is a useful 
astringent. Chloride of zinc paste is sometimes used to destroy cancerous 
masses and malignant ulcers, so as to obtain a healthy fresh surface. A solu- 
tion of this was long used for disinfectant purposes, under the title of W. 
Burnett's solution. 

Sulphate of zinc is the most important salt of the metal. It is got by dis- 
solving the metal in sulphuric acid, as when hydrogen is prepared. The salt 
occurs in crystals, very much like those of Epsom salts, but gives off water in- 
stead of abstracting it from the atmosphere. 

Sulphate of zinc, given internally in fair doses, gives rise to vomiting, 
speedily and surely. It is thus one of our best emetics in suitable cases, but 
must not be administered where there is already irritation. It is given in 
smaller doses like the oxide, as a tonic, in nervous complaints, chorea, epilepsy, 
hysteria, and the like. It is well combined with valerian. Externally, sul- 
phate of zinc is very largely used in various forms of discharge, and is a most 
valuable astringent. The dose as an emetic is from fifteen to twenty grains, 
as a tonic three to five. As a lotion three grains may be dissolved in an ounce 
of water. 

Carbonate of zinc and acetate of zinc are as yet little employed ; their effects 
are intermediate between those of the oxide and of the sulphate. 

Zymosis is a technical term applied to actions of a peculiar and not much 
understood nature, and allied to. fermentation. There are various fevers which 
seem to have their origin in some poison which enters the system, and there 
for a time the poisonous germs seem to multiply and increase ; thus, if a 
person be inoculated with a most minute quantity of small-pox matter he will 
catch the disease, if unprotected, and in the course of a few days hundreds of 
pustules will appear, and from each of these pustules a little fluid may be 
taken, and thousands of persons might in this way have the disorder. Now, 
although we are ignorant as to the exact nature of the poisons in the different 
fevers, there are fair grounds for assuming that when a small dose of any 
poison of this class enters the blood it there goes through a process of multi- 
plication, just as yeast does during fermentation* All these poisons are conta- 
gious. There are seven principal diseases of the zymotic class, and eleven others 
less common: (1) small-pox; (2) measles ; (3) scarlet fever ; (4) diphtheria ; 
(5) croup ; (6) whooping-cough ; (7) continued fevers, including typhus, ty- 
phoid, and simple continued fever; (8) quinsy; (9) erysipelas; (10) puerperal 
fever; (11) carbuncle ; (12) influenza; (13) dysentery ; (14) diarrhoea ; (15) 
cholera; (16) ague; (17) remittent fever ; (18) rheumatism. It is most im- 
portant to remember that all zymotic diseases are in a great measure pre- 
ventable, and if proper precautions were observed and sanitary measures 
regularly carried out an immense number of lives might be annually saved to 
the country. For further information the reader is referred to the article on 
Mortality. 



APPENDIX I. 



SICK-NURSING. 



APPENDIX. 



I. SICK-NURSING. 

I. Having Special Reference to Adults. — II. Having Special Refer- 
ence to Children. — III. Baths. — IV. Applications. — V. Diet 
during Disease and Convalescence. — VI. Cookery for the 
Sick-Room. — VII. Domestic Medicines. — VIII. Accidents. 

I. Having Special Reference to Adults. 
Health is acknowledged by every one to be a great blessing, to be indeed 
the chief of all blessings ; and yet when we come to inquire into the means 
that are taken to preserve it we may well be struck with astonishment. 
Nothing appears to be regarded more lightly or treated with greater careless- 
ness than those laws which have for their object the maintenance of health 
where it already exists, or the acquirement of it where it is wanting. This 
may be accounted for by the fact that health is an advantage of an abstract 
kind, the value of which we do not appreciate until we are deprived of it ; but 
in addition to this there is a very prevalent belief that because the breaking of 
nature's laws is not succeeded instantly by results which cannot be mistaken, 
no harm will result from the errors we have committed. Could we but see 
the folly of believing in such a fallacy, how much suffering might poor 
humanity be saved ! "We may not be conscious of any evil effect from a single 
breach of those laws of health, but by constant repetition we cannot fail of 
ultimately bringing upon ourselves suffering and misery proportioned to our 
disregard. We regard health as a fund from which we may draw at pleasure 
without leading to exhaustion ; the memory of the past, though present to our 
mind in all its vividness, we disregard ; we have the experience of others to 
warn us, but we are heedless, and imagine our individual case is to prove an 
exception to the general rule. Surely we ought to estimate more highly this 
blessing, without the possession of which name, rank, and position are deprived 
of their value, and riches and honor are as nothing. In health all the organs 
of the body act harmoniously and unconsciously ; we take our food, and the 
process of digestion goes on without attracting the slightest attention. When- 
ever there is any deviation from this condition the approach of disease may be 
dreaded, and should it not quickly pass away, and each organ act unconsciously 



832 APPENDIX. 



as before, we have the presence of actual disease. It is when this state has 
been brought about that the duties of the sick-nurse begin. 

Till recetitly the subject of sick nursing was little thought of, and even yet 
its fundamental rules are but little understood. Any sort of qualification was 
considered good enough for those who chose to undertake the work; and yet 
if we reflect for a moment upon the nature of that work we shall not think 
thus lightly of it. All the best qualities and all the finer feelings that go to 
form the character of woman are brought into exercise in discharging faithfully 
the arduous duties of the sick-nurse, and where these are wanting the work 
can in no true sense be done. The powers of endurance may be severely 
tested, the temper may be sorely tried, but she is but little fitted for the task 
who becomes impatient or gives way to anger. The sick are selfish, and to 
the strong their little whims may appear ridiculous ; but she who would fulfill 
the duty of sick-nurse aright must treat them at all times with thoughtful con- 
sideration. Happy would it be, indeed, if this subject formed part of every 
woman's education ! How much easier would sickness become, how much 
shorter its duration, how much more bearable its pangs ! The work of the 
physician would then be greatly lightened, his mind relieved of much anxiety, 
and the patient's recovery greatly hastened. 

We shall notice here a few of those things which influence the condition of 
the sick, aud which naturally come to be spoken about in any treatise on sick-, 
nursing, and we shall speak first of all of a subject whose bearing upon the 
condition of the sick is of vital importance, but which is ofteu grossly neglected 
in their management, namely : — 

Ventilation. 
It seems strange to have to say, " See that your sick-room is properly ven- 
tilated," and yet nothing requires to be more frequently reiterated, because 
nothing is more often neglected than this. A moment's thought would seem 
sufficient to convince any one that to breathe over and over again the same air 
unchanged and loaded with impurities, was not conducive to health, but con- 
trariwise was a fruitful source of disease, and yet, however apparent this might 
seem to be, it is a sad fact that nothing is more persistently disregarded ; the 
sick-room continues badly ventilated, and the patient, already weakened by 
disease, is subjected to the depressing and poisoning influence of impure air. 
Do we wonder that disease remains so long with us, that its virulence is so 
greatly increased, and that death snatches so many victims, where the health- 
giving influence of pure air is thus ignored? By a proper supply of pure air 
in health, how much sickness might be avoided ; by a sufficient supply in dis- 
ease how many deaths averted ! And yet we are heedless of all this, and 
from day to day go on inhaling impure air, and coop it up in our sick-rooms, 
till the atmosphere we breathe is laden with the germs of death. All this may 
seem strange, and so indeed it is, but it is no fanciful picture that is here- 
drawn, but a great and solemn reality. Go into the dwellings of our sick 



SICK-NURSING. 



poor from inhaling the fresh air, and your sense of smell cannot fail to he 
shocked hy the closeness of the atmosphere ; and yet in these dwellings there 
are sufferers from disease occupying the same apartments with those in health, 
and the healthy and the diseased are subjected alike to the same poisonous in- 
fluences. Do you wonder that disease spreads and that many die? Do you 
wonder that when fever breaks out its ravages are terrible ? Surely the con- 
sideration of such facts as these should impress us with the necessity of hav- 
ing an ample supply of pure air during health and seeing that the sick are not 
deprived of its blessing when it is most required. 

How the air of an apartment is rendered impure. From the surface of the 
body there is constantly passing away into the surrounding atmosphere a large 
quantity of effete matter in the form of perspiration, and mingled with this 
are the organic impurities from the skin. Besides these there is given off 
from the lungs, during expiration, a large quantity of watery vapor laden with 
carbonic acid. The amount of water thus given off varies from twenty-five to 
forty ounces in the twenty-four hours. In addition to these already men- 
tioned we have, as further causes of impurity, the products of combustion of 
lights, the products of simple uncleanliness of rooms or persons, and the prod- 
ucts of solid or fluid excreta retained in the room. In the case of the sick, 
where the exhalations from the body are increased, and effluvia from dis- 
charged excretions are superadded, the atmosphere of an apartment is soon" 
vitiated and rendered unfit for the purposes of respiration, and hence the de- 
mand for pure air becomes more imperative, and the necessity of complying 
with that demand even more essential than in health. 

How thorough ventilation may be accomplished. Many people are under the 
impression that in order to have a sick-room thoroughly ventilated the patient 
must be constantly shivering from cold, but this is altogether a mistake. It 
has been frequently remarked that the mere admission of cold air into a room 
does not imply its proper ventilation, however large the quantity may be ; for 
the air so admitted may have come from a hall itself badly ventilated, or from 
unoccupied rooms, the windows of which are never opened. In the true sense 
of the word ventilation means the removal of impure air, and the replacing 
the air so removed by an efficient supply of pure air, and for this purpose 
nothing answers so well as a window and an open fire. Many artificial meth- 
ods of ventilation have been invented and employed with varying results, but 
none are so useful, because none are of so universal application, as the system 
of ventilating by means of the window and the fire. And yet how often do 
we find these means of ventilation neglected, and the patient breathing an at- 
mosphere prejudicial in the highest degree to his recovery, from carelessness 
on the part of the nurse ! Earnest attention should be paid by those who have 
the care of the sick to see that these things are hot neglected. In opening the 
window there is no necessity that the patient should feel cold, and care must 
be taken that he does not. The bodily temperature must be carefully main- 
tained, and an extra supply of blankets or hot bottles to the feet supplied 



834 APPENDIX. 



whenever these are necessary. Sometimes the bed is so placed that whenever 
the window is opened the patient is exposed to a draught, with all its evil con- 
sequences. In order that no risk may be run the bed should be removed at 
once, and placed in such a position that all harm from this cause shall be ob- 
viated. Care should also be taken that while the door of the sick-room re- 
mains open the window is closed, otherwise the patient may be exposed to a 
draught. The condition of the fire ought also to engage attention, as without 
due regard to this the ventilation may be very imperfectly carried on. It 
must not be permitted to get too low and then be suddenly heaped up with 
coals, as by so doing the room will be filled with smoke, and the patient sub- 
jected to much unnecessary inconvenience in consequence. What a source of 
atmospheric contamination is to be found in chamber utensils that have been 
used being allowed to remain in the room ! Frequently these are placed under 
the patient's bed, where they are allowed to remain till the nurse finds it 
convenient to remove them. This ought never to occur. Whenever a cham- 
ber utensil has been used it should be removed from the sick-room (and should 
always be so covered), and before bringing it back it should be properly 
rinsed. On no account should it be allowed to remain even for a few minutes 
in the room. Slop-pails should, under no consideration, be admitted into the 
sick-room. Their employment is only an encouragement to laziness, and 
much harm to the patient may be the result. Cooking, and everything that 
would render the air of the sick-room impure, must not, of course, be done 
there ; besides, a patient is much less likely to partake of food that has been 
cooked in his presence than he is of that which has been prepared out of his 
sight, and brought to him in as enticing a manner as possible. 

Night air, A great dread prevails in this country in regard to night air, 
and many, even in health, prefer to sleep in a close and stuffy atmosphere and 
awake in the morning unrefreshed, rather than have the window of their bed- 
room down a few inches from the top. And when we see such fear existing 
in health with regard to night air, can we wonder at the careful manner in 
which it is excluded from the chamber of the sick ? We fancy when the win- 
dow is closed that we have shut out this deadly enemy, and that we may rest 
in security ; and yet what have we done ? Have we, by closing the window, 
excluded the night air, and if so what are we inhaling instead ? It requires 
little reflection to show us that at night we must breathe night air. There is 
no alternative, and the question we have to settle with ourselves is whether we 
will have it pure or impure. We cannot be made to feel the warming influ- 
ence of the sun's rays on the air we breathe while he is shining on lands far 
distant from our own, and yet it seems strange that so few should think of this. 
We should therefore see that our patient is properly supplied with abundance 
of pure air, not only during the day, but also during the night, and that the 
ventilation of the sick-chamber is not carried out with efficiency during one 
half of the twenty-four hours, to be neglected during the other. Thorough 
ventilation is equally demanded at all times, and where it is neglected the sick 
must suffer. 



SICK-NUKSING. 835 



Light. 

Next in importance to securing for the sick-room a sufficient supply of pure 
air, it should be our endeavor to see that it is also amply provided with light. 
There is an Italian proverb which says, " Where the sun does not enter the 
doctor does ; " and another which says, " All disease comes with the shade and 
gets well by daylight ; " and although the language here used may seem to 
convey a somewhat overdrawn picture to the mind, there is, nevertheless, much 
of truth in it, and it ought to impress us with the necessity we labor under of 
giving earnest attention to such matters in the treatment of disease. Where 
darkness is, vice and crime abound, dirt and filth accumulate, and disease, es- 
pecially of an infectious type, spreads with awful rapidity, and death has many 
victims. But, besides these, feebleness of body, rickets, and scrofula in chil- 
dren are the consequences of darkness and what darkness breeds *, also mental 
degeneracy abounds. Should these things be doubted, let those who disbelieve 
them go to some of the slums of our large cities, and there, in the miserable 
and squalid children that will gather round them, let them recognize the truth, 
and ascertain for themselves the effects of living in darkness, with its attend- 
ant filth and necessarily impure air. Compare these children with those who 
have been brought up in some of our rural districts, and been exposed to the 
health-giving influence of the sun and pure air, and you cannot fail to per- 
ceive how great the contrast is, and to recognize the important part which is 
played by the sun's rays both in health in maintaining it, and in disease in re- 
covering to health again. It has been well remarked that of all flowers the 
human flower has most need of the sun, and just as plants grow towards, not 
away from, the light, and become sickly and die without it, so does man turn 
naturally towards the light to be partaker of its revivifying power, without 
which he also must sicken and die. 

In planning our houses we do not think of providing a room with a few 
extra conveniences and with a proper situation that may act as a sick-chamber, 
and yet how many families are there where such is not required ? It is 
thought that any sort of room may answer this purpose, but it is necessary ? 
where no provision has been made, to select carefully the apartment that is to 
act as a sick-room, and in doing so it should always be made an essential that 
the situation of the room is such as to admit a plentiful supply of light at all 
hours of the day. There are, of course, special cases, such as diseases of the 
eye, where the plentiful supply of light would prove absolutely injurious ; but 
of these we do not at present sp'eak. If the light be too strong for the pa- 
tient's eyes it can easily be modified by means of a green blind. As light, 
when excessive, acts as a direct excitant upon the brain and nervous system, 
it will be the duty of those who wait upon the patient to see that in acute dis- 
eases, where there is nervous excitement, the room is properly darkened, and 
he is shielded efficiently from what might prove injurious to him ; but in cases 
of debility, in chronic diseases, and during convalescence, the sun's rays are 



APPENDIX. 



ever welcome, aud exercise the most beneficial influence alike on mind and 
body. 

But besides being thus beneficial, the sun's says exert a great oxidizing 
power upon organic matters, aud by reducing them to the simpler constitution 
of mineral substances renders them innocuous. The sun is a great purifier, 
and where his presence is excluded, as in rooms which have been kept closed 
and the shutters unopened for some time, mould and fungi accumulate, and 
hence the musty smell observed on going into such apartments. It has been 
remarked that on the shady side of deep valleys cretinism abounds ; that in cel- 
lars and unsunned sides of narrow streets there is degeneracy and weakness of 
the human race — mind and body equally degenerating. The great influence 
exerted by the sun's rays on the process of vegetation is familiar to us all, and 
physiology teaches its equal importance in the growth and development of 
man. Without light, during growth, the human flower cannot attain to per- 
fection. Now it must not be thought that the influence of the fire in the sick- 
room, however useful for purposes of proper ventilation, can ever replace that 
of the sun's rays. They are both necessary, and where each receives that at- 
tention which its importance demands, the patient will have been placed under 
those conditions which are most favorable to recovery. 

The manner in which the bed is placed in the room should be carefully at- 
tended to. It must not be so placed that the patient has to strain himself 
every time he wishes to look out of the window, but must be so placed that he 
is able to do so without making any effort. It is very important that the 
patient should be able to see out of the window, and that, if possible, the pros- 
pect should be a pleasant one. Thus a garden or a green field will engage 
his attention and exert a beneficial influence upon him. At night care must 
be taken to place the lamp, or whatever is employed for the purpose of artifi- 
cial illumination, in such a position that the eye does not suffer. In the case 
of children attention to this is very important, for a lamp carelessly placed may 
cause shadows about the room which may make the child frightened and uneasy 
and exert a hurtful influence upon it, which might have been obviated by a 
little thoughtfulness on the part of those who had the placing of it. Also im- 
pure oil, or an uneven fan-like flame, may cause the lamp to smoke, and so 
prove a source of annoyance to the patient. All flickering lights should be at 
once removed from the sick-room, otherwise their presence cannot fail to exert 
a disturbing influence upon the patient. A little care and attention in regard 
to these apparently trivial matters will save much unnecessary annoyance at 
a time when suffering makes it ill to bear, and will greatly conduce to a speedy 
recovery. 

Temperature. 

The temperature of the sick-room should be a matter of primary importance, 
and yet it is frequently neglected as if it were not essential in the treatment 
of disease. It requires little reflection to perceive that where this is unattended 
to or badly done much mischief to the patient must result, and yet how often 



SICK-NURSING. . 837 



are all precautions to keep the air of the sick-room uniform in temperature 
ignored, and. to how many changes is the sufferer frequently exposed during 
twenty-four hours ! We wonder sometimes how our patients can have caught 
cold, and when they complain of headache, running at the nose and eyes, and 
other symptoms of ordinary catarrh, we are at a loss to explain their appear- 
ance, and yet the explanation is not far to seek. Those who are suffering 
from fever or from chest affections cannot fail to be affected by the tempera- 
ture of the apartment in which they lie, and yet how often do we find the sick- 
room allowed to get close and overheated, and the window, which till now has 
been closed, thrown suddenly open to allow a supply of fresh air to enter the 
room. Or, again, the window may have been kept open a few inches and the 
air may have been entering the room imperceptibly, but in sufficient quantity 
to keep the atmosphere cool and fresh, when the nurse, who has allowed the 
fire to get very low, suddenly takes to heaping it with coals, and after perhaps 
filling the room with smoke the fire blazes up, the cold air rushes in with 
greater rapidity, and the patient suffers from what might easily have been 
prevented, and what ought never to have occurred. A good fire in the sick- 
room kept burning equally will suffice to maintain a uniform temperature, but 
care must be taken to have a good chimney. The imperfect action of chim- 
neys may be due to many causes : thus, the Hue may be too wide or too nar- 
row, the draught may be insufficient, or the chimney may be placed on the 
same side of the room as the door. 

In order to maintain the temperature of the sick-room as exact as possible, 
the thermometer should never be absent from the apartment ; but in order 
that the information derived from it should be correct, it must be placed on 
the same level as the patient, otherwise we do not ascertain the temperature 
of that stratum of air which he is breathing. Again, besides placing the ther- 
mometer on a level with the patient, we must be careful not to place it in such 
a position as to give us incorrect information ; thus by placing it between two 
doors where it would be exposed to a cool current of air, or by allowing it to 
remain in immediate proximity to a lamp or the gas, we should not be obtain- 
ing the correct temperature of the room. In the sick-room the temperature 
which answers best in most cases is one somewhere between 57.2° and 60.8° 
Fahrenheit. Should it be found desirable to increase this, it can be easily 
done by permitting steam to pass into the room from a kettle ; or if, on the 
other hand, it is necessary to cool the air of the apartment, this can be readily 
accomplished by placing a shallow dish, containing pieces of ice, in the room, 
or by suspending a piece of cloth that has been previously moistened with 
water. 

Furnishing of the Sick-Room. 

No article of furniture that is not required either by the patient himself or by 
the attendants should be allowed to remain in the sick-room. If there is suffi- 
cient space in the apartment to accommodate conveniently two beds, the twenty- 
four hours can be divided between them, the day being passed in the one and 



838 APPENDIX. 



the night in the other. Such an arrangement as this is often of great advantage 
to the patient, allowing, as it does, of thorough airing of both beds, and secur- 
ing for him, in many instances, that refreshing sleep that is so helpful in the 
removal of disease. Should the room be too small to admit of two beds re- 
maining in it, and the patient be in a fit state to be removed from bed, he may 
be lifted on to a sofa, where he may recline till the changing and airing of the 
bed are completed. The best and most convenient kind of bedstead for the 
sick-room is one made of iron, and not standing too high from the ground. 
Curtains round the bed ought to be dispensed with altogether ; in the case of 
infectious diseases they afford lodgment to the poison and increase its virulence 
many fold. The best kind of mattress is one made of hair, which admits of 
being frequently opened out and exposed to the air. A hair or straw pillow 
is much better and cooler for the head than one of feathers. The old wooden 
four-post beds, with their dense hangings of curtains and their feather mat- 
tresses, are now happily being done away with, and others more productive of 
health and comfort are quickly taking their place. These feather beds, by 
absorbing moisture and miasms, and retaining the offensive discharges from the 
body, are productive of feverishness and great discomfort to the patient, and 
ought not to be used. The position of the bed must also be attended to. It 
should not be placed in a dark corner, as uncleanliness is apt to be fostered in 
such localities, and, as before remarked, it should be so situated as to enable 
the patient to see out of the window without difficulty. 

Patients are apt to be overloaded with blankets, and their breathing, already 
sufficiently hampered by disease, is still more impeded by the weight that is 
laid upon their chests. Only light blankets should be used as a covering for 
the sick, and heavy impervious counterpanes should be avoided. Some pa- 
tients have a bad habit of sleeping with their head under the bedclothes ; this 
should be guarded against, and where any tendency to it exists in health, as it 
frequently does in children, it ought to be corrected before it has formed itself 
into a habit. In arranging the patient's pillows care should be taken not to 
pile them too high, and thrust the head forward upon the chest. Frequently 
this error is committed, and the breathlessness from which he suffers is greatly 
aggravated in consequence. The other articles of furniture which are neces- 
sary in the sick-room are two tables, a wash-stand, a chest of drawers, one or 
two chairs, and a sofa. One of the two tables should be small and easily 
movable by the patient himself, and should be placed at the bed-side. The 
other should be sufficiently large to contain the medicine bottles, measure- 
glasses, spoons, etc., which are in constant use. The wash-stand should be 
provided with one or two basins, and a plentiful supply of water should al- 
ways be at hand ready for immediate use. The chest of drawers ought to con- 
tain clean towels, old unsoiled linen (soiled linen must never be allowed to 
remain about the sick-room), scissors, pieces of tape, pieces of sticking-plaster, 
and sundry other things that are likely to be in requisition. Should there not 
be sufficient accommodation for a sofa, an invalid or reclining chair ought to be 



SICK-NURSING. 839 



provided, and should be so made that the patient can enter it with ease, and 
have efficient support while in it. If a mirror already exist in the room it had 
better be removed, or if allowed to remain, it must be so placed that the pa- 
tient cannot see himself in it while lying in bed. Unless the case be one of 
fever, the carpet need not be removed from the room, if it is already there. 
The walls also should be hung with pictures ; they exert a very beneficial 
effect upon the patient, and ought always to have a place among the furniture 
of the sick-room. A great dread used to prevail with regard to the admission 
of flowers into the sick-room, lest by their presence the atmosphere should be 
polluted, but the quantity of carbonic acid given off during the night by the 
few flowers that one usually finds is so insignificant as ought not to give rise 
to the slightest alarm. Moreover, the variety of form and color which they 
present is grateful to the eye, and the influence they exert upon many a poor 
sufferer is often of the most beneficial kind. 

Food. 

Too much attention cannot be paid by those in charge of the sick to the 
careful regulation of the patient's diet. How many suffer, especially among 
the poorer classes, from utter disregard of this important item in the treatment 
of disease ! How many of the ailments from which children suffer are attrib- 
utable to errors in connection with their diet ! How often, when an infant 
is suffering from the effects of an overloaded stomach, does the mother, in her 
mistaken kindness, increase its misery by giving it food ! The proper dieting 
of children is as yet but little understood ; they are allowed to partake of all 
sorts of suitable and unsuitable articles of diet, and frequently, on asking what 
food an infant of eighteen months or two years has been having, you are told 
that it has just been taking whatever they (the parents) happened themselves to 
be taking at the time. It is a fact sufficiently well ascertained that errors in 
diet are at the root of a vast amount of disease and death, and yet it is with ex- 
treme difficulty that the popular mind is brought to see it. If in health it is so 
necessary for its maintenance and the avoidance of disease to supply the body 
daily with a sufficient amount of food of proper quality and given at regular 
intervals, how important does attention to these matters become in the time of 
sickness, when the energy of the body is almost exhausted ! Badly cooked 
food is a frequent cause of indigestion in the healthy, and must on no account 
be admitted into the sick-room. Consider the enfeebled state of the patient's 
digestive powers, how little it will take to disturb them, and how necessary it 
is to save him as much labor as possible. Again, food must be given at regu- 
lar intervals, which must be determined by the nature of the case. In some 
diseases it requires to be given frequently, once every hour or two, but in small 
quantities at a time. 

If a meal has been brought to the patient, and been again taken away from 
him untouched, it would be very wrong indeed to allow him to fast till it was 
time for the next ; the probability is that when the time for partaking of the 



840 APPENDIX. 



next meal had arrived he would be found less able to eat than he was before. 
It is better to prepare something shortly after the ordinary meal has been re- 
fused, and bring it to the patient unexpectedly, and in as enticing a form as 
possible ; and in many cases where this is done you may have the satisfaction 
of seeing the sick one eat, and that with an apparent relish, and find that your 
labor has not been in vain. Many patients who have been unable to take 
food when brought to them at the regular time will rather suffer the opportunity 
when they feel a desire to eat to pass by than ask for anything. Especially is 
this the case when any extra trouble is made much of, and when any little 
favor asked is done in a grudging spirit. Much more kindness is shown to a 
patient by doing a spontaneous act, such as we have mentioned, than might at 
first be imagined. Everything that is intended for the patient's use should be 
made ready out of his sight, and be brought to him in as neat a form as possi- 
ble, and with all the dishes scrupulously clean. Patients are very particular 
in regard to these things, and when food is brought to them in dirty dishes, or 
with half of it spilled about their tray, it is no wonder they refuse to take it, 
A disagreeable loathing for a certain kind of food may thus be given rise to, 
which the patient may not be able to overcome during the remainder of his 
illness. Large quantities of food should not be brought to the patient at one 
time ; he is much more likely to be enticed to eat by a smaller amount. It is 
better not to trouble the patient by asking him what he thinks he could eat; 
rather exercise your own judgment, unless the medical man be in attendance, 
when, of course, his instructions with regard to diet, as with anything else, 
must be strictly adhered to. Should the patient express a desire for any 
special article of diet, or for food done in a certain way, his request should, if 
possible, be granted. Punctuality in bringing patients their food ought also 
to be attended to ; neglect of this may lead to much harm. If a patient ex- 
pects his meal at a certain hour, and has to wait ten minutes or a quarter of 
an hour for it, it is quite possible that he may be unable to partake of it when 
brought. Attention to these apparently trivial matters may appear quite un- 
necessary, but to the patient they are of vital importance, and ought therefore 
not to be neglected ; and the careful nurse will consider no part of her duty 
mean or insignificant that conduces to the well-being of her patient and tends 
to further his recovery in the smallest degree. Strict quiet should be main- 
tained in the sick-room during meal-times, and the opening and shutting of 
doors and bustling about the room should be as far as possible avoided. The 
attention of the patient ought on no account to be occupied while he is eating 
with thinking over questions that have been addressed to him and answering 
them. He should be kept perfectly undisturbed, and allowed to take his meals 
as deliberately as possible. 

There are many opportunities occurring from time to time in the sick-room 
for the exercise of common sense, and the closer the observation of disease is on 
the part of those in attendance, the more frequently will this be called into ex- 
ercise. One or two illustrations may serve to convey a more definite meaning 



SICK-NURSING. 841 



to the reader's mind. Should the medical attendant, for instance, order a cer- 
tain quantity of food to be given at stated intervals, and should the quantity- 
ordered be invariably rejected from the stomach almost as it was swallowed, 
it would be very wrong to allow this to continue ; and if the professional visits 
are only being made occasionally, say once or twice a week, the patient might 
very easily be rendered much worse unless common sense were used. Don't 
persist in giving always the same quantity ; try him with half, quarter, or even 
less, till you get the stomach to retain it, when the amount given at one time 
may be gradually increased as the stomach can bear it. Again, should a 
patient be unable to take food at any stated time, but express an ability to do 
so at some other time, it ought not to be kept from him. Frequently patients 
who are unable to take anything at regular mealtimes feel a desire to eat 
half an hour or an hour afterwards, and this desire should not be disregarded. 
Examples such as these might be multiplied indefinitely, but those given may 
serve to illustrate the necessity there is for close observance of the sick, and 
for the proper exercise of common sense on the part of those who are in con- 
stant attendance upon them. 

Cleanliness. 

Without scrupulous attention to cleanliness in the sick-room, all that has 
been accomplished by ventilation will prove useless; for what amount of air 
must be hourly passing in at the window to compensate for the accumulation 
of dirt and filth in a room? It is surely the duty of those who have the care 
of the sick to attend to this. The health of the patient imperatively demands 
it at their hands, and if there is any neglect in the fulfillment of what renders 
his recovery more certain, a grave responsibility is incurred. How often at 
the bed-side of the sick poor is the physician repelled by the odor of soiled 
linen, unwashed garments in which everything loathsome has been accumu- 
lating for no one knows how long, and that from an unwashed body, and how 
glad is he, on completing a hurried examination, to get once more into the 
open air, and away from such an atmosphere of pollution ! Does it appear 
wonderful that the recovery of the sick should be retarded in such cases, that 
disease should frequently take a more malignant form, and that the mortality 
should be high ? In the treatment of disease, attention to cleanliness is of the 
utmost importance ; it is impossible to carry out any line of treatment success- 
fully without it, and with it the patient's recovery is invariably made more 
certain. Cleanliness in sick-nursing refers to cleanliness of the rooms itself, 
and to personal cleanliness. 

The sick-room in which there is no carpet is likely to be cleanest, being 
free from those organic impurities which store themselves up in its substance ; 
but, unfortunately, in most private houses the sick-room is carpeted, and we 
have to consider how the process of sweeping can be best accomplished, so 
that as little of the impurities retained in it shall reach the patient as possible. 
This can be best done by sweeping with a soft hair broom, taking care to 



842 APPENDIX. 

move the dust gently before it, and not raise it in clouds about the patient ; 
but the only way by which a carpet can be really " cleaned " is to take it up 
every quarter or half year. Should the floor of the sick-room be uucarpeted, 
it can be gone over with sponges wrung out of hot water, and dried by means 
of the floor-brush. Damp cloths may be used instead of sponges. By this 
means the sick-room can be kept clean. The articles of furniture should also 
be dusted by means of damp cloths, otherwise the dust is only dispersed 
throughout the room, to fall again shortly on the patient and the articles of fur- 
niture alike. The floor of the sick-room may be washed if the patient is able 
to be removed to another room. This must not be done on a damp day, as the 
room should be perfectly dry and free from all traces of damp on the patient 
again coming into it. The bed-pan and chamber utensils must be kept scru- 
pulously clean, being removed from the room whenever they have been used, 
and carefully rinsed and disinfected before being brought into it again. 

The walls best suited to the sick-room are those that have been painted, or 
those that have been whitewashed with lime. Papers on the walls act as dust- 
traps, and unless they are removed, and the walls scraped from time to time, 
they are apt to act injuriously on the sick. When fever patients have occu- 
pied a room, the walls of. which are papered, it is necessary on their recovery to 
have the walls properly washed and scraped, because, as is well known, poison 
from infectious diseases may cling to the paper on the walls or to curtains for 
an indefinite length of time ; and unless such precautionary measures are em- 
ployed the disease may be propagated. There are many papers which, besides 
acting injuriously by retaining dust and germs of disease, are themselves 
sources of poison to human beings. Such are the papers which owe their color 
to arsenic. If we consider how much of this poison may be inhaled during 
twenty-four hours by those who inhabit rooms, the papers on whose walls owe 
their color to arsenical preparations, we shall not be greatly astonished at the 
results we sometimes see. If any paper is put upon the walls of the sick-room 
it had better be a light-colored one, because, in addition to the fact that the 
dust will be more easily detected where such a paper is used, and the room, in 
consequence, be kept cleaner, it will be more lightsome for the patient, and 
exert a more beneficiaHnfluence upon him than a darker and more dingy one 
would. 

In regard to bedding, the utmost cleanliness must be observed ; and, in order 
to render this easier, the iron bedstead and light hair mattress already men- 
tioned will be found superior to anything else that can be made use of. By 
means of this bedstead free ventilation can be carried up to the mattress. The 
old wooden bedsteads and feather beds, by being very hot-beds of filth and 
dirt, soaking up discharges and emanations from the body, and retaining them 
in their substance, act most injuriously on those in health, and doubly so on 
those enfeebled by disease. It need hardly be said that, for purposes of strict 
cleanliness, these must be banished from the sick-room. To insure cleanliness 
there must be order ; everything should have a place of its own, and, unless in 



SICK-NURSING. 843 



use, should be kept in it. Unused articles of food and scraps of every kind 
should be removed from the sick-room. Attention to the few foregoing rules 
will secure to the patient that comfort which is the result of cleanliness, and 
which is so essential in the treatment of every disease. 

A word or two now remains to be said on the subject of personal cleanli- 
ness. It might almost seem at first sight superfluous to insist on the necessity, 
in time of disease, of keeping the patient's body clean, and yet it is a fact that 
nothing is more frequently neglected. Among the poorer classes especially 
this want of regard for personal cleanliness in the sick is often witnessed to a 
lamentable extent, but it does not confine itself to these alone. By those who 
presumably are better informed there is often much ignorance displayed in 
regard to this matter. How often, for instance, is the body linen allowed to 
remain unchanged for several days, frequently longer, — linen that is already 
saturated with the increased exhalations from the body that occur during sick- 
ness, and which cannot fail to act injuriously upon the patient? Frequently, 
on inquiry, the cause is found to be fear lest the patient should catch cold 
during the operation ; but surely, with a little care to see that everything is 
properly aired, — not in the abominable sense of being worn by somebody else, 
as used formerly to be done, but by hanging for some time before the fire, — 
no harm is likely to occur. How often are physicians called to visit a child 
whose bed is one mass of confusion, and whose comforts, in the way of per- 
sonal cleanliness, are very few indeed? Uncombed, unwashed, unchanged, is it 
any wonder that the little sufferer is irritable and restless, hot and feverish ? 
Insist upon the application of soap and water to its face, attention to iis hair, 
and a change of linen to its body, and mark the change ! Before, his features 
could scarcely be recognized from the thick layer of dirt that covered his skin ; 
he was restless and irritable from the soiled linen chafing his skin ; but now 
he is altered : his features are distinctly seen, and the expression on his face is 
one of pleasure and happiness, arising from the comfort which personal clean- 
liness brings with it. He can now lie easily, and the restlessness that aggra- 
vated the fever is gone with the cause that gave rise to it ; and the skin that 
felt hot and burning is now cooler and less harsh to the touch. It seems 
strange that in the time of sickness, when the secretions from the body are no 
longer those of health, when the action of the skin is impeded, when the 
breathing is quick and hurried, at the very time when you are desirous that the 
pores, of the body should be acting vigorously and the lungs inhaling pure air, 
the daily ablutions should be suspended, and the lungs be supplied with air 
loaded with organic impurities. This want of cleanliness that is so frequently 
met with during the time of sickness arises partly from neglect and partly from 
prejudice. Should it be due to neglect, those in charge of the sick must be 
reminded of their duty, and the attention to personal cleanliness minutely in- 
sisted upon, but prejudice is much more difficult to contend with. If people 
are lax in regard to the carrying out of personal cleanliness during health, they 
are apt to be neglectful of it altogether in the time of sickness ; hence the care 



844 APPENDIX. 



that must be taken to impress them with its necessity. There is a great dread 
in the minds of many that the changing of the body linen in disease will prove 
hurtful to the patient. This, it need scarcely be remarked, is altogether un- 
founded, and, if properly done, the changing will always have a beneficial 
influence upon them. It is well known that new linen absorbs more moisture 
than old, and by so doing assists perspiration, besides being grateful to the 
patient, from the comfortable feeling it imparts. It is important in the time 
of disease, as in health, to have the hands and face washed daily, and to have 
the hair carefully combed out, so as to allow free circulation of the air about 
the roots, and by so doing keep the scalp cool. If this is neglected, the hair, 
especially the long hair of the female, will become matted from the retention 
of perspiration, and may require to be cut if attention is not paid to it in time. 
Nor must the body be neglected. It should be frequently washed. A sponge 
or piece of flannel and tepid water should be used, and care must be taken to 
expose only a small surface at a time, which ought to be rapidly dried with a 
heated towel or piece of flannel. In the process of drying, much good will 
result from rubbing the part well. In acute diseases it is well to change the 
body linen every day ; it greatly adds to the patient's comfort. 

Tranquillity. 
It need hardly be said that tranquillity in the sick-room is most essential to 
speedy recovery, and that neglect to insure it to a patient will retard progress, 
throw him back, and so prove injurious to him; and yet how often in the 
course of a disease has the poor sufferer to pass a restless and wakeful night 
from want of attention in regard to this matter? If a patient has fallen asleep 
and you shortly after wake him up by the slamming of a door, or the over- 
turning of some article of furniture, the chances are that sleep will forsake 
him, that his pain will be aggravated, and that after passing a troubled night 
he will be found in the morning feverish and unrefreshed. These things 
demand earnest attention from those who are in attendance upon the sick ; and 
while to those in health they may appear insignificant, they are weighty mat- 
ters in the treatment of disease. Some kinds of noise are more injurious to 
the sick than others, particularly those which give rise to any straining effort 
of the mind. Thus to talk in a whisper is very objectionable, because the 
patient's attention is roused, and he naturally strains every nerve to hear what 
is being said. The effect of this straining is to cause exhaustion afterwards, 
which may last for a considerable time. Equally objectionable, and for the 
same reason, is it to talk outside the patient's door. All conversation with the 
friends or attendants by the physician, if not conducted in the patient's hear- 
ing in the sick-room, should be so in an apartment sufficiently distant to be 
altogether out of his hearing. If the nurse has any question which she wishes 
to a?k the doctor, let her not wait till he has got outside the door of the sick- 
room, and then stop to ask him there. A patient is peculiarly alive to every- 
thing that is being said, and will anxiously and breathlessly listen to any 
conversation, the sound of which reaches his ears. 



SICK-NURSING. . 845 



There are other causes of disturbance to a patient, such as the creaking of 
doors and the flapping of window-blinds, which are peculiarly annoying, and 
ought not to occur. A little care on the part of the nurse should prevent the 
occurrence of anything of this kind. A heavy footstep which causes the floor 
to shake is most unbearable to the sick. The rustling of a silk dress is also a 
source of annoyance, and so should be avoided by those in attendance upon the 
sick. Let the material of which the dress is made be such as to cause no 
sound in moving about the room. When the door of the sick-room is being 
opened, it should be done expeditiously, and with as little noise as possible. 
When the door has been opened, it is a very common habit for nurses to stop 
and ask questions. This should not be done. The effort of raising the voice 
may prove hurtful to the patient ; rather close the door again and come back 
to the bedside for the information you desire. On coming into the sick-room 
there should be as little excitement as possible. All calling and shouting from 
tops of stairs for articles that have been forgotten should be strictly prohib- 
ited. The room immediately over the sick-room should, if possible, remain un- 
occupied, as all noise there is very trying to a patient. In bringing food to a 
patient, or removing the dishes after he has eaten, anything like rattling of cup 
and saucers, bowls and plates, should not occur. When a patient has been 
made right for the night, nothing should be allowed to happen that is likely to 
disturb him ; otherwise he may remain awake for hours. In order to secure 
for the patient a good night, attention must be paid to see that the bodily heat 
is maintained. Sometimes this is neglected, and the patient's feet are per- 
mitted to become cold, and his body to receive a chill, through fear of disturb- 
ing him. The application of a warm bottle to the feet towards early morning 
will not be a cause of much disturbance to the patient, and may secure him a 
good night, with a consequent alleviation of his sufferings on awaking. Many 
undoubtedly suffer from carelessness on the part of the attendants in regard to 
these matters. 

The admission of too many people into the sick-room is another fruitful source 
of harm to a patient. Many friends, doubtlessly well-intentioned, come in and 
keep up an incessant conversation, either among themselves, or with the patient, 
and so do him an injury. While they are there the patient is probably flushed, 
and they tell him he is looking so much better ; but could they see the same 
patient some time after they have left, and when reaction has occurred, they 
would probably find reason to change their hastily-formed opinion. When the 
physician has ordered the room to be kept quiet, every effort should be made 
to do so, and the entreaties of friends who insist on seeing the patient must be 
resisted. Frequently, during convalescence, the visits of friends unduly pro- 
longed produce an effect of depression and debility upon the patient which 
greatly tends to hinder recovery. If careful attention were given to securing 
to the patient tranquillity during disease and convalescence, recovery would be 
more speedy and complete, and relapses much less frequent than they are. 



846 APPENDIX. 



Gossip. 

Nothing is more obnoxious in the sick-room than gossiping friends, and noth- 
ing is more productive of harm to the patieut. They should be excluded from 
the sick-room altogether, as their presence is unwelcome to every sufferer, and, 
besides being unwelcome, is positively injurious. By the stories which they 
tell, they tend to destroy that evenness of mind which is so necessary to a pa- 
tient's recovery, and are apt to diminish his confidence in the physician who is 
in attendance upon him. If part of the patient's symptoms are cough and pain, 
they tell how Mr. So-and-So, a very intimate friend of their own, had a cough 
exactly similar, and suffered from the same excruciating pain, and how by this 
or that external application, or the employment of some particular drug, he 
was immediately and completely relieved. Now all this is most unkind, be- 
cause both cough and pain are symptoms of many different diseases, which they 
in their ignorance cannot possibly have any idea of ; and besides, it is very apt 
to lead to distrust in the patient's mind of the physician who is in attendance, 
and to neglect in pursuing the line of treatment which he has laid down. The 
friends of the sick should be careful themselves not to entertain for a moment 
any advice that is so given, and should do everything in their power to dissuade 
the patient from doing so. When one comes to inquire a little more minutely 
into the history of the cases they relate, their information is generally found to 
be derived, not from self-observation, but from some second individual, who is 
in every respect most trustworthy, and who, they are sure, only related the case 
to them as it occurred. Now is it not most injudicious to subject a patient to 
the torture of listening to all this nonsense? It is really wonderful how mauy 
misguided friends there are who are ready to act the part of medical advisers 
during the time of sickness, and how many remedies are suggested to the poor 
sufferer for his employment. 

The following anecdote, taken from a work by Laurent Joubert, a physician 
of the sixteenth century, is related by Professor Fonssagrives in his book called 
The Mother's Work with Sick Children, and may serve to illustrate these 
remarks. " It is said that the Duke of Ferrara, Alphonso de Este, once pro- 
pounded the query of what trade contained the greatest number of persons. 
One said the shoemakers ; another, the sewing people ; another the carpenters, 
the pettifoggers, the laborers. Gonelle, the famous buffoon, said that there 
were more physicians than any other sort of persons, and offered to bet with 
the duke, his master (who flatly declined the honor), that he would prove it 
within four-and-twenty hours. The next morning Gonelle set out from his 
abode with a great nightcap on, and his chin bandaged up with a handkerchief, 
then a hat over all, and his mantle thrown over his shoulders. In this guise 
he took his way towards the palace of his Excellency by way of the Rue des 
Anges. The first person he met asked him what was the matter with him, to 
which he answered, 'An atrocious toothache.' ' Ha ! my friend,' said the other, 
'I know the best receipt in the world for that,' and he rehearsed it to him.' 



SICK-NURSING. 847 



Gonelle wrote his name upon his tablets, pretending to write the receipt. A 
step further on he passed two or three who put the same question to him, and 
each one gave him a remedy ; he wrote down their names, as in the first instance. 
And thus pursuing his course through the remaining portion of the street, he. 
met no one who did not offer him some receipt, all differing the one from the 
other, each one telling him that his own was well tried, sure, and infallible. 
He wrote down all their names. Arrived at the lower court of the palace, he 
was surrounded (being known to everybody) by persons who, after learning 
his trouble, insisted upon giving him receipts, each one said to be the best in 
the world. He thanked them, and wrote down their names also. When he 
entered the duke's chamber, his Excellency cried out to him from afar off, 
' Oh ! what is the matter with thee, Gonelle ? ' He replied very piteously, 
and in a whining manner, ' The cruelest toothache that ever was.' His Ex- 
cellency then said to him, 'Ah, Gonelle, I know something which would 
quickly banish your pain, even were the tooth spoiled. Master Antonio Musa 
Brassando, my physican, never made use of a better. Do this and that, and 
you will be cured immediately.' Gonelle at once threw down his head-gear 
and other appliances, exclaiming, 'And you, too, sire, are a physician. Look 
at my list, how many others I have found between my dwelling and yours. 
There are nearly two hundred, and I have passed through only one street. I 
will undertake to find more than ten thousand in this town, if I were to go all 
through it. Find me as many persons of any other trade.' " 

This anecdote may serve to show how common this habit of giving advice to 
the sick was in those days, and in our own it remains very much as it was then. 
Pity the poor sufferer who should endeavor to put into execution, for the sake 
of trial, the advice thus gratuitously given. How can he make use of all the medi- 
cines thus suggested ? And is it not extremely injudicious, when a medical man 
is in attendance, to make any suggestions of this kind ? Surely he who has 
watched a case carefully through weeks and months of dangerous illness, who 
knows all the peculiarities of his patient's constitution, is the one best able to 
give advice, to apply or withhold remedies as he sees fit ; and yet it is strange 
how little this is considered. Disease is not a thing to trifle with ; while we 
dally it is busy working, and to assist nature in her endeavors towards recovery 
requires careful and skillful management, which can only be successfully car- 
ried out by those who are competent to do so. In our care of the sick we ought 
to do all in our power to prevent the intrusion of any one who is likely to shake 
a patient's confidence in his medical adviser. "He performs most cures in 
whom most trust," was the saying of the Father of Medicine, and it is as true 
of our day as it was of his. All interference, then, with the treatment that is 
being pursued must not be permitted, and any suggestion of this or that remedy 
by well-meaning but ill-advised friends should be ignored. How frequently 
when patients are seriously ill do we hear such people attempting to cheer them 
by the assurance that there is nothing the matter with them, — as if the patients 
themselves were not better informed on this point than they. Surely when a 



848 APPENDIX. 



patient is dying, and knows that he is, it is little in the way of consolation to 
be told that he will soon be about again, that he only wants change of air, etc., 
to put him right. Such false hopes as these a sick man does not want, and it 
is anything but kindness to trouble him with them. He is not foolish enough 
to suppose that the opinion formed by such people from a cursory glance can 
have any weight when placed side by side with the carefully formed opinion of 
the physician who lias been in constant attendance upon him ; but to tell them 
his reasons for disbelieving what they say would cost an amount of mental and 
bodily effort which he in his debilitated state is ill able to bear. These remarks 
have, of course, no reference to the true friend, whose visit is looked forward 
to by the sick with unfeigned pleasure, who perhaps remains shorter time and 
during that time says far less than the other, but speaks to the point, and in 
that kindly, sympathizing way that tells the patient how much he feels for him 
and with him, and manifests that genuine sorrow in trouble so dear to the 
afflicted. If after the visit of a friend the patient appears cheerful and soothed, 
depend upon it such visits will exert a beneficial influence upon him; but should 
he instead appear jaded and fatigued, the influence will be of an opposite kind, 
and the recurrence of such visits should take place as seldom as possible, if 
they cannot be altogether obviated. As any mental disturbance may prove 
injurious to our patient, it is well that his letters should be opened by a trust- 
worthy friend, and only those parts read to him that are likely to exert a bene- 
ficial influence upon him. We shall consider this, however, more fully in the 
following article. 

Influence of Mind on Body. 

That there is an intimate relationship existing between mind and body by 
which they act upon and influence one another, all must admit. 

In health the influence of the mind strongly directed to a part, and concen- 
trated sufficiently long upon it, will produce in the first instance functional de- 
rangement, and afterwards lead to serious organic mischief. Thus when at- 
tention is directed to the heart, it beats with greater rapidity, and the individual 
is then said to suffer from palpitation ; and should the palpitation continue un- 
checked for a sufficient length of time, it leads to enlargement, or, as it is tech- 
nically called, hypertrophy of that organ. Now when the influence of the mind 
upon the body under the ordinary conditions of health may be of such a seri- 
ous nature, how much more serious must that influence be when directed to- 
wards an organ already enfeebled by disease. In health the changes which 
are observed to take place in the countenance of a person who is under the in- 
fluence of shame or fear must be familiar to all, — the crimson cheek in the 
one case, the deathly pallor in the other, — and when such wonderful effects 
are manifested when the bodily powers are strong and vigorous, how great 
must be the effect when these are debilitated by disease ! Hence the impera- 
tive necessity for preserving the patient as far as possible from the influence 
of passion, and preserving his mind in that calm and equal state which acts so 



SICK-NURSING. 849 



beneficially upon the body in the time of disease. If a patient's attention is 
always directed to the seat of suffering, his misery is aggravated and his pain 
greatly increased ; but endeavor to withdraw his attention, and, if you succeed, 
you will allow the part that rest which is so necessary to the successful carry- 
ing out of those restorative changes which in disease nature is ever working. 

But to withdraw a patient's attention from himself is no easy task, and fre- 
quently it lies completely beyond his own power so to do. Did we, however, 
instead of urging the necessity of this upon the patient, endeavor to lead his 
thoughts into a different channel, we should accomplish more for him, and suv 
ceed better in the attainment of the object we have in view, than by all the 
arguments at our command, however eloquently uttered. If you tell the pa- 
tient that to habitually concentrate his mind upon himself is bad; if you tell 
him that by thinking about his disease he will aggravate the symptoms and in- 
crease his malady, and that by withdrawing his attention from the seat of suf- 
fering he is doing what is best to facilitate recovery and bring about a speedy 
cure, he will answer you that he is aware of all that, and will agree with every- 
thing you have said ; but the mental concentration still remains ; the symptoms 
are aggravated and recovery is delayed. The fact is that the patient has not 
the power to cope with this influence so as to overcome it, and if instead of 
urging him so to do we engage his attention involuntarily, and get him thus 
thoroughly interested, we shall have accomplished for him, without an effort on 
his part, greater and more permanent results than could have been attained 
by many weary hours of struggling and fighting. By thus engaging his atten- 
tion involuntaiily you will have secured the desired rest to the part, and while 
he has been forgetful of his sufferings be assured that the work of recovery 
has been going on. The best means by which to attain this end is to tell the 
patient a good story that has a pleasant ending, or to read to him something 
in which he can feel interested. 

Anything that weighs upon a patient's mind, producing care or anxiety, exerts 
a depressing influence upon the nervous system and tends to retard recovery. 
Everything of this kind should therefore be carefully guarded against, and as 
far as possihle evenness of mind maintained throughout. To worry a patient 
with household affairs when suffering from disease is certainly not the way to 
bring about a speedy return of health and strength. There are, however, some 
people of peculiarly anxious temperament, who, when under the necessity of 
relinquishing household duties, imagine everything to be going wrong during 
their absence, and are continually fretting in consequence. Especially is this 
most frequently met with in mothers who have large young families. As far 
as possible the anxiety of such should be relieved by providing a thoroughly 
competent and trustworthy person to take her place. If this is done her mind 
may be greatly relieved and her recovery hastened. Let everything, the ten- 
dency of which is to cause excitement in the patient, be carefully guarded 
against. Anything that does so is most injurious, and cases are not wanting 
where a sudden burst of anger has proved fatal. 
54 



850 APPENDIX. 



Equally dangerous is it to allow anything of a depressing nature to weigh 
upon the patient's mind. Despondency or despair act as direct sedatives, and 
although their influence may not be so readily manifested as in the case of 
anger, and those passions which give rise to excitement, they nevertheless are 
as certain in their effects, and anything that would lead to the one or the other 
should be carefully guarded against. Should despair take possession of a pa- 
tient's mind, and every effort be unavailing to drive it away, the effect upon 
the body is soon apparent in the pallor and dejection which now show them- 
selves, and in the gradual failure of the bodily powers that speedily supervenes. 
Everything ought to be done on the part of those who attend upon the sick to 
cheer them and instill hope into their minds ; otherwise fear may take posses- 
sion of them, and add to their danger by increasing the severity of the disease 
from which they suffer. The effect of inspiring a patient with hope and confi- 
dence in the means that are being employed, which is the daily work of the 
physician, must only be carried out imperfectly, unless his efforts in this direc- 
tion are backed up by the efforts of those who are in hourly contact with the 
patient. In order to do this the physician~and friends alike must impress the 
patient with the belief that interest is being taken in his case. Anything like 
making light of a patient's sufferings must be carefully avoided, and any friend 
who is inclined to laugh a patient out of his troubles had better keep away 
from the sick-room. Above all, let those in constant attendance upon the sick 
do everything in their power to assist in maintaining the patient under the in- 
fluence of those conditions of body and mind which are such powerful agents 
in their recovery, and strive assiduously to prevent the appearance of anything 
which would tend in an opposite direction. 

Observation. 

There is perhaps no habit so little cultivated by those who have charge of 
the sick as the habit of observation. Attendants and friends alike fail in the 
exercise of it, and much information that would be of value to the physician is 
thus lost. How often, when the medical man asks a question, does he receive 
the most vague, and misleading statement by way of answer ! How frequently 
is the physician told that a patient has eaten nothing all day, when all that is 
meant is that his appetite to-day has not been so good as it was yesterday ! 
When an attendant is asked, " How did So-and-So sleep last night? " it is not 
at all unusual for the physician to be told in reply that " he never closed an 
eye all night," when all that is meant is that his sleep was disturbed, and that 
he was more restless than usual. Now unless information given to the physi- 
cian by nurses and friends be correct, how can he arrive at a true knowledge 
of his patient's condition during the intervals ? All ambiguous language should 
be avoided in reporting to a medical man upon the condition of a patient, and 
guessing at the truth must never be attempted. When information upon any 
point is asked for, only that which is definite is desired, and that alone should 
be given. A physician would far rather have the nurse or attendant acknowl- 



SICK-NUKSING. 851 



edge ignorance in regard to what is asked, than that attempts be made to an- 
swer his questions which can only prove misleading. If the information thus 
supplied should be misleading rather than guiding in its nature, the patient 
may suffer in consequence. A careful habit of observation on the part of those 
in attendance upon the sick cannot be too highly estimated, nor its culture too 
strongly recommended, while its absence must always be deplored. The ob- 
servation at the bed-side should only relate to facts. These, as before inti- 
mated, are what the physician desires ; all else, such as what the nurse or at- 
tendant thinks of this or that, is regarded as extraneous matter, and had better 
be left out. Now, although this kind of observation appears simple enough, 
it is just the kind that the physician finds the greatest difficulty in obtain- 
ing. Frequently, while the patient is listening to what the doctor is being 
told with regard to his case, he could supply, were he able to speak or willing 
to do so, information that would be strangely at variance with what was being 
furnished by the attendants as a correct statement of facts professed to have 
been observed. By the careful cultivation of this habit, much valuable in- 
formation might be daily and hourly stored up for guidance in the treatment 
of the case, and by clear and definite answers given to the questions addressed 
the physician would be greatly aided in estimating the true condition of his 
patient. Should the memory be insufficient for the storing up of these facts, 
a note of them should be taken and kept for reference. 

A few hints may now be thrown out as to the kind of facts which it is de- 
sirable for those who have the care of the sick to observe. Facts with regard 
to food and sleep are of primary importance as objects of observation. If the 
patient has been ordered a certain quantity of beef-tea at say twelve o'clock in 
the day, the quantity taken should be carefully noted and reported to the doc- 
tor at his visit. There are many nurses who carry food to a patient, and take 
it away again only half eaten, or perhaps scarcely touched, who are neverthe- 
less quite ignorant of the fact, and who, if asked if the patient had taken what 
was ordered him, would answer that he had. Now information of this sort 
is very misleading, and can scarcely be excused, since a little extra care and 
trouble would suffice to prevent its occurrence. It ought also to be observed 
whether in eating the patient does so with relish, or whether he rather forces 
himself to eat against his inclination. Any article of diet which the patient 
eats with greater avidity than another, and any peculiar article that he ex- 
presses a wish for, should also be carefully noted. Much valuable information 
may be obtained from the careful observation of this one point alone, because 
in certain diseases, especially connected with the nervous system, there is a 
peculiar craving for strange and altogether unsuitable things as articles of diet. 
The effect which the food produces upon the patient should also be carefully 
noted. Is he distressed after eating ? Does he complain of fullness or other 
uncomfortable sensation over the stomach ? Or does he remain easy and free 
from pain ? To be correctly informed in regard to these various details would 
enable the physician to judge more correctly of the patient's condition, and 



852 APPENDIX. 



enable him to vary the articles of diet from time to time, as it might he found 
necessary. When any " fresh " article of diet is employed, its effect upon th- 
patient should he particularly noted. With regard to sleep, the number of 
hours should he recorded, also which hours. Did he sleep during the early part 
of the night, and remain wakeful afterwards, or was he restless and wakeful 
throughout the first part of the night, and did he then fall into a troubled doze 
and awake unrefreshed in the morning? Careful attention to ascertain these 
facts is very important, as the remedy to he applied in the two cases is differ- 
ent. In the former, on applying external warmth, or giving food or stimulants, 
you will frequently put the patient under those conditions which shall enable 
him to obtain undisturbed sleep during the remainder of the night ; while in 
the latter, by administering some sedative, you obtain a like result during the 
earlier hours. The appearance of the patient on awaking from sleep should 
also be observed, and the kind of sleep obtained, whether quiet and peaceful, 
or disturbed and rambling. By the careful observance of such facts the med- 
ical man will be put in possession of much valuable information which will 
serve to act as a guide in regard to the line of treatment most likely to act 
beneficially upon the patient. All facts thus observed by nurses and those in 
attendance upon the sick, and reported to the physician, will be carefully 
weighed by him. and due importance attached to each, and, taken in conjunction 
with what he himself has observed, may prove of great service in the manage- 
ment of the case. 

Another object of careful observation ought to be the pulse. By attention 
to this much valuable information is gained. Now in speaking of the pulse, it 
is not only meant that the number of beats should be recorded ; this can be 
very easily learned ; but there are other points in connection with the pulse 
which those in attendance upon the sick would do well to make themselves 
familiar with, and from which much true knowledge and clearer insight in re- 
gard to a case can be obtained. Thus a pulse is sometimes found to intermit. 
The number of intermissions and the period of their occurrence should be 
carefully observed and noted down. In one pulse a beat may he wanting in 
every six or seven pulsations, or you may have a series of beats all succeeding 
each other in perfect regularity, followed by a series in which the pulsations 
are more or less irregular. Again, it should be noted whether the pulse is hard 
and raises forcibly the fingers with which it is being felt, or whether it is soft 
and compressible. There are other peculiarities in connection with the pulse 
which should also be learned. Thus in aneurism the character of the pulse 
may be described as " splashing." When the contraction of. the left ventricle 
of the heart is prolonged and forcible, it gives rise to a "full " pulse ; that is 
to say, to a pulse the volume of which is greater than usual. Fullness of 
blood, technically called plethora, also gives rise to this kind of pulse, whereas 
anything which causes a general deficiency of blood throughout the body gives 
rise to a pulse which is termed small. 

Thread-like is a term which is applied to a pulse when it is very small. In 



SICK-NURSING. 853 



acute inflammations, or where there is risk of haemorrhage, the pulse has a 
peculiar " throb." These different characters of the pulse can be learned only 
by careful observation at the bed-side ; but to know them is of great value 
to all who are in attendance upon the sick. In examining the pulse of a 
patient the fore and middle fingers of the right hand should be made use 
of, and the number of beats counted by means of a watch having a seconds' 
hand. The pulse of a healthy adult beats about seventy times in a minute. 
The pulse of a woman beats more rapidly than that of a man. During sleep 
the pulse beats less rapidly than when awake. Only the facts in connection 
with these various points ought to be reported ; the interpretation of their 
meaning belongs to the medical man. 

Besides this ohservation of the pulse there are many other things which 
should be noted and reported to the physician at his visit. Thus if a patient 
is suffering from a cough, the frequency of the paroxysms should be noted ; 
the time of their occurrence, whether during the early part of the night, or 
towards morning ; their duration, whether a few minutes or half an hour ; also 
the appearance of the patient during the continuance of the paroxysms.- In 
whooping-cough the face becomes congested and of a purply hue during the 
paroxysm ; while in consumption it remains pale, and is bathed in perspiration. 
The character of the cough should also be observed. In croup it is hard, 
barking, and has a peculiar metallic ring about it, whereas in bronchitis it is 
softer. No less important is it to observe the appearance of what has been 
expectorated. Much valuable information is to be derived from a careful ex- 
amination of the sputum, and the preservation of it for the physician's inspec- 
tion should never be neglected. In pneumonia, or inflammation of the lungs, 
the sputum has a rusty appearance ; in pleurisy it is frothy ; in bronchitis it 
consists of viscid mucus ; while in consumption it is streaked with blood. 

As the evacuations from the bowels frequently afford much information in 
connection with a case, they should be preserved for inspection. It is also 
very necessary to preserve a quantity of the patient's urine, as this also often 
throws light upon a case. The physiognomy of disease is often spoken of, and, 
if carefully studied, may be of much value ; those who are in attendance upon 
the sick should strive to make themselves familiar with its varied manifesta- 
tions as these come under their observation. 

There are also peculiarities of temperament, a correct knowledge of which 
on the part of nurse or attendant may save the patient much annoyance. 
As these differ in individual cases, a careful study of each is necessary to make 
one familiar with them ; but where this has been done much may be achieved 
in the way of avoiding those things which are known to be sources of irritation 
to a patient, and rendering his illness much more bearable than it would other- 
wise he. It is a well-known fact that many superstitions are the result of 
bad observation, and that had observers are almost all superstitious ; hence the 
necessity there is for the cultivation of correct habits of observation on the 
part of those in attendance upon the sick. Without this, serious changes in the 



854 APPENDIX. 



patient's condition may be allowed to pass unnoticed, and much harm ensue in 
consequence. During the progress of disease it is important that the nurse or 
attendant should be able to recognize those symptoms which denote recovery 
and those which denote the reverse ; and yet there are few who are able to 
distinguish between the one and the other. After many fevers recovery is 
slow, and it may be long before the patient is able to stand on being taken out 
of bed ; and yet if his appetite returns, and he begins to take food with greater 
relish, he may be looked upon as progressing. Again, if a patient who was 
able to stand or to sit up in bed is unable to do so any longer, although in 
other respects little alteration may be noticed in his condition, he is undoubt- 
edly becoming weaker. These changes, especially in chronic cases, are fre- 
quently allowed to pass by unnoticed, and the end often comes unexpectedly, 
when more careful observation might have warned the friends of its approach. 
The work of the physician would be greatly augmented and facilitated if in 
every sick-room a chart were kept to record facts, especially such as have been 
indicated in connection with each case. The more important to note, if such 
a method should be adopted, are those connected with the pulse, which ought 
to be recorded regularly night and morning ; also the number of respirations 
and any peculiarity that may be observed in connection with the breathing. 
Observations in connection with food and sleep are also most important. The 
amount of fever may be roughly estimated by means of the hand. True ob- 
servations in regard to this can only be made by employing the thermometer ; 
but as this requires skill for its proper application, it had better be left in the 
hands of the physician. If a record such as this were kept, the medical man 
would be able to see at a glance the condition of his patient during the time 
that elapsed between his visits, and by the information thus obtained, added 
to the facts which he himself had observed, would be enabled to judge more 
definitely of the real progress of the case. The value of adopting such a 
plan will be more apparent when it is considered what effect the doctor's 
visit frequently produces. How often, for example, when his footstep is 
heard on the stair, does the patient become flushed and excited, and his pulse 
quicken, and unless the physician can remain till all excitement has passed 
away, how easily may he take away an erroneous impression with regard to 
the case ! In order that, the facts recorded by those who have the care of the 
sick be of value, the observations must be made methodically and shown to the 
physician at each visit. With regard to this habit of careful observation too 
much cannot be said in its favor, and if it should entail some extra trouble 
from those in attendance upon the sick, the fact of so much incorrect and mis- 
leading information being daily supplied to the physician shows the necessity 
there is for its adoptiou. 

Convalescence. 
The period of active disease being now at an end, the patient passes into 
that state which is called convalescence, during which the powers of nature are 



SICK-NURSING. 855 



exerted towards repairing the waste of structure that has occurred during dis- 
ease. Up to this time the efforts of nature have been directed towards ena- 
bling the body to combat successfully the disease that threatened to overwhelm 
it, and now that this has been achieved, and the combative part is over, her 
energies are called into play for another purpose. The frame that has been 
wasted by disease requires to be built up again, the worn-out frame needs to 
be supplied with fresh power to fit it for its accustomed duties, and the vital 
energy expended during disease requires to be restored. During the continu- 
ance of active disease there must always be more or less apprehension, lest the 
issue should be a fatal one, but how welcome to the friends who have anx- 
iously watched by the bed-side of the sick is it to be told by the physician that 
the fever is abated, and that pulse and temperature are again normal ! With 
what joy do they listen to the welcome news, hope that had well-nigh be- 
come extinguished the while reanimating their breasts and filling their minds 
with bright pictures of the future ; and yet what need is there for care, lest the 
dangerous hopes which convalescence brings with it should meet with disap- 
pointment ! 

During convalescence the greatest care is necessary, as relapses may occur 
and the disease end fatally, or it may assume a chronic form ; hence the ne- 
cessity there is, when active disease is over, of those who have the management 
of the sick attending in every particular to the rules laid down by the med- 
ical attendant, and avoiding everything that would be likely to exert a hurtful 
influence upon the patient's recovery. It is now that the iujudiciousness of 
friends begins to manifest itself, and unless firmness be exercised on the part 
of those in attendance, the patient may suffer through their mistaken kindness. 
Hitherto a barrier has prohibited their entrance into the sick-room ; but, this 
being removed, they now enter, and fresh dangers arise to the patient. In the 
case of children, especially, there arises the danger that sweetmeats and pas- 
try stuffs may be thus brought within their reach, and, being eaten, a relapse 
maybe caused. Both in hospitals and private homes this is constantly met 
with, and notwithstanding the vigilance which obtains in the former, patients 
receive from their friends, and consume stealthily, what in many instances 
does them a positive injury. There is at this time call for increased vigilance 
on the part of those who wait upon the sick, and for increased efforts to see 
that the patient is placed under the influence of those conditions which will 
operate most beneficially upon him, and be most helpful in recovery. 

One of the most frequent signs of returning health is the return of the pa- 
tient's appetite. While the disease was at its height he had no desire for food, 
and perhaps only took it with an effort ; but now his appetite is returned, it 
seems as if his craving for food could scarcely be satisfied, and it is at this 
time, on the return of the patient's ability to eat, that the greatest caution re- 
quires to be exercised on the part of attendants and friends. The patient's de- 
sire for food should never be fully satisfied. If attention is not paid to this 
the enfeebled stomach may have too much work thrown upon it suddenly, and, 



856 APPENDIX. 



being unable to accomplish the work thus given it to do, indigestion may re- 
sult, and the patient in consequence suffer a relapse. A very common error is 
made by supposing that when the patient has become convalescent the work 
of the attendants and friends is almost at an end, but how different in reality 
is the true condition of things. It is indeed true that the visits of the doctor 
are not now so frequent as they were ; cases of more urgency may be demand- 
ing his attention ; but on this account do not let it be supposed that the efforts 
of those who hitherto have had charge of the sick are to be relaxed. On the 
contrary, and just because the visits of the medical attendant are less frequent, 
more devolves upon the nurse and the friends, and whereas formerly they were 
able to receive daily instruction as to what they should do, they are now 
thrown much more upon themselves. For this reason also it becomes more 
necessary that careful observations should be made in regard to a case ; other- 
wise the physician will be unable to form so correct an idea of the condition 
of his patient as he might. The instructions given at each visit should also be 
carefully attended to, and nothing be permitted to interfere with the carrying 
of them out. 

The time which the patient must remain in hod varies in individual cases, 
and can only be satisfactorily determined by the medical attendant. It may he 
said, however, that during the febrile part of every disease the patient should 
be kept in bed. To keep a patient in bed too long exerts a weakening influ- 
ence upon him ; the bowels are apt to become sluggish, the appetite flags, and 
the respiration is less active than when he is up. In the case of children this 
can be more readily determined, and when they are observed moving about the 
bed instead of lying still, after all feverishness has left them, it is an indication 
that they are in a tit state to leave bed. When a patient gets out of bed for 
the first time after a severe illness, it is generally allowed for a short time 
only, and the effect produced upon him should be carefully watched, as it will 
best show whether or not he is able to leave bed with impunity. Should the 
patient, instead of appearing better for his first short sitting up, seem greatly 
fatigued, and instead of sleeping soundly appear restless and disturbed, he had 
better be allowed to remain in bed a few days longer, after which he should be 
again tried, the same precautions as formerly being taken and the effect once 
more closely watched. While care is taken to see that the patient does not 
remain up too long, care must also be taken that he is exposed to no draught. 
If on first leaving bed he is exposed to this influence he may suffer serious 
relapse, and his recovery be in consequence greatly impeded. 

The clothing of the patient should also he attended to. It should be warm 
and comfortable. There is greater likelihood at this stage of mischief result- 
ing from insufficient than from too much clothing; hence the necessity of seeing 
that the patient is well clothed. Of all the agencies that, operate beneficially 
and serve to restore the patient to health and strength again, change of air is 
perhaps the most potent. The patient who has remained for weeks in very 
much the same state, getting neither better nor worse, will often wonderfully 



SICK-NURSING. 857 



improve after a few days spent in the country or at the sea-side. The inhaling 
of pure air and the effect upon the mind of new scenery aud fresh objects of 
interest are marvelous. If the period of sickness has been passed in a room 
whose only view was the backs of houses or the fronts of those which formed 
the opposite side of the street, how grateful and invigorating must be the 
change ! What an influence for good after leaving such a scene must the sight 
of green fields and mountains and rivers have upon the patient's mind ! How 
many different channels are thus opened up to him into which his thoughts are 
involuntarily directed ; and while his mind is thus busily occupied his bodily 
powers are rapidly restored. No less beneficial is the change to the sea-side. 
Here the fresh sea breeze exerts a wonderful' power over the frame enfeebled 
by disease, and the languid bodily powers are speedily restored. 

During convalescence, if the patient is at all intellectually inclined, much 
pleasure may be given him by reading to him, or by supplying him with liter- 
ature of an interesting nature. If he is read to it must not be overdone. It 
should not be continued so as to fatigue the patient, and the manner of reading 
must be slow and deliberate. If he prefer reading himself he ought not to be 
allowed to pore incessantly over books, as harm may thus result. Very often 
at this time, also, the visits of friends, if unduly prolonged, prove hurtful ; or it 
they engage the patient in too lengthy conversation may give rise to fatigue 
and exhaustion. These things should be always kept in mind, and the patient 
guarded as far as possible from their prejudicial influence. Attention to such 
will be of great service in facilitating the patient's recovery, and will go far to 
prevent those relapses which are only too frequently met with from carelessness 
in these respects. The amount of harm and permanent injury which often 
result from negligence during the period of convalescence are but little known. 
Many lives have indeed been sacrificed from carelessness and thoughtlessness 
at such times, and this fact ought to impress itself deeply on the minds of those 
who are in attendance upon the sick, and arouse them to a consciousness of the 
necessity there is during the whole period of convalescence for increased in- 
stead of diminished vigilance. A little more caution than is usually found, and 
the chances of relapse occurring would be greatly lessened, an otherwise pre- 
carious time rendered comparatively safe, and the patient's recovery be made 
more permanent and complete. 

II. Having Special Reference to Children. 

Although the foregoing remarks have been made with special reference to 
adults, most of the subjects treated of are equally applicable, and the carrying 
out of their various details equally necessary, to the proper management of 
children during the time of sickness, so that to treat in this chapter of what 
had been already dealt with in the previous one would merely be to repeat 
what had been there said at sufficient length. There are, however, certain 
peculiarities arising from the age, the growth, and the diseases to which child- 



858 APPENDIX. 

hood is specially liable that call for a few remarks in addition to those which 
have already been made in connection with the sick-nursing of adults. The 
necessity of strict attention being paid to the rules already laid down in con- 
nection with the important subject of ventilation need not be dwelt upon now. 
These rules must be adhered to in the case of children in all their stringency, 
and, if possible, more care taken to see that they are efficiently carried out, be- 
cause, being unable to influence their surroundings, they are utterly at the 
mercy of those who have the making of them. Again, in regard to tempera- 
ture, the greater susceptibility of children to the slightest variation renders it 
all the more necessary to attend carefully to this. Also in regard to the 
lighting of the apartment the same scrupulous care must be exercised. From 
neglect of this, light may be allowed to stream in upon the child's face, and 
being unable to alter its position the little sufferer has to submit to this, to say 
the least of it, unpleasant influence ; or again a candle may be so placed that 
the child, turning towards the light as it invariably does, has to twist and turn 
about in the most pitiful manner, when a little forethought on the part of 
those who had the placing of it had been sufficient to obviate any such occur- 
rence. 

Incautious Use of Medicines. 

During the early years of childhood the incautious use of medicines by those 
who are ignorant of their properties is a fertile source of danger. To some, 
indeed, the effect may be speedy and fatal ; in others impairment of body and 
mind may be the result, and the child grow up weakly and delicate, and bear- 
ing the marks of this injurious practice upon it to its dying day. Too much 
stress cannot be laid upon the necessity there is for parents abstaining from 
this pernicious habit of dosing their children with medicines. Wejfe the drugs 
thus freely employed harmless in their nature, no great mischief might result ; 
but unfortunately there are charlatans in every city ready to take advantage 
of duplicity, and the number of those who believe in and are in consequence 
led astray by them is truly marvelous. The daily papers are full of their 
advertisements; our streets are crowded with their placards; they themselves 
gather together assemblies of the simple, who after hearing of the wonder- 
ful cures which have been wrought by the vaunted remedy, purchase it, and, 
taking it home with them, administer it to their helpless babes. Would that 
people were aware of the evil that is done daily by such means, and that they 
knew the consequences of their io\]y upon their little ones. Frequently by 
the administration of such drugs, which generally contain some preparation of 
opium, a dreamy somnolent state is induced, from which the child may never 
recover. 

There is another prejudicial habit which parents frequently have of giving 
their children purgative medicines with a view to " cool their blood " as it is 
called. This is generally resorted to in spring and autumn, and is frequently 
made use of altogether as a precautionary measure, there being people who 
imagine that medicine taken in health acts as a sort of reserve fund in time of 



SICK-NURSING. 859 



disease. With a little extra care in dieting at such seasons of the year, and 
the substitution of one article of food for another, much of this unnecessary 
drugging might be avoided. At the beginning of every illness of childhood, 
if parents would have recourse to the employment of simple hygienic precau- 
tions instead of flying at once to drugs, and using them to the injury and hurt 
of their children, the simpler ailments would be more easily got ricl of, and 
if anything more serious were the matter with the child, less precious time 
would be wasted than at present. It is really sad to think how much evil re- 
sults from thus dallying with disease, how many valuable opportunities are 
allowed to slip, and how many fatal results are the direct consequence. The 
parent with her medicine chest employs first one drug, then another, being per- 
haps all the while perfectly ignorant of the compaint from which the child is 
suffering, and frequently giving it those things which instead of doing good 
are the means of doing positive harm. Thus days are wasted, valuable time is 
lost, the disease meanwhile making rapid progress, and when the child has 
almost succumbed to it the assistance of the physician is sought ; surely con- 
duct such as this ought not to occur. 

It seems indeed extraordinary that the diseases affecting the human frame 
should be thus tampered with, and that any kind of hand should be thought 
sufficiently skilled to adjust its complex machinery when anything has gone 
wrong. While we w r ould not trust the mending of our watch to a blacksmith, 
nor think of sending for a plumber when we had broken the leg of a chair, 
this same human body, with all its complexity and with all its extreme delicacy 
of structure, is daily submitted, in the treatment of those ills to which it is 
heir, to those who are altogether ignorant of its structure and unable to treat 
its diseases. The following case is not imaginary. A child is noticed by its 
parents to be restless and irritable ; its sleep is disturbed, and its appetite be- 
comes impaired. The cause of these symptoms may be variously interpreted; 
generally the child is supposed to be suffering from worms, wind, or, if young 
enough, teething is looked upon as the cause. The opinion of the neighbors 
is then sought, and after consultation the disease from which the child is 
suffering is agreed upon, and a course of treatment adopted. If the symptoms 
have been referred to teething, some well-known teething powder or soothing 
syrup is recommended, and the child is subjected to its influence ; but as most 
of these powders and syrups owe their efficacy to the presence of some prepa- 
ration of opium, — a drug most pernicious to children, — the harm resulting 
from their administration is great. Were parents only aware at what cost to 
their helpless infants their cries had been stopped and their restlessness put 
an end to, they would surely be less reckless in adopting such treatment ; and 
when a sucking child has been known to die from the effects of a single drop 
of laudanum, it shows the necessity there is for the exercise of the utmost 
caution in the administration of opium in any form to infants and children. 
When worms are supposed to be the cause, tablets and powders of various 
kinds are suggested, which are likewise given unhesitatingly to the child. If 



860 APPENDIX. 



vermifuge remedies are given, whose composition is known and which are 
simple in their nature, no great harm may result, but the indiscriminate em- 
ployment of worm cakes and tablets as sold in the shops cannot be too strongly 
condemned. Numerous diseases of childhood are attributed to the influence 
of worms; and while, undoubtedly, their presence may lead to great disturb- 
ance of the system, and be the starting-point of serious mischief, there are 
cases in which their presence gives rise to no serious symptoms at all. When 
they are present in a child the diet should be regulated so as to prevent as far 
as possible their occurrence, and proper means employed, under the physician's 
direction, for their removal. Parents are, however, too apt to attribute to 
the influence of worms an altogether exaggerated part in the production of the 
diseases of childhood, and many children are subjected to courses of vermifuge 
medicines when the diseases from which they are suffering are not in the least 
dependent upon the presence of these parasites. Wind also is magnified into 
great importance, and looked upon as the cause of many of the ailments of 
childhood, and instead of the condition which has given rise to the presence of 
flatulence being sought out, the easier though much less certain method of 
treating the wind is had recourse to. Strange indeed are the powers with 
which wind is vested in the popular mind : in the strangest and most unac- 
countable manner it shifts about from place to place, now appealing between 
the skin and the flesh in one place, now giving rise to pain in another, and yet 
in a third even causing convulsions. It ought to be distinctly understood that 
flatulence is an effect, not a cause, and that to treat it satisfactorily the more 
laborious work of discovering what that cause is, and treating it, must be had 
recourse to. 

There is a practice widely prevalent in this country of parents going to 
apothecary shops and asking the apothecary to prescribe for a child he has not 
seen. Usually the apothecary gives only such simple remedies as are not likely 
to do much harm if they are the means of doing no good, but in this way much 
valuable time may be lost, and if the disease is serious it may have made rapid 
progress before the physician is called in. We would again inculcate the 
necessity, when a child is seen to be ailing, of the employment of ordinary 
hygienic precautions, and if the child is merely suffering from temporary in- 
disposition the adoption of such measures will generally be sufficient to re- 
move it, whereas if anything more serious should be hanging about the child 
which fails to be removed by these means, no time should be lost in sending 
for the physician. Delay in such cases may prove dangerous, ami the benefit 
of early advice and early treatment skillfully conducted cannot be over- 
estimated. There is one other subject in this connection about which a few 
words may be said, and that is the reckless employment of physicians' pre- 
scriptions. Instances such as the following are of frequent occurrence. A 
lady has consulted a physician, who, after careful investigation of her case, 
prescribes for her, but along with the medicinal treatment he lays down cer- 
tain rules as to diet, exercise, baths, and other hygienic precautions which he 



SICK-NURSING. 861 



deems necessary to the proper management of the case, and without which 
the medicine would be of little avail. In all probability the patient has been 
neglectful of these measures, and their adoption, with the necessary giving up 
of a bad system, has of itself an influence upon the patient beneficial in the 
highest degree. On good resulting, and a cure being ultimately established, 
the effect is attributed entirely to the influence of the drug, the hygienic 
measures adopted being altogether ignored in the result that has been attained. 
Of course the prescription is greatly thought of, and is carefully put away. 
Some time after a letter is received from a friend in the country who has been 
suffering for some time and been feeling very unwell. A long description of 
her ailment is given, and the symptoms having much in common with those 
of her own, the two diseases are considered identical, and without a single 
word about diet, exercise, or anything of a hygienic nature, on the adoption of 
which her medical adviser was most particular, she sends the prescription to 
her friend. The prescription is received and made up at the apothecary's, and 
taken according to instruction. It may be that benefit is derived from it ; but 
the probabilities are greatly in favor of no good resulting, and after valuable 
time has been thus wasted, and disease tampered with, the physician is called 
in and shown the prescription, which he pronounces as unsuitable in the pres- 
ent case. Such a practice as this, leading to waste of time, with its conse- 
quent risk of life, ought surely to cease. The number of failures in such cases 
is never known, but should the remedy succeed, its wonderful virtues are ex- 
tolled, and its powers greatly magnified. Now, should the drugs so employed 
be comparatively safe, no great harm may result; but as frequently physicians' 
prescriptions contain drugs of a poisonous nature, which require to be given 
cautiously, and their effect upon the constitution carefully watched, the result 
might at any time be most serious. There is another practice which is prej- 
udicial in its effects, but one which widely obtains, especially among the upper 
classes of society, namely, that of giving medicines to the poor. Fortunately 
homoeopathic medicines are generally made use of for this purpose, which have 
always the good quality of not in themselves being able to do much harm, 
should no good arise from their employment, but the practice is one that is 
pernicious, and ought to be condemned. ]f instead of giving the poor drugs 
they would teach them the value of pure air, proper dieting, exercise, clean- 
liness, etc., they would be bestowing a much greater blessing upon them. 

Signs of Disease in Children. 
To be able to distinguish disease in a child from some mere transitory ail- 
ment forms a most important part of the work of those who have the care and 
rearing of children entrusted to them. To send for the physician when there 
is nothing the matter with the child, and to refrain from so doing when the 
child is seriously ill, are mistakes which are at present of daily occurrence. Bet- 
ter far, however, that the former should take place, than that a grave disease 
should be neglected and the patient suffer in consequence. There are, fortu- 



862 APPENDIX. 



nately, marks by which the observant mind may be able in most cases to dis- 
tinguish between the one and the other, but when there is an\ r doubt existing 
in the mind we would urge the necessity of calling in the aid of the physician. 
By so doing all unnecessary delay is avoided, and if the disease is serious it 
will be all the better for the patient that it has been taken in time. When any 
serious disease is impending in a child he is generally noticed to he out of sorts 
for some time; he is observed to be restless and irritable, his sleep becomes 
disturbed, he may wake up with a scream; occasional muscular tsvitchings 
may also be observed. The child becomes dull and listless ; he has no inclina- 
tion to join with his brothers and sisters in their sports ; he will remain 
motionless for a long time, only following them in their amusements with his 
eyes ; his features are those of an aged person. The appetite also becomes 
capricious, or may be altogether lost. When these symptoms are observed 
coming gradually upon a child no time should be lost in seeking advice, as in 
all probability something of a serious nature is impending. Besides the fore- 
going symptoms there are others which will be noticed more in detail here- 
after, the presence of which give valuable information, not only as to the fact 
of impending serious disease, but also with regard to the part of the body 
affected. Now the importance of information of this kind in the case of chil- 
dren who are able to express their feelings to those around them only very 
imperfectly, if at all, must be apparent to every one.. The expression of coun- 
tenance, the voice, the movements, are all carefully studied by the physician, 
and employed by him in diagnosing the diseases of infancy and childhood, and 
to the unskilled a knowledge of some of these under the modifying influence 
of disease may prove useful. We shall consider those signs of disease which 
may be derived from — 

The condition of the body. If a child who has been plump and well begins 
to lose flesh, and is noticed day by day to become more wasted, in all probabil- 
ity there is something serious threatening the child. The production of ema- 
ciation is associated in the popular mind with various affections ; thus worms, 
teething, diarrhoea, and growth are all supposed to give rise to emaciation. 
With regard to the first, although undoubtedly a cause of emaciation some- 
times when present in large numbers, they certainly do not give rise to it with 
anything like the frequency with which they are credited. Should worms, 
however, be observed in the motions, means should be employed to get rid of 
them as soon as possible. Another frequently supposed cause of emaciation in 
children is dentition, but this can only be attributed as a cause when its exist- 
ence is evident, and when, instead of going on naturally, it is accomplished 
irregularly, and in a tumultuous manner. Brain diseases, as is well known to 
the physician, generally manifest themselves by emaciation ; and unless this 
fact is borne in mind, the coming on of a serious disease may be overlooked, 
and much valuable time be lost in consequence. Another cause of emaciation is 
jealousy on the part of a child. Anything that might lead to this developing 
itself in one member of a family towards another should be carefully guarded 
against by those who are entrusted with their rearing. 



SICK-NURSING. 863 



Altered demeanor. When a child who was bright and happy is observed to 
become listless and morose, careless in regard to everything that formerly 
gave it happiness, unwilling to join its brothers and sisters in their play, and 
sitting silently watching them in a half-interested sort of way, depend upon it 
there is something seriously wrong. A child when in health is bright and 
active, seldom at rest for any length of time, unless when asleep, and when this 
natural activity, which is a sure sign of health, ceases the cause should be at 
once inquired into, and should the parent be unable to give herself a satisfac- 
tory explanation, no time should be wasted in sending for advice. It has 
been remarked that a child indisposed is a grumbling child ; that one suffering 
from disease is dejected. There is much truth in this, and indeed it has deep 
root in the popular mind ; for it is always looked upon as a favorable sign when 
a child that has been passing through a serious illness begins to grumble and be 
dissatisfied with his surroundings. The child that is really ill is dull and mo- 
rose ; he is seldom heard grumbling about and raging at everything ; he takes 
little notice of what is going on round about him, and has quite an aged and 
almost ludicrously serious expression of countenance. Who is there that 
does not rejoice in the boisterous mirth of children, and bemoan its absence 
when it is not there ? Where health is, there is activity — ceaseless, restless 
motion ; when disease is impending, activity ceases, and languor and depression 
come in its stead. It is well that parents should be familiar with these mani- 
festations of disease, and with some of those more apparent signs which indi- 
cate departure from a state of health. Much time may thus be saved that 
would otherwise be' frittered away ; and disease, by being combated early, 
would be much more easily dealt with. 

The cry. From the cry of a child much valuable information may be de- 
rived. By observation both parent and physician are able at once to perceive 
the difference between the cry of hunger and that of pain. The cry of a child 
in pain is peculiarly sharp and sudden, while that of a hungry child is gen- 
erally preceded by a series of grunts, and is accompanied by a turning of the 
head from side to side, and by certain movements of the mouth, as if search- 
ing for the breast. 

Pain. When a child is suffering from pain in any part of the body, the 
pain is accompanied by certain external manifestations, which not only ren- 
der its existence apparent, but which point to the locality from which it arises ; 
thus pain in the abdomen causes a child alternately to draw up its legs and 
straighten them again, the fists remaining meanwhile clinched. The fea- 
tures become more or less contracted, and the child cries while the pain lasts ; 
so that if the pain is spasmodic in its nature there will be periods of crying 
followed by intervals of complete rest. When the child is suffering from inflam- 
mation of the lungs it cries at the time of coughing and for some little time 
after. When the child is suffering from pleurisy every effort at coughing 
gives rise to pain. When a child is suffering from brain disease the cry is 
very significant — it takes the character of a sudden shriek. In general 



864 APPENDIX. 

uneasiness the cry is of an irritable nature, and ceases when soothing treat- 
ment has been adopted. 

Appearance of face. The appearance of the face is often expressive of the 
diseases of childhood, and different parts of the face are affected according to 
the seat of the disease. Thus if the brain is the seat of disease, the forehead 
and eyes are noticed to be principally affected ; the former is contracted, the 
eyebrows are knit, and light cannot he borne by the latter. In diseases af- 
fecting the chest, the parts of the face chiefly altered are the nose and cheeks. 
The nostrils are seen to dilate with each inspiration, and the cheeks are 
flushed. 'When the stomach and bowels are affected there is a peculiar pallor 
and contraction about the mouth. 

Position. The attitudes assumed by the child should be carefully observed. 
Does it lie on one side in preference to the other, is the hand frequently up- 
lifted towards the head, does it burrow in the pillow, etc. The ascertaining 
of these various points should be carefully attended to, as they arc of much ser- 
vice in throwing light upon the case. There are symptoms which manifest 
themselves in children from time to time, the signification of which may be 
very grave and indicative of serious disease, or which may be trivial and pass- 
ing in their nature, and of no importance. Thus a child may suddenly become 
feverish, the temperature may be raised, the pulse quickened, the skin become 
hot and burning, and the face flushed, and yet, after a lapse of a few hours, 
the child may be perfectly well. Some children are much more liable to such 
attacks than others, and they frequently are the cause of much unnecessary 
alarm. If the child has been in its usual health up to this time, if it has not 
been restless, irritable, listless, or morose, if its appetite has remained good 
and its sleep been undisturbed, the fever will generally pass off in a few hours. 
If, however, it should persist, treatment had better be adopted without further 
delay, as fever of a serious nature may be impending. Many children suffer 
from this kind of feverishness from fright, from errors in diet, and from other 
like causes. In all cases in which the feverishness is of longer duration than 
a few hours, medical assistance should be sought, as one of the eruptive or 
continued fevers may be impending. 

Should there be along with the feverishness the symptoms of an ordinary 
cold in the head, such as running at the nose and eyes, sneezing, dry hacking 
cough, hoarseness, great heat of skin, in all probability an attack of measles is 
impending. If there is chilliness and lassitude with pain in the head and sore- 
ness of the throat preceding the fever, and a pulse that is very frequent, there 
is cause to dread the approach of scarlet fever. If there is shivering, high 
fever, headache, vomiting, and especially severe muscular pains referred to the 
back, and if there is the absence of throat and head symptoms characteristic 
of scarlet fever and measles respectively, there is strong reason to suspect 
small-pox. Additional assistance may be obtained in forming a correct opinion 
with regard to any individual case by a knowledge of the existence of small- 
pox in the neighborhood. When there is little or no constitutional disturb- 



865 




tflG. CLXI. 



Fr&. clxvii. 



TLATE XXIX. 



SICK-NURSING. 867 



ance, and a rash beginning on the shoulders and back, and consisting of rose- 
colored pimples which become converted into transparent vesicles, the disease 
is chicken-pox. It is well, whenever any one of these diseases is suspected, to 
call in the aid of the physician, because, although the attack may be mild, the 
after-consequences are frequently serious, and if neglected may lead to perma- 
nent mischief or to a fatal result. Thus, after measles, inflammation of the 
lungs, bronchitis, or croup may supervene, unless sufficient care has been exer- 
cised, after the departure of the fever, to guard against cold. Also after scarlet 
fever kidney affections are apt to arise unless care is taken to prevent expos- 
ure. The fact of such complications being liable to occur in the mildest cases 
should prevent them being treated lightly, and in regard to these, as well as 
the graver forms, the utmost caution is necessary till all risk is over. There 
are other fevers, called continued fevers, such as typhoid, which are ushered in 
by long-continued disorders of the digestive and nervous systems which can- 
not fail to attract attention ; and when observed early assistance should be 
obtained, as long and careful management is necessary in such cases. 

Cough in children may be a symptom of serious or trivial import, according 
to the cause from which it has arisen ; thus it may proceed from worms, den- 
tition, bronchitis, pneumonia, or may arise in connection with ordinary catarrh ; 
but whatever the cause, it ought not to be looked on slightingly, nor to be 
allowed to go on unchecked. 

Whooping-cough. This affection of the nervous system is regarded popularly 
with very little gravity, but the number of deaths annually recorded as caused 
by this disease shows it to be much more fatal than is generally believed, and to 
be a disease requiring careful medical treatment. Moreover, there are many 
grave complications that may arise in connection with it, such as bronchitis, 
inflammation of the lungs, convulsions, and disorders of the bowels ; and so, 
although the disease, if mild, may run a favorable course, scarcely requiring 
any medical treatment whatever, still the fact that these complications may at 
any time arise, unless sufficient care be taken, should make patients careful not 
to treat this disease slightingly. Again, there is a liability, if the disease has 
been allowed to run its course, of a habit of coughing being established, which 
may be got rid of only with great difficulty. A case is recorded Irv Dr. An- 
thony Thompson in which a child who had suffered from whooping-cough re- 
tained the cough for a long time after, and was ultimately cured by threaten- 
ing to put on his chest a blister one foot square unless the cough ceased. The 
blister was made, and, being placed where the child could see it, had the desired 
effect of putting an end to the cough. 

Croup. This disease, which is most frequently met with in changeable cli- 
mates like our own, and which is most prevalent during the spring and winter 
months, is one the mention of which sends a thrill through every parent's 
heart. The peculiar brassy cough usually heard for the first time in the still- 
ness of the night naturally causes great alarm, but as this cough may be due 
to false croup, an affection which has nothing of the deadliness about it so 



868 APPENDIX. 



characteristic of the other, a few words will be added in regard to both, which 
may enable the parent to distinguish between the two, and so relieve the 
mind of much anxiety. True crop is generally ushered in by fever, irritable 
temper, and those symptoms which are characteristic of an ordinary cold, such 
as hoarseness, suffusion of the eyes, and running at the nose. False croup, on 
the other hand, usually occurs without any warning, and when the child ap- 
pears in the enjoyment of excellent health. The child is frequently seized 
during the night, and the attack may be so slight that after two or three crow- 
ing inspirations it may fall asleep ; or instead of appearing thus mildly it may 
be more severe, and the child may then struggle for breath and seem almost 
suffocated when, the spasm ceasing, air is again drawn into the lungs with a 
crowing inspiration, and the paroxysm is over. Whenever there is any doubt 
in a parent's mind as to the nature of the cough from which the child is suffer- 
ing, it is always well to send for medical assistance ; if it be nothing serious, 
anxiety is relieved, and if serious all reflection will be obviated by so doing. 

There are several other affections, such as vomiting and diarrhoea, which 
may be significant only of disorders of the digestive system, or which may be 
more serious in their nature. Thus vomiting is frequent at the commence- 
ment of many diseases, and unless there has been anything at fault in the way 
of errors in diet to account for it, it should not be treated lightly. Generally 
a parent will be able to distinguish between the simple and that which is of 
more serious import. Should the vomiting, however caused, be persistent, it 
must on no account be allowed to go on unchecked. Diarrhoea, especially in 
children who are teething, is frequently neglected till very considerable ema- 
ciation has occurred. This cannot be too strongly condemned, as the mortal- 
ity from this cause in children is very great. If the diarrhoea does not yield 
in a day or two to careful dieting, no further delay should occur in sending for 
medical assistance. Should the case then be judged one merely of indisposi- 
tion, the means to be adopted are rest, regulation of temperature, and careful 
dieting. 

Many of the ailments of childhood would be easily got rid of by the em- 
ployment of such means ; and if they persisted, and skilled advice was required, 
the physician would find that the course that had been, adopted had already 
prepared the way for such medicinal treatment as he might thiuk necessary. 
In his book, called The Mother's Work with Sick Children, Professor Fons- 
sagrives urges the necessity of every mother keeping a sort of sanitary record- 
book for each of her children, in which she might enter, in a methodical man- 
ner, a few notes from time to time, having reference to the natural processes 
of growth and dentition, how they have been accomplished, and the diseases 
which each of them has passed through. He shows the value of this in after- 
life to physician and patient alike, and to the good that would be likely to re- 
sult from it. Of course were such a plan adopted by any parent it would re- 
quire to be systematically gone about and regularly attended to, to be of any 
practical value when the child had attained to maturer years. This habit of 



SICK-NURSING. 869 



carefully recording a few facts from time to time would also lead to habits of 
closer observation on the part of the mother ; and as the time that would be 
occupied in so doing would be infinitesimal when extended over a number of 
years, the want of this cannot be urged as an excuse. The plan which he rec- 
ommends is simple and natural, and for the sake of those who may wish to 
adopt it a translation is here appended : — 

(1.) Date of birth. 

(2.) The mode of lactation and the particular circumstances which influ- 
enced it. 

(3.) The diseases of lactation, with their dates, their duration, some in- 
dications of their severity, and the measures successfully employed against 
them. 

(4.) The first dentition. The time of appearance of incisors, of the eye teeth, 
of the first large teeth ; the various accidents of dentition (convulsions, diar- 
rhoea, different ophthalmic affections) ; the date of the appearance of the 
twentieth tooth. 

(5.) The date of weaning; the ease with which it was accomplished, or the 
accidents with which it was complicated (diarrhoea, loss of flesh, marasmus). 

(6.) Walking. At what age did it become possible ? Was it advanced, re- 
tarded, or interrupted ? 

(7.) Vaccination. At what age, and under what circumstances ? Were the 
pocks regular in their progress ? 

(8.) The intermediary dentition, or eruption of the first four molars. The 
concomitant incidents. 

(9.) The second (ar seventh year) dentition. The peculiarities which it 
presented. 

(10.) The eruptive fevers (measles, scarlet fever, chicken-pox, etc.). 

(11.) Growth. Measure every three months, and note the manner in which 
it is done. Precocious, tardy, or irregular growth. Accidents connected with 
growth. 

(12.) Accidental diseases, ordinary attacks of indisposition, etc., etc. 

A plan such as the foregoing, if carefully and regularly executed, could not 
fail to be of use in the treatment of the diseases of adults, and the light thus 
thrown upon the previous history of the individual would be of the most valu- 
able kind. Of course, in any such system of note-taking, only facts should be 
recorded, and these expressed as briefly as is consistent with thoroughness in 
their execution. A mother's work in sick-nursing may extend to observations 
in regard to pulse, respiration, cough, etc., and many of the facts which she is 
able to supply may greatly assist in supplementing the work of the physician. 
The respirations should be counted either by the hand being placed upon the 
chest, or by means of the ear, and any peculiarity noticed about the breathing 
should be recorded. Thus it should be noted whether the breathing is harsh 
or soft, and whether or not there are any accompaniments, such as wheezing, 
etc. The number of pulse beats may be counted by placing the fore and 



"0 APPENDIX. 



middle fingers upon the artery at the wrist on the thumb side, or by counting 
the pulsations in the artery of the temple or neck. Any irregularity in con- 
nection with the pulse should also be noted. In regard to whooping cough, 
an accouut should be kept of the number of kinks which the child has in 
the day. 

The remarks which have already been made in the section having special 
reference to adults with regard to ventilation, warming, cleanliness, etc., are 
applicable here in all their force. The child's sick-room, as much as that of 
the adult, needs to be thoroughly ventilated; the temperature requires to be 
kept of great uniformity, and only the most perfect order and cleanliness 
should obtain. Any deviation from those ordinary hygienic rules, so essential 
to the successful treatment of disease in the adult, cannot fail of being hurtful 
in the case of children. Indeed, in their case our precautionary measures should 
be increased, and the carrying out of them insisted upon with greater vigor. 
This is all the more necessary from the fact that they are so frequently ignored, 
and that the child's sick-room presents anything but the most favorable place 
for the successful combating of disease. The best means for securing the most 
perfect hygienic conditions in the sick-room, and so putting the patient under 
the influence of those circumstances most calculated to facilitate recovery, are 
those which admit of two rooms being used. These chambers should commu- 
nicate with one another, and the twenty-four hours be divided between them, 
the day being passed in the one and the night in the other. In the case of 
adults some difficulty might be incurred in removing the patient from one bed 
to the other, but in the case of children no such difficulty can arise, for, with 
a blanket wrapped round it, the child can be carried ifi any one's arms with 
the utmost ease and without any risk of exposure from the room in which the 
day has been spent to the one in which the night is to be passed. A plan such 
as this admits of the most perfect ventilation being carried out in both apart- 
ments, and the change is one which is most grateful to the child. The tem- 
perature of the night room must be carefully regulated, being always raised to 
the same degree as that of the day-room, before removal takes place. In this 
way all chance of the patient suffering chill is obviated. The fear of air, 
especially in diseases affecting the lungs, is frequently so great that children 
are allowed to inhale the same air over and over again rather than allow a 
supply of fresh air to come in at the window. This dread of harm resulting 
from the admission of pure air into the sick-room is, it need hardly be said, 
altogether unfounded, provided it be properly attended to. Air must not be 
admitted into the sick-room so as to cause currents or give rise to draughts, 
and when this condition is complied with, and the temperature of the room 
properly regulated by means of the fire, and kept as uniform as possible, no 
harm can attach to the admission of air by the window. On the contrary, to 
the patient who is suffering from disease, no matter of what nature it is, a 
good supply of fresh air is always beneficial, and is a powerful aid towards 
recovery. 



SICK-NURSING. 871 



Frequently, when a sick-chamber is improperly ventilated, and the sense of 
smell begins to be offended by the impurities that load the atmosphere, recourse 
is had to the employment of various disinfectants, by the diligent use of which 
the air of the sick-room is supposed to undergo sufficient purification to render 
it fit for breathing. No greater mistake than this could well be made, and the 
feeling of security to which a belief like this gives rise is one which cannot 
fail to operate injuriously upon a patient. Let it not be imagined that any 
amount of disinfection, however perfect in itself, can purify the air and render 
it fit for the purpose of respiration. It may, indeed, so alter it that the sense 
of smell shall not be offended, but the mischief is still there, the air is yet im- 
pure. The organic impurities with which the atmosphere is laden may be 
rendered inoffensive, but the supply of oxygen is not in this way increased, 
and without this life-sustaining ingredient being present in due proportion no 
human being can long survive. When it is deficient, plants and animals alike 
suffer, and no amount of destruction of organic impurity can replace its want. 
Disinfection in its own place is very well, and should undoubtedly play a part 
in the hygienic management of the sick-room ; but the part it has to play, im- 
portant as it is, cannot supplant the necessity that is constantly arising for an 
efficient supply of pure air. In speaking of disinfectants, we shall notice here 
only a few of the more important, and those which are in most frequent de- 
mand, such as chloride of lime, Condy's fluid, and carbolic acid. Chloride of 
lime, by virtue of the chlorine which it contains, is at once one of the most 
powerful and one of the most frequently employed of disinfectants. The 
chlorine which is liberated from it on exposure to the atmosphere acts upon 
any infectious or deleterious matter that may be in an apartment, causing its 
destruction. The manner of its action is as follows : The gaseous compounds 
which are given off from putrefying matter have their hydrogen abstracted by 
the chlorine, and in so doing destruction of the organic substance results. The 
best way to use chloride of lime is to place a layer in a plate, and expose it to 
the influence of the atmosphere. The carbonic acid of the air will liberate the 
chlorine sufficiently quickly to keep down infection ; but should it be desired 
to cause a more rapid liberation of chlorine, a little vinegar sprinkled over the 
chloride of lime will suffice. Condy's fluid exerts a purifying influence upon' 
the air, and lessens the smell of ill-ventilated rooms; and, being free from 
smell itself, there is not the same objection to its employment that there is in 
regard to chloride of lime. Carbolic acid is an exceedingly good disinfectant, 
concealing all odors that may be about an apartment ; and a solution either of 
this or of Condy's fluid should always be kept in the sick-room, and used for 
disinfecting discharges, etc. Some of the solution should also be kept in the 
chamber utensils, and ihese, on being used, should be carefully disinfected be- 
fore being again brought into the sick-room. Many other disinfectants might 
be noticed, such as animal and vegetable charcoal, chloride of zinc, sesquichlo- 
ride of iron ; but those already mentioned, being more familiarly known, may 
serve to show the purposes for which this class of substances is employed. 



872 APPENDIX. 



We must, however, again repeat that the most perfect system of disinfection 
can never replace the necessity for a free supply of oxygen in the sick-room ; 
and this can only be obtained by attending to the thorough ventilation of the 
apartment. In those houses where uncleanliness prevails, and in which the 
laws of sanitation are either altogether unknown or their teaching disregarded, 
another class of enemies is to be found destroying the comfort and adding to 
the misery of many a little sufferer, namely, the class called parasites. Only 
the maintenance of scrupulous personal cleanliness can combat successfully 
the inroads of these creatures ; but where that is found their appearance will 
be prevented, or, if they are already present, their disappearance will be more 
certainly guaranteed than by the employment of the most perfect insecticides. 
A few words are necessary here by way of supplementing what has been 
already said on the subject of light. In the case of children it is necessary that 
the shades employed for the purpose of darkening the room should be free 
from all figures, as these may give rise to hallucinations and cause the child 
much unnecessary terror. A green shade will prove a grateful one, and, if 
devoid of figures, will answer perhaps better than any other. Care must be 
taken, in the placing of a lamp or light of any kind, to choose a situation in the 
room such that if any shadows are caused they shall be so obscured as to exert 
no prejudicial influence upon the child's mind. Unless this is attended to, the 
child may be greatly terrified. Especially is this the case when the shadows 
are caused by those who are in the room, and are iu consequence always in a 
state of change. 

The remarks already made in connection with the subject of cleanliness are 
applicable here in all their force. Popular prejudice, which is strongly in favor 
of abolishing all, or almost all, the ablutions of health in the time of disease, 
must be combated, and the fact of the necessity of employing soap and water 
during the continuance of disease, at any rate as freely as in a state of health, 
must never be lost sight of. Where the ordinary rules of cleanliness are ignored 
in the time of health, they are generally found to be so also in the time of 
disease, and thus an item of the utmost importance to the speedy and successful, 
treatment of any case is found to be altogether wanting. With many the em- 
ployment of a warm bath in disease is looked upon as a very serious matter 
indeed, and by some the mention of it is associated with the speedy decease of 
the child. In pulmonary diseases especially there is a great dread of the em- 
ployment of a warm bath, lest the patient should be the worse for it ; but, if 
proper care be taken, there need be no ground for any apprehension. In the 
diseases of childhood warm baths are invaluable, and their employment is fre- 
quently followed by the most salutary results. In a child that is feverish and 
restless, marked diminution of the febrile symptoms results, and the little suf- 
ferer who had tossed about unable to obtain rest, on coming out of the bath 
falls into a gentle sleep, and awakes with marked diminution of all his symp- 
toms, and often is perfectly well. 



SICK-NURSING. 873 



III. Baths. 

Among the poor chiefly, and to a less extent among other classes, the em- 
ployment of baths as a means of preserving health and warding off disease has 
been hitherto greatly neglected. While their value in regard to both is un- 
doubted, there exists a strange reluctance to employ them for either. In people, 
also, who have suffered from bronchitis and other chest affections, a means of 
security against cold, and consequently against future attacks of their malady, 
will be found in the daily employment of a cold or tepid sponge bath. It exerts 
a most beneficial influence upon the body ; it acts as a general tonic to those 
of delicate constitution ; the functions of the skin are stimulated ; nervous 
energy is rendered more vigorous, and the frequently heightened functional 
activity of the nervous system is diminished ; the balance of the circulation 
throughout the body is better maintained, owing to the free and unembarrassed 
action of the skin, and the appetite and digestion are likewise improved. Many 
who were formerly afraid to go out-of-doors if the day seemed cold and stormy, 
or if it happened to be damp and wet, are enabled, on making use of a morning 
bath, to do so with freedom and impunity. The general tone of their system 
is raised, and when the wind blows upon them they do not feel chilled now, 
as they did formerly, but are able to resist the action of the cold in a way they 
could not do before. This prophylactic influence of baths cannot be overesti- 
mated, and the effect which they exert both physically and morally is very 
great ; for besides influencing the body for good, they exert a powerful influence 
upon the mind as well, and in the case of children and young people especially 
this mental effect is of very great importance. As there are many kinds of 
baths used medicinally, we shall only notice those which are most important 
and most frequently employed. 

Sponge bath. In diseases accompanied by fever, in which the skin remains 
hot and dry to the feel, sponging is made use of ; and as it is sometimes entrusted 
to those in charge of the sick for its performance, a few words may be added 
as to the best method of doing it. The manner in which it is accomplished 
is as follows : Remove the patient from bed, and, having undressed him, pass 
several large sponges rapidly over the body, until the whole of it has been 
sponged, after which the patient is to be dried and placed in bed. The object 
for which this bath is employed is to reduce the heat of the surface by means 
of evaporation, to cause the skin to act well and render perspiration more per- 
fect, to reduce the irritability of the nervous system, and promote sleep. This 
sponging must not be undertaken unless by the advice of the medical attendant. 
Sponging of the chest and trunk is most valuable in those who have a tendency 
to asthma or other chest affections, in infants during dentition, and in those who 
are rather delicate. It may be performed while the patient is in bed, and brisk 
friction should be afterwards employed so as to cause a glow upon the surface. 
When salt and water or vinegar and water are used instead, the friction need 
not be had recourse to, as we wish merely to remove the water, which can be 



874 APPENDIX. 



accomplished by soaking it up with a soft towel. The proportion of either salt 
or vinegar to be employed should be about four tablespoonfuls to every pint of 
water. These spongings should be used just before the patient leaves bed in 
the morniug, and may be employed in winter as well as in summer. With 
open-air exercise and proper attention to diet, this proves a valuable remedy. 

Cold affusion. This has been employed to reduce the temperature in cases 
of typhus fever, and for this purpose it is a powerful agent. It must, however, 
on no account be made use of without the sanction of the medical attendant. 
In its action it is more sudden and more decisive than sponging or the applica- 
tion of lotions. The manner in which it is accomplished is as follows : The 
patient, having been stripped, is placed naked on a stool in an empty bath or 
tub, and three or four buckets of cold water, at a temperature of about 40° Fahr. 
are then to be poured over his head and chest from a height of two feet or more, 
The greater the height from which the water is poured, the more powerful is 
its action. The patient, having been dried, is again placed in bed. Cold affu- 
sion is made use of when the temperature of the body remains permanently 
above the normal. In its action as a reducer of temperature it is more sudden 
and more certain than sponging, but requires to be used more cautiously. It 
is also used where there is great stupor. Its employment is contra indicated, 
although the temperature be high, in those cases in which the patient feels 
chilly or in which the skin is covered with perspiration. Also, if the patient 
be a woman, and the monthly discharge present, it must not be employed. 
Being a powerful remedy, cold affusion cannot be repeated more frequently than 
once in twenty-four hours. The best time for using it is at night. 

Shower bath. This bath partakes of the nature of cold affusion, only it is 
not so severe. It may be employed either cold or tepid, the former acting more 
powerfully and having a greater stimulating effect than the latter, but for those 
who are of a rather delicate habit of body the tepid shower-bath will answer 
best. The best time for taking this kind of bath is immediately on getting out 
of bed in the morning. Should the patient, however, not be able to stand the 
shock then, it should be postponed till an hour after breakfast, when the body 
will be better able to bear the shock and produce that state of reaction on which 
the utility of this kind of bath depends. Reaction after the employment of the 
shower bath is greatly accelerated by friction with horse-hair or coarse flannel 
gloves previous to taking the bath. The friction should be kept up till the 
body feels comfortably warm. We shall now notice those baths which are 
employed when it is wished to act upon special parts of the body, and which 
have received the name of partial baths. They are the hip bath, the foot bath, 
and the hot and cold douche. 

Hip bath. When it is wished to act upon those organs which are contained 
in the pelvis, the hip-bath is made use of. In order that the patient may be 
able to sit in the bath with comfort it should be provided with a back. These 
baths are generally used hot or cold, according to the effect that is wished to 
be produced, and the quantity of water employed should fill little more than 



SICK-NURSING. 



one-third of the bath, as it might otherwise overflow on the patient sitting down. 
When this bath is made use of for the purpose of relieving pain, the tempera- 
ture of the water should not exceed 90° Fahr., and the patient may remain in it 
for half an hour, but when used to increase the activity of the womb when the 
monthly discharge is defective, it should be employed as hot as the patient can 
bear it, but the time during which the patient should be in the bath ought not 
to exceed ten minutes or a quarter of an hour. The best time to employ this 
batli is in the evening just before the patient retires to rest. 

Foot bath. When the face is full and flushed and the head feels congested, 
and apoplexy is threatened, or where apoplexy has already occurred and a de- 
rivative action is wished to be brought about, the foot-bath is generally had re- 
course to. It acts by causing an increased flow of blood to a part remote from 
the seat of injury or from the part where injury is dreaded. In order that this 
derivative action may be efficient, the water should be as hot as can be borne 
by the patient, or at any rate sufficiently so to redden the skin. The quantity 
of water employed should be sufficient to come up to the patient's knees when 
the feet are in the bath. A zinc pail answers very well for the purpose. Fre- 
quently mustard is added to the water to increase its derivative effects. Three 
or four tablespoonfuls of mustard are sufficient for each bath. The feet must 
be thoroughly dried on coming out of the bath and a warm pair of stockings 
immediately put on, and after the patient has been placed in bed hot bottles 
should be applied to the feet. This bath is also sometimes made use of in cases 
of difficulty of breathing. In order to promote perspiration a blanket should 
be placed over the patient's legs, encircling the bath as well. 

Hot douche bath. The object of this bath is to combine heat and percussion, 
and this may be accomplished by pouring the water through a narrow tube so 
as to cause it to strike forcibly upon the part, at the same time keeping up 
beating by means of some soft material. The douching may go on for about 
half an hour at a time, after which the patient should be put to bed and perspi- 
ration promoted. This bath is very useful in chronic rheumatism when the 
joints have become enlarged and painful. 

Cold douche. In some cases of fever, and in certain brain affections, this 
form of bath is made use of. No percussion need be employed in this instance. 
Frequently the medical attendant orders a bath, merely mentioning the name, 
and without giving any instruction as to the temperature. Thus he may order 
a cold bath, a tepid, a warm, or a hot bath, without giving any further injunc- 
tions, and in order that the meaning attached to each of these words may be 
known the following table is introduced, giving the deg-ee of heat which is 
represented by the terms thus employed : — 

Bath. Bath. 

Cold 33° to 65° Fahr. I Tepid ..... 85° to 94° Fahr. 

Cool . ... 65° to 75° " Warm 94° to 98° " 

Temperate . . . 75° to 85° " | Hot 98° to 112° " 

Vapor-baths are also employed : — 

Tepid bath 90° to 100°. Warm bath 100° to 115°. Hot bath 115° to 140°. 



APPENDIX. 



We shall now notice a few of these haths in detail. 

The cold bath. This bath is employed to increase the vigor of the constitu- 
tion, and is used with a view to causing reaction. The best time to take the 
cold bath is in the morning, but as many invalids are unable to produce the 
necessary amount of reaction at this time it had better be deferred till after 
breakfast, when the body is in a condition more fitted to stand the shock. The 
patient ought not to remain in the bath longer than five minutes, as reaction 
may be prevented and danger result in consequence The temperate bath causes 
less shock than the cold, and consequently is followed by less reaction. It is 
better suited for invalids and children than the cold. Tepid and warm baths 
are used in disease to promote perspiration and increase the action of the skin 
when the latter is hot and dry. It is necessary when these baths are employed 
to maintain the temperature of the water uniform throughout, and in order to 
insure this being done it should be tested from time to time by the thermom- 
eter, and hot water added when necessary. The period of immersion varies 
from a quarter to half an hour. These baths are of great service in the diseases 
of children. If the child is too feeble to sit erect, a sheet may be spread from 
one side of the bath to the other, and the child lowered to the necessary depth. 
The hot bath. This bath should not be employed recklessly, as harm may 
result from its use. Its action is that of a powerful stimulant, increasing the 
force and rapidity of the circulation and causing copious perspiration. It should 
not be used in cases of heart disease or when there is any tendency to fainting. 
It is useful in cases of kidney disease and diseases of the liver. The period 
of immersion had better not exceed a quarter of an hour, lest exhaustion 
should result. The vapor bath is very useful in promoting perspiration, and 
is employed as follows: The patient being seated on a chair, a bucket or jar 
filled with boiling water is placed at his side, and the whole enveloped in a 
blanket. Friction may be employed if necessary while the patient is in the 
bath. 

There are several other baths which are not so frequently employed as those 
already mentioned, but which are nevertheless sufficiently well established in 
domestic medicine to require notice here. They are the bran bath, the starch 
bath, and the gelatine bath. The bran bath is prepared by boiling a pound of 
bran for a quarter of an hour, straining it, and adding it to the bath. The starch 
bath is made by mixing half a pound of starch or potato-mash in two or three 
quarts of water ; while the gelatine bath is prepared by dissolving a quarter or 
half a pound of gelatine in a quart of water. These baths are emollient or 
soothing in their action. There are other baths, such as those made with aro- 
matics, which are occasionally employed, but which require no notice here. 



IV. Applications. 

Fomentations. Sometimes these are medicated and rendered more soothing 
by the addition of opiates, as in the well-known decoction of chamomile flowers 



SICK-NURSING. 877 



and poppy heads, but the principal object for which they are employed is to 
convey warmth to a part. The best application of this kind is made by wring- 
ing flannel — by means of two sticks turned in opposite directions — out of 
boiling water, and then, shaking it up, apply it lightly over the part. In this 
way the heat may be retained for a considerable time. In order to do this 
thoroughly two pieces of flannel should be made use of, each of the pieces 
being about three yards long, and having the ends sewn together so as to ad- 
mit of the boiling water being wrung out of them. One of these should always 
be getting ready while the other is being applied. The coarser the flannel the 
more efficiently does it act ; owing to its diminished power of conducting heat, 
warmth is longer retained. 

Poultices. There are few applications more constantly in demand in sick- 
ness than poultices ; and yet few people make them well. Poultices when 
made well should be sufficiently thick to retain their humidity, but not too 
thick, as they may then press injuriously upon the part to which they are ap- 
plied.' They should be of uniform consistence throughout, and ought to be 
applied at a proper temperature. This last can generally be sufficiently accu- 
rately ascertained by applying the poultice to the back of the hand or to the 
face before putting it to the part. That which is of most frequent use is a 
poultice made of linseed meal. The meal should be got from those who can 
guarantee its being well prepared, as much that is sold in the shops is objec- 
tionable from this quality being wanting; and unless it is good, it may occasion 
considerable irritation of the skin, giving rise to redness and eruptions. Lin- 
seed meal derives its emollient properties from two principles which it contains, 
the one an oil, and the other a mucilaginous substance. By the presence of 
the latter the water is retained in the poultice ; while by the presence of the 
former the entrance of air is prevented, and heat retained. Besides this, the 
oil exercises a soothing influence upon the part to which it is applied. It is very 
common in making a linseed-meal poultice to pour boiling water on the meal, 
and stir it up till it is of the proper consistence ; but poultices so made are sel- 
dom homogeneous, and in consequence do not retain either heat or moisture 
well. The poultice, to be properly made, should be boiled till it is of the 
consistence of a thick pap, when it will be found to retain heat and moisture 
longer, and answer the purposes for which it was intended better, than if 
this precaution is neglected. Instead of using water alone, milk and water 
may be employed, or decoctions of mallows, flax-seed, etc., by which the emol- 
lient properties of the linseed meal are increased. The emollient action of the 
poultice may be further increased by smearing the surface with olive oil or 
lard, which substances have the additional advantage of allowing the removal 
of the poultice with the greatest facility. Many people are in the habit of 
interposing a piece of cloth between the poultice and the part to which it is 
applied. As this is unnecessary, it had better not be done ; or if anything of 
the kind is made use of, let it be of the lightest possible material, such as a 
piece of gauze. In order to prevent evaporation and retain heat longer, a piece 



878 APPENDIX. 



of oiled silk may be placed external to the poultice. Care should be taken in 
placing the poultice to see that there is no chance of its slipping and the sur- 
face being left bare. The means to be adopted for this purpose must of ne- 
cessity vary according to the part of the body to which it is wished to apply 
the poultice. Besides poultices made from linseed meal, there are others in 
frequent use, such as those made, from bread and water, oatmeal, arrowroot, 
bran ; and others, which are much less often employed, made from carrots, 
potatoes, onions, sweet apples, etc. In addition to these there are poultices 
more strictly medicated, such as those made of foxglove or hemlock. As these 
last may prove dangerous if carelessly employed, they ought only to be made 
use of when ordered by the medical attendant. 

Sinapisms. These being of frequent use in domestic medicine, a few words 
in regard to them are necessary here. As mustard is frequently adulterated, 
and its action in consequence impeded, we should endeavor to obtain only that 
whose quality is undoubted; and to attain this object, it had better be pro- 
cured from the apothecary. The goodness of the mustard may be Judged 
of roughly, by placing a little upon the tongue, and perceiving the nip im- 
parted to it. The ordinary mustard poultice is made by sprinkling the surface 
of a linseed-meal or other poultice with mustard, and covering the surface with 
muslin to retain the mustard in place. Should a poultice of mustard alone be 
prepared it ought to be made with tepid water, as this develops the active 
principles of the mustard best. It should then be spread upon a piece of rag 
and applied to the part. The length of time which a sinapism should be kept 
on varies, some skins being much more sensitive to its action than others. In 
the case of children and those adults who are delicate and sensitive, a period 
of ten minutes will generally suffice for its application ; in others it may be 
kept on for a quarter or half an hour. In those who are insensible, care must 
be taken not to allow the sinapism to remain on longer than this, as ulceration 
or gangrene may result. Recently, instead of the ordinary sinapisms, mustard 
leaves have been used, and have been found very effectual in their application. 
They are exceedingly convenient, and can be cut to any size or shape that 
may be required. 

Blisters. No blister should be applied unless ordered by the physician. 
By the careless application of blisters, large and disfiguring scars may be left, 
and much harm result. There is also danger that the cantharides of which 
they are composed may be absorbed and give rise to strangury. With a view 
to obviate this, blotting paper soaked in oil has been interposed between the 
blister and the skin. By dissolving the active principle of the cantharides 
more quickly its action is rendered more prompt, and in this way it was 
thought that the occurrence of strangury would be prevented. The best ap- 
plication, however, for this purpose is to sprinkle the surface of the blister 
with camphor. A solution of camphor in ether may be made by pouring ether 
over a piece of camphor till the camphor is dissolved. Some of the solution 
thus prepared should then be sprinkled over the surface of the blister ; the 



SICK-NURSING. 879 



ether evaporates, and an invisible film of camphor is left behind. The blister is 
usually allowed to remain on for six or eight hours ; but in those who are of an 
irritable temperament it may be removed sooner ; and if it has not risen, a poul- 
tice applied after its removal will generally affect this. The blister should 
be retained in position by means of a bandage suited to the part to which it 
is applied, or by strips of adhesive plaster, or by being spread upon plaster. 
Previous to applying the blister the only preparation that is required is to 
wash the part with soap and water and dry it well with a rough towel, using 
sufficient friction, while so doing, to make the part glow. Some prefer apply- 
ing a sinapism previous to applying the blister, but this is unnecessary. The 
after-treatment of the part will vary according as it is desired to keep the sore 
open or to heal it. Usually it is desired to heal it, and for this purpose, on 
removal of the blister, the blebs should be cut with a pair of scissors in their 
most dependent part, after which a piece of fine cotton wool should be applied. 
On removing this three or four days after, the sore will generally be found to 
be quite healed. Instead of cotton wool being used, the sore is frequently 
dressed with spermaceti ointment spread upon lint. This also forms a very 
nice and cooling application, and answers well. Should the intention be to 
keep the sore open, the cuticle must be removed by cutting round the edges 
with a pair of scissors ; or, instead of doing this, a bread poultice may be ap- 
plied, which will answer equally well for this purpose. Some irritating sub- 
stance is then applied upon a piece of lint or rag, which should not be larger 
than the blistered surface, as it would then unnecessarily irritate the surround- 
ing sound skin. The substance which is most usually employed for this pur- 
pose is savine ointment. As a film results from the application of this oint- 
ment, it ought to be removed by means of a poultice each time before a new 
dressing is applied. If this is not attended to, the part will dry and heal. 
Sometimes it is desirable to cause a more rapid blister, in which case blistering 
fluid should be made use of. This should be painted on with a camel's-hair 
pencil, care being taken to prevent it spreading beyond the part which it is 
wished to act upon. This forms a very ready and efficient means of producing 
a blister. The strong solution of ammonia is sometimes used for the same 
purpose, and here the same care must be taken to prevent it spreading as in 
the former case. 

Leeches. Leeches are not now so frequently used in the treatment of dis- 
ease as they were formerly ; but as they are still employed, a few hints may 
be given as to the best manner of applying them. There are several kinds of 
leeches, but the one most generally employed is the olive-colored leech. It 
has six longitudinal stripes upon the back, and the quality may be judged of 
by the readiness with which it contracts into the form of an olive, as well as 
by its lively movements and brilliant appearance. Leeches vary in size, and 
tlie wound which they make is proportionate to this, — the large leeches mak- 
ing a larger wound, and the small leeches making a smaller one ; so that in 
the case of children, when the application of leeches is deemed necessary, only 



8S0 APPENDIX. 



those which are small should be made use of. Leeches which have been pre- 
viously used ought not to be employed in the treatment of disease, — they sel- 
dom act well a second time ; and besides, as leeches take a long time to get 
thoroughly rid of the blood they have taken, disease may be carried from one 
person to another. . Used leeches may be known by taking and squeezing 
them from the large to the small end, when, unless several mouths have 
elapsed since their former application, they will yield a small quantity of 
blood. This test is not, however, an infallible one, as the blood may be pres- 
ent from other causes than that mentioned, as, for example, the manner in 
which they have been caught; but whenever a leech on being squeezed yields 
blood, it should not be used. When leeches are shedding their skin they are 
not of so much value in the treatment of disease. Different methods are 
adopted by people to make leeches adhere, but generally those which are in 
good condition take best on applying them immediately after removal from the 
bottle. They should be held in a piece of clean rag. and thus applied to the 
part ; or a cylinder of paper may be made, into which they can be put, or a 
glass may be inverted over them. Other means than these are sometimes had 
recourse to, such as scooping out the interior from half an apple or potato, and 
inverting this over the leech. The part to which the leeches are to be ap- 
plied is frequently " prepared," as it is called, by bathing it with milk and 
sugar, etc. ; but all that is necessary in this way is to cleanse the part well 
with soap and water, and then employ friction by means of the back of the 
hand, or a piece of flannel. This will answer better in making the leeches 
adhere than anything that can be applied to the part with a view to entice 
them to fasten. They usually remain adherent for three-quarters of an hour 
to an hour, after which they drop off. No attempt should be made to pull 
them off, as by so doing the teeth are sometimes left in the wound, and an 
abscess may result. Should they remain on longer than is necessary in a 
torpid state, and after they are filled with blood, a little pepper sprinkled over 
them will generally serve to remove them. After the leeches are either fallen 
off of their own accord, or removed as advised, bleeding is usually kept up 
for some time by means of hot fomentations, or, what will answer equally well, 
linseed meal poultices, changed every half-hour. The time during which the 
bleeding is allowed to go on will vary according to the amount of blood which 
it is desired to abstract. When sufficient blood has taken from the part, the 
fomentations or poultices are removed, and on their withdrawal the bleeding 
generally ceases. Occasionally, however, the bleeding goes on and may prove 
very troublesome to check. Should this occur, the wounds must be wiped 
perfectly clean, all blood being removed, and before any fresh accession of 
bleeding take-* place a piece of cotton wool or shredded lint applied to the part. 
A popular remedy for checking haemorrhage is cobweb, which occasionally 
answers very well here. Should these means fail, recourse may be had to 
powdered starch or rice, and on all of these proving ineffectual a piece of lint, 
or a pledget of cotton wool steeped in tincture of the perchloride of iron, should 



SICK-NURSING. 881 



be applied to the part. This is often of great service in checking haemorrhage 
when otlier simpler and more ordinary remedies fail. Bleeding may some- 
times be kept up from constant movement of the part to which the leeches 
have been applied. Thus, frequently in cases of pleurisy leeches are applied 
to the sides, and on their removal the constant movement of the ribs during 
inspiration and expiration sometimes prevents coagulation of the blood in the 
wounds and leads to haemorrhage. There are also some parts of the body 
more liable to bleed freely than others ; thus, where the skin is thin, this may 
occur ; and lastly, there are people with a peculiarity of constitution which 
makes them liable to bleed most profusely on the slightest prick. In such, 
leeches should be employed with very great caution. 

V. Diet during Disease and Convalescence. 

In disease strict attention to the diet is of the greatest consequence, and al- 
though the physician is generally careful to attend particularly to this, and 
give his instructions regarding it, nevertheless the carrying out of the details 
is left to those in charge of the sick. Generally the physician, in giving in- 
junctions with regard to the diet of the patient, mentions certain classes of 
food which he considers suitable to the case and to the stage at which the dis- 
ease has arrived, thus leaving some latitude for those who are in attendance 
upon the sick to vary the particular article from time to time. The quantity 
of food given in disease should be carefully regulated, and the quality ought 
in every case to be above suspicion. An egg whose taste suggests to the pa- 
tient's mind anything akin to badness may do him much harm by partaking 
of it, and, besides, may give him such a dislike to this article of diet as to de- 
prive him of its nutritive properties during the remainder of his illness, and so 
it ought to be a rule that none but perfectly fresh eggs be admitted into the 
sick-room. The more recently laid the eggs are the better, and none that 
have been kept by processes of varnishing, etc., to prevent their becoming bad, 
should ever be used. If once your patient gets a distaste for them, your ef- 
forts may be unavailing to get him to try them again. Remember his stomach 
is weak, and requires enticing to take food, and anything that causes disgust 
creates nausea, or makes his stomach revolt at sight of it, is very apt to be 
productive of harm. The hours of taking food should also be carefully reg- 
ulated, and as far as possible these should coincide with his ordinary meal- 
times during health. In active disease all solid nutriment, and that which is 
stimulating in its nature, had better be withheld from the patient after five 
o'clock in the afternoon, as towards night he becomes feverish and restless ; 
and if food that has a stimulating effect is given, or the stomach called into 
greater activity by solid food being given it to digest, the state of vascular ex- 
citement to which digestion gives rise produces a physiological fever to be 
superadded to the one from which he is already suffering. Therefore let it be 
a rule that only fluid food be given during the evening and towards the ap- 



882 APPENDIX. 



proach of night, and let this be of as light and un stimulating a character as 
possible, lest the patient's symptoms be aggravated and harm result. When 
a patient is suffering from difficulty of breathing, solid food given at night has 
a tendency to augment it, and so should be avoided. 

Of course, should the necessities of any particular case demand a different 
line of treatment than that which we have recommended, or should the medical 
attendant have given directions at variance with those whicli are here laid 
down, regard must not be paid to what is intended to be of general application, 
but the physician's instructions be minutely obeyed. In every instance the 
physician should direct the diet of the patient, ordering those things which he 
considers necessary and best adapted to the nature of the case, and he should 
also regulate the quantities to be given at one time, and the hours best suited 
for giving the patient nourishment. Some cases require that nourishment he 
given more frequently and in smaller quantities at a time than others, hence 
the necessity of careful regulation on the part of the physician, and the scrupu- 
lous carrying out of every detail by those who are in charge of the patient. 
The effect of the different articles of diet should be watched by those in at- 
tendance, and the result communicated to the physician. In this way much 
valuable information may be given, which will doubtless prove serviceable 
in the management of the case. Another point to which attention should be 
directed is to any desire which may be expressed by the patient in, regard to 
special articles of diet. These requests should not be ignored ; frequently 
nature, in disease, is the best judge ; and, at any rate, whatever wish has been 
expressed by the patient should be carefully noted and communicated to the 
medical attendant, who will endeavor, as far as possible, to comply with it. It 
is quite possible that things may be asked for which, if given, would prove in- 
jurious to the patient. This daily happens in the case of children, and if par- 
ents were to accede to their request without consulting with the physician, 
much harm might result in consequence. Caution therefore is needed on the 
part of the attendants to distinguish between a real desire and a mere whimsi- 
cal crave, the gratifying of which might prove most injurious to the patient. 
When any article of diet causes the patient disgust, we must not insist upon its 
repetition. Vegetable soups when made for the sick-room should not be loaded 
with ingredients ; the patient's stomach can rarely stand soups of this descrip- 
tion, and they are apt to create a disagreeable loathing towards a kind of nour- 
ishment which, if properly made, is very valuable, both during disease and 
convalescence. For the sake of convenience we shall divide the different arti- 
cles of food used during disease and convalescence into the two classes of solid 
and fluid aliments. 

Solid Alimknts. Milk. This article of diet, which forms the sole suste- 
nance of young animals, and their principal food during the early years of life, 
is one, the importance of which in the treatment of disease cannot be over- 
estimated. When the stomach is young and tender, Nature provides this sub- 
stance for the support of her offspring, and the manner in which life is sus- 






SICK-NURSING. 



tained and growth enabled to go on is sufficient proof of its great nutritive 
value, and when the stomach is again in a feeble state, and the system requir- 
ing nourishment with as little expenditure of energy as possible, what form of 
food should be able to answer so well as that which was the only source of 
supply in early life ? For easiness of digestion and for nutritive value there 
is nothing to take its place, and in the treatment of all diseases milk ought to 
occupy the very foremost place. Like all fatty foods, it is more easily digested 
when some condiment is given along with it, and for this purpose nothing an- 
swers so well as sugar. Salt and other substances may also be used, but sugar 
on the whole does best. For children who are deprived of the breast, ass's 
milk is that which is most suitable as a substitute, owing to its more nearly 
resembling human milk in composition than any other ; goat's milk is also 
very good, but as there is more or less difficulty attending the procuring of 
these, recourse is had in the majority of cases, and almost always in disease, to 
cow's milk. When cow's milk is given cold it is apt to produce diarrhoea in 
some people, and it also increases the urinary secretions, so that in order to 
prevent these occurrences it should be boiled. Water should not be added, 
as the diarrhoea may return or be kept up if the milk is thus diluted, even al- 
though it has been boiled. Milk answers best in the treatment of disease if 
used as it comes from the cow, that is before the curd and whey have sepa- 
rated. The component parts of milk are not so good, nor do they prove so 
serviceable as the milk itself in which they are combined. The cream in the 
milk, and before separation has occurred, is the most easily digested and most 
nutritive part of the milk, but when separated it does not answer so well in 
the treatment of disease. The curd also when given alone is indigestible, and 
whey is apt to prove flatulent, although containing much nourishment. 

Eggs. Eggs form a most important article of diet in the sick-room, but in 
order to obtain the large amount of nourishment which they are capable of 
supplying to the body without interfering with digestion, they must be fresh 
and only lightly boiled. New-laid eggs only should be admitted into the sick- 
room, and they are best adapted to a delicate stomach when lightly boiled. 
Any other mode of preparation than this, tending as it does to coagulate the 
albumen, renders the egg more or less indigestible, and consequently bad as an 
article of diet for the sick. It is a difficult thing, however easy it may appear, 
to get an egg properly cooked, and in that state best suited to an invalid's 
stomach. Usually eggs are boiled too long, the white being quite hard instead 
of milky, as it ought to be when they are properly done. A good rule to follow 
is to keep a hen's egg " two minutes in boiling water, and two minutes more 
in water below the boiling-point," when it will have undergone that amount of 
preparation which renders it most suitable as an article of diet in the sick-room. 
Sometimes mulled eggs are employed, which are made by beating up the yolk 
of an egg with some orange-flower water or tea, sweetening with powdered 
sugar, and then adding boiling water, and while so doing keeping up constant 
stirring. 



884 APPENDIX. 



Fish. When the digestive powers are still feeble, and have not yet regained 
their former tone, and when the system is unable to stand the greater vascular 
excitement which accompanies the digestion of meat, ftsh forms a very nice 
article of diet. Fish is easy of digestion, and creates little vascular excitement, 
and consequently forms a light and wholesome article of diet for the invalid. 
It answers very well during the transition from fluid food to a meat diet. 
Only rock and flat fish, such as whitings, soles, turbot, haddock, cod, and floun- 
ders, should be employed in the sick-room. Eels, herring, mackerel, trout, and 
salmon being more heating in their nature, although a more nourishing article 
of diet, are not so well adapted to the invalid as those already mentined. Fish 
ought simply to be boiled, as in that condition it suits the patient best, being 
more easily digested than when fried or cooked in any other way. Oysters, 
being easy of digestion, may be given to the invalid, but crabs, lobsters, and 
other shell-fish should not be admitted into the sick-room. 

Bread. If well made and kept for a sufficient length of time, bread forms 
an important article of diet. Starchy matters, used as food, such as tapioca, 
sago, arrowroot, etc., contain but little nourishment, and should not be too 
much employed. 

Meat. White meat, such as chicken and veal, and dark meat, such as beef 
and mutton, are best prepared for the sick-room by boiling or roasting. When 
the patient is in a fit state to be permitted solid animal food, that which is 
easiest of digestion should be selected and prepared as before indicated. With 
regard to the relative digestibility of different articles, tripe, lamb, and fricas- 
seed chicken are easy of digestion ; beef, pork, mutton, veal, and boiled and 
roasted fowls are rather less digestible. Salt beef and pork are very difficult 
of digestion. It has been found, by actual experiment, that the first three dis- 
appear from the stomach in about two and three-quarter hours, those enumer- 
ated second taking from three to four hours, and the last two not disappearing 
till four and a quarter hours had elapsed. The mixing together of different 
articles of food aids digestibility ; thus when fat is given along with meat the 
digestion of the meat is assisted. Minuteness of division has also much to do 
in assisting the stomach with its work. The varying of the diet is of great im- 
portance, and should never be lost sight of, as the constant repetition of the 
same article from day to day is apt to lead to a distaste for it. In children 
especially are the good effects of variety manifested. Venison, although more 
nutritive and more digestible than mutton, is of a more stimulating character, 
and hence not so well suited as an article of diet in the case of invalids. Only 
slight cooking should be employed in the case of dark meats, but thorough 
cooking is requisite in the case of white meats to make them suitable for the 
sick-room. To make these articles of diet serve their purpose well, there should 
also be a softness of texture, a freedom from stringiness, and a delicacy of 
flavor about them. Raw foods, ragouts, and all pastry-stuffs are bad, and must 
on no account be admitted into the sick dietary. 

Vegetables. Potato, cabbage, cauliflower, asparagus, and spinach should be 



SICK-NURSING. . 885 



used in moderation in the diet of the sick. In preparing them they should he 
boiled until they are soft and very soluble, nothing being left that might act 
upon the intestinal canal as an irritant. When thus carefully prepared they 
are free from all stimulant properties, and answer very well as articles of diet 
in the sick-room. 

Fruit. Apples or pears stewed seldom do a patient any harm, and generally 
prove grateful to him. Prunes are also very useful, inasmuch as they act 
upon the bowels and keep up a mild aperient action. Ripe peaches and 
grapes are admissible, the stones and skins being carefully rejected. Straw- 
berries may also be used. They are easy of digestion, cooling, and are 
little stimulant. Currants and gooseberries had better be done without, as 
harm may follow their use. It is always advisable before giving fruit of any 
kind to a patient to obtain the sanction of the medical attendant. In typhoid 
fever strict guard must be kept upon the patient lest friends, in mistaken 
kindness, bring him fruit, and he partake of it. In this disease the bowel is in 
such a tender state that the slightest irritation may give rise to the most seri- 
ous results. 

Jelly. The error that calf's-foot jelly is a substance possessed of great 
nutrient value is one that is very wide-spread in the popular mind, and accord- 
ingly patients are constantly given it, and eat it under the impression that they 
are partaking of an article of diet that is strength-restoring and health-reviving 
in no ordinary degree. The truth is that the amount of nourishment con- 
tained in it is very small indeed, and it must never be trusted to for the re- 
pair of tissue waste that has occurred during disease. Its use in the sick-room 
ought never to take the place of those articles of diet the dietetic value of 
which is undoubted. 

Fluid Aliments. (1.) Water. Given in small quantities at a time during 
fever nothing is so grateful to the patient as cold water. Much harm may, 
however, be done if the thirst of a fever patient is satisfied with large quanti- 
ties. It is wonderful how grateful to him a spoonful of cold water is, and how 
far it will go in quenching his burning thirst. The best kind of water for use in 
the sick-room is rain or river water. All hard waters are inadmissible here. In 
cases where it is desired to increase £he functions of the skin and promote per- 
spiration, hot drinks of various kinds are given in preference, but in all of 
these the beneficial agent is the water, whatever be the nature of the diluent 
that is added. (2.) Toast-water. This is one of the most frequently adminis- 
tered drinks of this nature. The water is slightly colored, and is flavored by 
the bread, which ought not to be charred in making this drink. To those who 
do not care for simple water this may form a good substitute. (3.) Barley- 
water. This is one of the oldest ptisans of the sick-room ; being the drink 
almost exclusively employed by the Father of Medicine, and being more nour- 
ishing than simple water, it helps to diminish the rigors of a strict diet, and by 
its volume and temperature increases the action of the skin, while it does not 
act as a stimulant. (4.) Gruel made from oatmeal is another substance in fre- 



886 APPENDIX. 



quent use in the sick-room. Like barley-water it is both nutrilious and 
demulcent, but is more apt to undergo fermentation in the stomach, especially 
when such substances as sugar aud butter are added. When it is desired to 
act as a diluent in disease the gruel should be made thin. (5.) Rice-water. 
This is another drink that is frequently employed. It is credited with astrin- 
gent properties. (6.) Tea. This substance is too much abused in health and 
disease to allow of its indiscriminate use as a ptisan in the sick-room. In the 
case of children its action on the nervous system precludes its employment; 
but in the case of adults, if properly used, it may prove both grateful and re- 
freshing. Of course it must not be used in too great quantity, nor must it be 
made too strong, as it may then tend to derange the stomach and lead to indi- 
gestion. A very good way to give it is to add sugar and milk, if the patient 
prefer it so, aud then add to it about twice the quantity of cold water, and 
allow the patient to drink this. It forms, given in this way, a most grateful 
and refreshing beverage. There are also acidulous drinks, such as lemonade, 
which are in frequent use. They had better not, however, be employed with- 
out receiving the consent of the medical attendant. Coffee and cocoa are 
also sometimes employed, but had better be so only on the recommendation of 
the physician. 

VI. Cookery for the Sick-Room. 

The importance of bringing the art of cookery to bear upon the treatment 
of disease having of late years been recognized, and the great benefit that 
has arisen to patients in consequence, render a few remarks upon the subject 
necessary here, although for anything like details some of the works devoted 
to the subject must be consulted. To be able to present a dish to an invalid 
in an enticing form, and so prepared that the stomach shall be relieved of as 
much labor as possible, is by no means the smallest blessing that cookery be- 
stows upon the patient. Nor should attention to these things be deemed un- 
deserving of our consideration, nor anything that conduces to his recovery, 
however apparently insignificant, be regarded as trivial. The cookery em- 
ployed in the sick-room should be of the simplest and most unpretentious kind. 

Boiling, baking, and roasting will accomplish everything that is necessary 
in this respect. By the first of these processes the animal fibre is rendered 
softer, and can then be more easily acted upon by the juices of the stomach. 
The manner in which the boiling is conducted has much to do with the result 
achieved : thus if it is allowed to proceed rapidly the albuminous matter con- 
tained in the meat is coagulated, and the meat is rendered dry, tough, and in- 
digestible. The water also should not be too rapidly brought to the boil in 
case the same result be produced. The nature of the water has also much to 
do with the result that is obtained : thus hard water employed in boiling beef 
or mutton always renders it more juicy and tender than when boiled in soft 
water. The reverse is the case with fish, which is always rendered firmer 
if boiled in water containing salt. Vegetables, on the other hand, are better 



SICK-NURSING. 887 



to be boiled in soft water, and care should be taken to see that they are boiled 
a sufficient length of time. This precaution is frequently neglected, and the 
vegetables in consequence are rendered less digestible. By the second, various 
kinds of puddings are prepared, only the lightest of which can be admitted 
into the sick-room. As few auxiliaries as possible should be employed in 
their preparation. They are, it need hardly be said, unsuitable articles of diet 
during active disease, and only come into requisition when the period of con- 
valescence has been reached. By the third, meat is rendered more nutritive, 
but is not so digestible as when it is boiled. The cookery for the sick-room, 
or that which is applicable during the period of active disease, differs consider- 
ably from that which is required during convalescence. The former includes 
the different kinds of farinaceous preparations, such as arrowroot, tapioca, 
gruel, beef and mutton tea, broths, etc., while the latter comprehends such 
farinaceous and animal preparations as are more nutritious and more stimulat- 
ing than can be employed with safety during active disease. 

A few receipts are here given of those preparations which are in frequent 
use in the sick-room. 

Arrowroot mucilage. Take a tablespoonful of West Indian arrowroot, mix 
it with a little cold water, and then pour about a pint of boiling water over it 
gradually, constantly stirring till it is of a pleasant consistence. Boil for 
five minutes, sweeten with a lump of sugar, and grate a little nutmeg on the 
top. Instead of the nutmeg a little lemon juice may be added. 

Tous-les-mois. This substance may be prepared like arrowroot, over which 
it has no advantage. They both contain little nourishment. 

Sago. Take a tablespoonful of sago, and macerate it in a pint of water on 
the fire, or a hot plate, for two hours, and then boil for fifteen minutes, 
stirring constantly. It may be sweetened with sugar and lemon juice added, 
as in the case of arrowroot. Instead of water milk may be used. Sago has 
little nutritive value. It is frequently employed where a non-stimulating diet 
is necessary. 

Tapioca. This may be prepared in the same way as sago, only, being more 
soluble in water, it requires just half the time for maceration and boiling. 
Sweeten and flavor like sago. 

Grit gruel. Wash the grits in cold water, after which the fluid should be 
poured off and fresh cold water added. Boil them slowly until the water last 
added is reduced to one-half, after which strain through a sieve. Allow about 
an ounce and a half of grits to make one pint of gruel. 

Oatmeal gruel. Take two or three tablespoonfuls of oatmeal, and rub it in 
a basin with a little cold water. Repeat the process, each time adding fresh 
water, until all milkiness ceases to be communicated to the water. Put now 
the washings into a pan, and boil till a thick mucilage is formed. These gruels 
contain more nourishment than sago, arrowroot, tapioca, etc., as they contain, 
besides starch, a small quantity of gluten. Sweeten to taste, and mix with 
milk if preferred. Butter and honey are sometimes added to them, but as 



888 APPENDIX. 

these are apt to derange the stomach they had hetter he done without. Besides 
being used as articles of diet these gruels are frequently employed as vehicles 
in which to administer substances when given in the form of clyster. 

Iceland moss jelly. Iceland moss contains a bitter principle, from which 
it should be freed before being used as an article of diet. For this purpose 
pound it iu a dry state, and soak in tepid water along with a little bicarbo- 
nate of soda for twenty-four hours, after which press in a coarse cloth. Add 
an ounce of the moss so prepared to a quart of water, and let the mixture boil 
to one-half. Strain through a sieve, and sweeten and acidulate, or mix with 
milk according to taste. 

Irish moss jelly. Take an ounce of carrageen, or Irish moss, and boil it in a 
pint and a half of water, sweeten and acidulate, or mix with milk, as in the 
former case. 

Ground rice milk. Take a tablespoonful of ground rice, mix well with a 
pint and a half of milk, add half an ounce of candied lemon-peel cut into slices, 
and boil for half an hour ; strain while hot. This forms a very nice nutri- 
tious article of diet for acute disease and early convalescence. 

Bread panada. Grate a piece of stale bread, and put it into sufficient water 
to form a thick pulp ; cover it, and after it has soaked for an hour, beat it up 
with two tablespoonfuls of milk and a little sugar, and allow it to boil for ten 
minutes, stirring all the time. 

Beef-tea. (1.) After removing all skin, fat, and gristle from a pound of 
rump steak, cut it into squares, and put it into a large-mouthed hottle, add a 
little salt, and having corked it tightly, put it into a saucepan with cold water, 
and allow it to boil for six hours. Skim, strain, season, and serve hot. (2.) 
Take a pound of beef, and having minced it fine, put it into a common earthen- 
ware teapot, with a pint and a half of cold water. Place the pot upon the 
fire, and allow it to simmer for at least three hours. Thus about three-quar- 
ters of a pint of good beef-tea will be obtained. Although beef-tea contains 
only a small amount of solid nitrogeneous matter, each pint of it, as ordina- 
rily made, containing "scarcely a quarter of an ounce of anything but water," 
it nevertheless is possessed of great nutrient power in sickness. Added to 
other articles of diet, beef-tea greatly augments their power. 

Essence of b^ef. Take a pound of gravy beef, free from skin and fat, chop 
it fine, put it into a mortar along with three tablespoonfuls of soft water, and 
pound it ; then allow it to soak for two hours, put it into a covered earthen 
jar, with a little salt, the edges of the jar being cemented, and a cloth tied over 
the top. The jar should then be placed in a pot half full of boiling water, and 
kept on the fire for four hours. It should then be strained through a coarse 
sieve, so that not only the fluid, but also the smaller solid particles of the meat 
may pass. Two teaspoonfuls or more of this may be given at a time when 
there is great debility. 

Chicken-tea. Take a small chicken, and after removing the skin and the fat 
between the muscles, divide it into two lonsjitudiual halves, and after remov- 



SICK-NURSING. 889 



ing the lungs and everything adhering to the backbone and chest walls, cut it 
into as thin slices as possible. Put the slices so cut into a pan, with a suffi- 
cient quantity of salt, and then pour over it a quart of boiling water. Cover 
the pan, and boil with a slow fire for two hours, and having allowed it to stand 
for half an hour longer on the fire strain off the fluid through a sieve. Both 
beef-tea and chicken-tea can be employed during disease, should animal diet be 
admissible, and by adding of flour, or other thickening substance, may be made 
useful as articles of diet during convalescence. 

Mutton-tea. Take a pound of mutton, free from fat, cut it into thin slices, 
and pour a pint and a half of water over it, allowing it to macerate, as in the 
preparation of beef-tea. After macerating, boil for half an hour, and strain. 

Veal-tea. Take a pound of fillet of veal, free from fat, slice, and then boil 
it for half an hour in a pint and a half of boiling water. 

Beverages. Toast-water. Cut half a slice of stale bread, toast it thor- 
oughly, and put it into a jug. Boil a quart of water, allow it to stand till cold, 
and then pour it over the bread. A little lemon or orange peel may be added. 
After it has stood for two hours decant. This forms a very agreeable drink 
in febrile affections. 

Barley-water. Take three tablespoonfuls of pearl barley, wash in cold 
water, and pour about a tumblerful of cold water over it ; boil for fifteen 
minutes. Throw this water away, and having heated two pints of water pour 
them over the barley ; boil down to one-half, then strain. 

Linseed-tea. Take two drachms of licorice root, bruised, and an ounce of 
linseed, and put them into a jug with a pint of boiling water. Allow the jug 
to stand near the fire for four hours, and then strain through linen or calico. 
Take care not to bruise the linseed. This decoction forms a useful demulcent 
drink in cases of cough and affections of the urinary organs. 

Rennet whey. Take a piece of rennet, and infuse it in a quantity of boiling 
water, sufficient to remove from it all soluble matter; after pouring off the 
fluid, take a tablespoonful of it, and mix it with three tablespoonfuls of milk. 
Place the mixture so prepared before the fire, covering it with a piece of clean 
cloth. When a uniform curd is formed, remove it, divide it into small pieces 
with a spoon, and separate the whey by gentle pressure. This forms a very 
pleasant drink in febrile conditions. 

White wine whey. Take half a pint of new milk and put it into a deep pan. 
Place this upon the fire, and the moment the scum is seen rising to the edge 
of the pan, pour it into a glass of sherry, or other white wine, and sweeten 
with a teaspoonful of refined sugar. Allow it again to boil, stirring constantly, 
and then place it at the side till the curd forms one lump ; then strain the 
whey through a sieve or piece of muslin. It may be taken either cold or 
tepid, and is an excellent way of administering wine, when a moderate degree 
of stimulation is required. 

Egg brandy. Take the whites and yolks of three eggs and beat them up in 
five ounces of plain water. Add three ounces of brandy slowly, also add a 



890 APPENDIX. 



little sugar and nutmeg. Two tablespoonfuls of this may be given at a time. 
This is a very useful way of administering brandy in cases of prostration, as 
in typhus and other low fevers. Another good preparation is made by taking 
the white of a new-laid egg and stirring it up with a tablespoonful of cream, 
and adding to the mixture a tablespoonful of brandy, in which a lump of sugar 
has been dissolved. 

Milk and soda-ioaler. Take half a pint of milk, and sweeten it with a tea- 
spoonful of refined sugar ; bring it almost to the boiling point, and pour over 
it a bottle of soda-water. When there is much acid secretion in the stomach 
this will prove an excellent way of administering milk. 

Sago posset. Take two tablespoonfuls of sago, and put them into a pint of 
water ; boil till a mucilage is formed. Take now the rind of a lemon, and rub 
a quarter of an ounce of loaf sugar on it, and put it along with half a tea- 
spoonful of tincture of ginger into five ounces of sherry wine ; then add this 
mixture to the sago mucilage, and boil for five minutes. A wineglassful of 
this may be taken at a time. It is an excellent preparation in great debility 
resulting from acute disease of a non-inflammatory nature. When the period of 
active disease is over, and that of convalescence has taken its place, the patient 
is able to advance to something more substantial in the way of diet than the 
preparations that have just been mentioned. He is now in a condition to ben- 
efit from puddings of a farinaceous nature, and animal food that is non-stimu- 
lating and easy of digestion. Care must, however, be taken not to advance to 
these articles of diet too rapidly, lest the stomach should be overtaxed, and 
the patient suffer relapse. By easy gradations let the food approach in char- 
acter the ordinary diet of health. The following receipts are a few giving the 
preparation of the more ordinarily employed articles of diet during the period 
of convalescence. 

Boiled flour and milk. Wheaten flour, kneaded with water, is put into a 
linen cloth and tied firmly, after which it is placed in a pan with water, and 
allowed to boil slowly for twelve hours. It is then placed before the fire to 
dry. The thick rind which has formed should be taken away on removing the 
cloth, and it should be again dried. A tablespoonful of this grated and boiled 
with a pint of milk is very good as an article of diet in recovery from diarrhoea 
or dysentery. 

Arrowroot pudding. Rub a tablespoonful of arrowroot in a basin with a lit- 
tle cold water, and add to it, stirring constantly, a pint of boiling milk. With 
this mix the contents of one egg and three teaspoonfuls of powdered refined 
sugar, which have previously been beaten up together. Boil in a basin, or 
bake. This forms a very good pudding for the early stage of convalescence. 

Arrowroot blanr-mange. Take three tablespoonfuls of arrowroot, and make 
into a mucilage with water; then add milk in sufficient quantity, and boil till 
it is of a proper consistence. Pour into a mould, and allow it to cool and set. 
It may be eaten with currant jelly or with lemon juice aud sugar. Milk or 
beef-tea may be used instead of water iu the preparation of arrowroot muci- 



891 




Kg clxxiii 



F.IG CLXXY ElG CLSX.VI 



SICK-NURSING. 893 



lage. It should be boiled for twenty minutes. This forms a very nice light 
article of diet for early convalescence. 

Oatmeal porridge. Into water that is kept boiling sprinkle from time to 
time a small quantity of oatmeal, stirring constantly while so doing, until a 
moderately consistent mixture is formed. Continue to boil, after adding the 
meal, for half an hour. This, taken with milk, forms a very good article of 
diet during early convalescence. 

Rice and apples. Take a sufficient quantity of rice, and boil it rapidly in 
hot water ; then strain through a colander ; expose for a quarter of an hour 
before the fire, and having stewed separately the requisite number of apples, 
mix them together with a moderate quantity of sugar. This forms a nice dish 
for those recovering from acute disease. 

Boiled bread pudding. Take of stale bread half a pound; pour over it a 
pint of hot milk, and allow the mixture to soak for an hour in a covered 
basin ; then beat up with the contents of two eggs. Now put the whole into a 
covered basin, tie a cloth over it, and place it in boiling water for half an hour. 
It may be eaten with salt or sugar. 

Simple rice pudding. Add two tablespoonfuls of rice to a pint and a half 
of milk, and let it simmer until the rice is soft. Now take two eggs, whites 
and yolks, beat them up with half an ounce of sugar, and add this to the prepa- 
ration. Allow it to bake for three-quarters of an hour in an oven. 

Macaroni pudding. To four tablespoonfuls of cinnamon water add two 
ounces of macaroni, and allow this to simmer till the macaroni is tender. To 
this add three yolks of eggs, one white of egg, an ounce of sugar, one drop of 
oil of bitter almonds, and a glass of raisin wine, all beat up together in half a 
pint of milk, and bake in a slow oven. 

Batter pudding. Beat up the contents of two eggs with half an ounce of 
sugar, and mix this with a tablespoonful of wheaten flour and a pint of milk. 
Put into a basin of boiling water, and boil with a cloth tied over it. 

Tapioca pudding. Make a pint of tapioca mucilage with milk, and beating 
up the yolks of two eggs with half an ounce of sugar stir this into the muci- 
lage. Bake in a slow oven. Sago and arrowroot may be made into puddings 
of a similar kind, and used instead. They are very good as articles of diet dur- 
ing convalescence. 

Mashed carrots and turnips. Having peeled the carrots and turnips, boil 
them separately in three successive waters, and having pressed the water out 
of them through a clean coarse cloth mash them together with a sufficient 
quantity of milk to make them into a pulp, and season with salt. Place them 
before the fire till the surface seems dry. This will prove an agreeable dish in 
convalescence from severe disease, when the diet is restricted to farinaceous 
food and vegetables. There is nothing to prevent the use of most kinds of 
vegetables during convalescence, provided they are properly boiled. 

Vermicelli or macaroni soup. To a quart of beef-tea boiled down one- 
third add an ounce of vermicelli or two ounces of macaroni previously well 



894 APPENDIX. 



boiled in water, and boil down the whole to one pint ; add salt to taste. In- 
stead of vermicelli or macaroni rice may be used. It should be added to the 
soup after its concentration, having been previously prepared by boiling and 
slightly drying before the fire. 

Chicken broth. Take the yolk of an egg, and beat it up in two ounces of 
soft water, and add this along with a little parsley or celery to chicken-tea made 
as before directed, and boiled down one half. Rice, vermicelli, or macaroni 
properly boiled may be added with advantage. 

Rice and gravy. Let the gravy from a leg of roast mutton or a sirloin of 
beef stand till a cake of fat forms upon the surface. Remove this, and stir a 
sufficient quantity of well-boiled rice into it to constitute a meal. 

Sago milk. Soak an ounce of sago in a pint of water for an hour, after 
which pour the water off and add a pint and a half of milk; boil slowly until the 
sago is well incorporated with the milk. 

Mutton broth with vegetables. Boil slowly in a pan for two hours a pound of 
mutton chops freed from fat. Remove the chops, and to the remainder add 
three carrots and three turnips that have been peeled, cut into slices, boiled, and 
the water drained off", and two onions sliced and boiled, and season with a lit- 
tle salt and celery. Simmer slowly for four hours. Put in the chops again, 
and allow the simmering to go on for another hour. 

Tripe. Boil some onions in two waters, and partially boil a sufficient 
quantity of tripe. Then boil both together slowly till the tripe is soft and ten- 
der. Add salt and a few grains of cayenne pepper. As tripe is easily digested 
it forms a very suitable dish for a convalescent. 

Water souchy. Take two flounders, soles, whitings, or haddocks, and boil 
them in a quart of water to one third, so that the fish are reduced almost to a 
pulp. Strain, and removing the fins from four other fish of the same kind, 
put them into the strained liquid. Add salt and cayenne pepper to taste and 
a small quantity of chopped parsley. Boil sufficiently long to render the fish 
eatable, and eat along with the sauce. This is easily digested, and much relished 
by patients during convalescence from fever. 



VII. Domestic Medicines. 
It is not intended under this heading to mention a long list of drugs which 
may be used by the patient or his friends at their own discretion, but rather to 
mention a few of the simpler and more commonly employed remedies to be 
used only during an emergency, and principally to have in the house in case the 
physician should be called during the night. To a person living in the coun- 
try, at a considerable distance from help, much valuable time might be wasted 
in endeavors to procure what was wanted iu time of an emergency. With a 
few of the simpler and more frequently employed l-emedies at hand this might 
be obviated, and all disagreeable after-reflections prevented. In the purchase 
of drugs it is absolutely necessary to procure none but the best. They should 



SICK-NURSING. 895 



be kept iu bottles properly stoppered, and should be under lock and key. If 
this latter precaution is attended to, many of the disagreeable accidents which 
occur from time to time would be avoided. Unless care be taken to see that 
the bottles are properly closed, and the entrance of air excluded, the medicinal 
power of the various articles may be impaired, or, what is worse, they may 
become more concentrated, as in the case of laudanum, and thus be rendered 
dangerous. 

The following is a list of those drugs which are in most frequent demand in 
cases of emergency, and which it would be well for every one to have in the 
house, more especially if they are living in the country : — ■ 

Castor oil. A bottle of the finest cold-drawn castor oil. This acts as a gen- 
tle but efficient purgative, and may be given in doses of a teaspoonful to chil- 
dren and a tablespoonful to adults. 

Rhubarb. A small quantity of the finest Turkey rhubarb should be kept in 
powders of from ten to fifteen grains each, one of which, given with the same 
quantity of magnesia, will act as a mild purgative in the case of an adult. It 
is useful in dyspepsia. 

Magnesia. This may be kept either in bulk or in powders containing from 
twenty to thirty grains apiece. In acidity of the stomach, magnesia is one of 
the best medicines that can be given, and is very certain in counteracting its 
influence. It may be administered in doses of twenty to thirty grains to 
adults, and to those under ten years, from five to twelve grains may be given. 

Epsom salts. The dose for an adult is half an ounce. They should be 
taken the first thing in the morning, and warm drinks freely administered 
afterwards. They form, when so taken, an excellent saline purgative, and by 
stimulating the orifice of the bile duct they cause an increased flow of bile, 
and so relieve the system. 

Dill-water. This is frequently given to children during teething, when they 
appear to be griped from the presence of wind in the stomach and bowels. It 
would be better to attack the cause, as wind is merely the result of something 
more serious. A little magnesia may be given with advantage along with the 
dill-water, which may be given in doses of a teaspoonful or more to a child a 
year old. 

Lime-water. This is an excellent medicine to give children along with 
their milk when there is any tendency to acidity, or where the bowels are re- 
laxed to a greater extent than natural. One tablespoonful should be mixed 
with three tablespoonfuls of milk. 

Aromatic spirit of ammonia. This, which is commonly called sal volatile, 
is a very useful stimulant in fainting, hysteria, or flatulent colic. It may be 
given to adults in doses of a teaspoonful in a wineglassful of water, and may 
be repeated at frequent intervals. A drop or two given to children in a little 
water is also useful in pain due to flatulence. 

Ipecacuanha wine. In coughs of a bronchitic nature it may be administered 
in doses of from five to ten drops to children, and ten to twenty or more to 



896 APPENDIX. 



adults. To young infants a drop will be sufficient at a time. "When it is wanted 
to act as an emetic, it must be given in doses of half a teaspoonful to a tea- 
spoonful at a time. In croup an emetic of ipecacuanha wine is often of great 
service. 

Tincture of the perchloride of iron. A small quantitj 7 of this should be kept 
in the house to arrest bleeding from leech bites, etc., when other means have 
failed to do so. 

Spirit of minderus. To promote sweating in cases of cold or in slight fe- 
brile affections this is a very useful remedy, and may be given in doses of a 
tablespoon ful to adults, or a teaspoonful to children between six and twelve. 
It is generally combined with a few drops of sweet spirit of nitre and some 
camphor water. 

Sweet spirit of nitre is a valuable refrigerant in fever, and acts as a diuretic 
as well. It should be given in small doses of five or ten drops largely diluted. 

Laudanum. Great care must be exercised in the use of this drug, as evil 
habits of laudanum drinking may be begun from its too frequent employment 
for the relief of pain. For an adult about twenty or twenty-five drops may be 
given for a dose. This drug should on no account be made use of for the relief 
of pain in children without medical advice, as much harm may result in conse- 
quence. Children are very susceptible of the action of laudanum, and none but 
the physician can decide the utility of employing it in any case. 

There are certain points in regard to the administration of medicines which 
are deserving of attention, and which we shall briefly notice here. In order- 
ing the administration of a particular drug the physician leaves instructions as 
to the frequency with which he wishes it to be given ; and in so doing he acts 
under the belief that every medicine produces a specific change on the system 
which lasts for a certain length of time, and then tends gradually to disappear 
unless renewed. Accordingly, he renews the doses at definite periods, timing 
the succession of each, so that the effect of the previous one shall not have 
ceased before the action of the succeeding one has begun. It is very important 
that those in attendance upon the sick should pay particular attention to the 
physician's directions in regard to this, and if a medicine has been ordered to 
be given every four hours, the doses ought not at one time to be three and at 
another five or six hours apart. Especially is it necessary to attend to this in 
the administration of such medicines as mercury, arsenic, etc., which have to 
accumulate in the system before their effects are manifested ; and unless the 
action of the preceding dose is kept up, each succeeding one has to begin 
afresh. 

Medicines are generally directed to be given in teaspoonful, dessertspoonful, 
or tablespoonful doses, but as these are inaccurate measurements it is always 
advisable to have in the sick-room a graduated measure-glass, into which the 
medicines should be poured and carefully measured before being given to the 
patient. One drachm is equivalent to a teaspoonful, two drachms to a dessert- 
spoonful, and four drachms, or half an ounce, equivalent to a tablespoonful. 



SICK-NURSING. 897 



It is also well to have a smaller glass for the purpose of measuring any medi- 
cine that may be ordered to be given in drop doses. One minim is equivalent 
to a drop. Volatile medicines should not be poured out and then allowed to 
stand before being, administered, but should at once be given on being poured 
from the bottle. 

Many medicines, administered in their ordinary forms, are very disagreeable 
to the taste, and in order to obviate this they are frequently given in an effer- 
vescent state, in which condition they are much less objectionable and can 
be taken readily. Various substances are also used for the purpose of remov- 
ing the taste left in the mouth after so many medicines, but for this purpose 
nothing answers better than a piece of ship biscuit. Many substances are 
given along with nauseous drugs, which have the power of greatly lessening 
or completely removing this disagreeable property : thus, a few drops of dilute 
sulphuric acid will greatly lessen the nauseating taste of Epsom salts; in like 
manner milk covers the taste of rhubarb, and warm milk or coffee that of 
castor oil. By infusing senna with cold instead of warm water the taste 
is greatly lessened. 

Many persons have great difficulty in swallowing medicines when admin- 
istered in a solid form ; thu-, some people find it almost impossible to swal- 
low a pill, although they can easily swallow a piece of bread or meat many 
times larger. This difficulty arises from the mind being directed to the act, 
and on raising the pill to the roof of the mouth, the sensation of a larger mor- 
sel not being conveyed to the mind, it becomes impressed with the difficulty 
of the task, and so fails to accomplish it readily. By putting the pill into 
bread or conserve, and making a larger mass of it, this is generally obviated. 
Volatile medicines, such as ether, being very inflammable, should not be poured 
out of the bottle which contains them in too close proximity to the gas or the 
fire, as a disagreeable accident may result. Idiosyncrasy powerfully affects the 
action of medicines. 

Generally the effect of idiosyncrasy is to increase the action of drugs, and 
render a dose that would only act normally on one person productive of grave 
symptoms in another. Thus opium, instead of causing sleep, may give rise to 
delirium ; a dose of calomel, that might be given with perfect safety in one 
case, might cause salivation in another. Many articles of food, as shell fish, 
which can be freely partaken of by some, produce a poisonous effect when 
eaten by others. The odor of ipecacuanha is followed, in some people, by a 
paroxysm of asthma. Sometimes the idiosyncrasy takes an opposite character, 
and the individual is then enabled to take poisons with impunity. Whenever 
a person is known to have any idiosjmcrasy, the physician in attendance should 
always be made aware of it. As habit tends to lessen the action of medicines, 
as exemplified in the case of opium eating, any which the patient may have 
formed, and which are known to the friends, should be communicated to the 
physician. As some medicines, in certain doses, give rise to effects which are 
calculated to excite alarm, but which ultimately pass off on the use of the 



898 APPENDIX. 



medicine being continued, it is well that those in attendance upon the sick 
should be aware of this fact, and not alarm themselves unnecessarily. 



VIII. Accidents. 

As many accidents are of too trivial a nature to call in medical assistance, 
they are treated by the individual himself, or by his relations and friends ; but, 
as the domestic management of such cases is often imperfectly understood, 
what was at first of little moment becomes, through mismanagement, much 
more serious, and difficulties arise in connection with the case which a little 
care at the beginning might have obviated. To prevent mismanagement in 
the treatment of such cases, the following hints are given : — 

Burns and scalds. When excessive heat is applied to the surface of the 
body, the result is either a burn or a scald, according as the medium of con- 
veying the heat has been a solid or a fluid. The effect produced by a burn or 
scald upon the tissues of the body varies according to the intensity of the heat 
and the length of time during which contact lasted. If the application has 
been sudden and brief, only slight disorganization of the cuticle or scarf-skin 
may result, along with some inflammatory redness. If the duration has been 
longer, vesication or blistering results, through the separation of the cuticle 
from the true skin by serous fluid. Should the heat be still more intense, 
sloughing or death of the part takes place. The effects produced by a burn 
or scald upon the constitution are serious, according to the extent rather 
than according to the depth of tissue involved ; and the sudden shock to the 
nervous system, when a large extent of surface has been burned, frequently 
proves fatal, especially in the case of children. The great susceptibility 
of children to external impressions should always be borne in mind in 
applying hot bottles to them, in giving them warm baths, or in applying 
hot fomentations to different parts of the body, — the two latter having some- 
times caused death. When a burn or scald has occurred, our first object should 
be to relieve the patient's suffering, which is generally great unless the burn 
has been very severe, in which case he becomes cold and collapsed from the 
intensity of the shock upon the nervous system, and appears to suffer less 
acutely. In some cases this is best accomplished by the application of cold to 
the injured part, in others heat answers better; and the sensations of the 
patient may be taken as our guide in choosing between those two remedies. 
Where the injury has been very severe, and the patient appears cold and 
shivering, stimulants must be administered. The local applications for burns 
are numerous and various ; thus flour, starch, cotton wool, Carron oil, etc., 
have each their advocates ; but the object is the same whichever remedy we 
employ, namely, to protect the injured surface from the air. Perhaps the best 
of these local applications is the Carron oil, which consists of equal parts of 
olive oil and lime-water. It should be applied on linen rags or cotton wool. 
Too frequent changing of the dressings should be avoided. When the cuticle 



SICK-NURSING. 899 



is raised in blisters, a small opening should be made in the most dependent 
part, and the serum carefully pressed out. When the clothes take fire the 
patient should be as quickly as possible enveloped in a rug or table-cloth, and 
great care should afterwards be taken in removing the patient's garments. 
When the burn is very severe, and the patient in a greatly depressed state, a 
dose of opium should be given, varying according to age, along with some 
stimulant. The after-treatment consists in regulating the action of the bowels 
by mild purgatives. Should inflammation arise, appropriate means must be 
adopted. Ammonia and bark should be administered, and afterwards, should 
the discharges be profuse, tonics must be given. 

Bruises. A bruise or contusion is caused by a blow, or by direct pressure 
upon a part. The skin is unbroken, but blood is always extravasated amongst 
the tissues, varying in amount according to their laxness. Thus, in the eye, 
where there is a large quantity of loose cellular tissue, the extravasation is 
always considerable. It is this extravasated blood which gives rise to the 
discoloration of the part ; and the tints vary according to the age of the con- 
tusion, — a recent bruise being of a purple tint, and one of some standing being 
green or yellow. In the treatment of bruises rest of the part is essential, and 
various substances may be applied to relieve the pain and remove the swelling 
and discoloration. The best are tincture of arnica, Friar's balsam, compound 
soap liniment, and hot fomentations and poultices. 

Sprains, which are the result of violent stretching of the tendons or liga- 
ments in connection with a joint, are of frequent occurrence, especially in the 
upper limbs. There may be rupture of some of the fibres, or they may only 
be violently stretched. The treatment varies according to the severity of the 
case. If the sprain is severe, and accompanied by much pain and swelling, 
absolute rest must be enjoined and leeches applied. Afterwards hot fomen- 
tations should be applied, or hot linseed-meal poultices. The limb should be 
elevated to diminish the flow of blood to the part. Slighter sprains require 
rest, and cold lotions to be applied to the part. 

Cuts. Sometimes the bleeding from a cut or wound of the external parts 
may prove difficult of stopping, and medical assistance may be required in order 
to check it ; usually, however, moderately firm pressure will suffice. When 
the haemorrhage is not great, gentle pressure should be applied on each side of 
the wound, the edges being approximated, and a lint compress dipped in cold 
water should then be bound over the wound. 



APPENDIX II. 



MATERNAL MANAGEMENT. 



II. MATERNAL MANAGEMENT. 

Introductory Remarks. — Menstruation. — Pregnancy. — Diseases of 
Pregnancy. — Miscarriage. — Confinement. — Preparations. — In the 
Absence of the Doctor. — The Mother. — The Child. — Treatment 
after Delivery. — Nursing. — Bringing up by Hand. — Health of 
the Infant and the Child. 

INTRODUCTORY REMARKS. 

With the conviction that many women on entering into the state of matri- 
mony do so ignorant of the position they are to occupy as young wives and ex- 
pectant mothers, ignorant of their own constitution and of the laws by obedi- 
ence to which their health can alone be maintained, and believing that in this 
ignorance is laid the foundation of much of that distress which embitters the 
after-years of many a married woman, we write the following pages in the 
hope that they may be the means of enlightening some who still remain in 
darkness, and rendering their married life one of happiness and pleasure. It 
is our intention to throw out a few hints in regard to those matters which are 
daily influencing the health and lives of multitudes of our fellow creatures, 
.trusting that, in their endeavors to obey what is written, they may be enabled 
to. live more happily because more in accordance with Nature's laws. In 
knowledge there is safety, and to impart a correct understanding in regard to 
those laws which govern health is to give power, which, if rightly exercised, 
cannot fail to be productive of the happiest results. For lack of this knowl- 
edge many women, ere they well know what they, are about, have their ex* 
istence rendered miserable ; and with hopes blighted, and dreams of pleasure 
unfulfilled, they labor on in suffering and distress. 

There is no time when more care is necessary on the part of a woman than 
during the first few months of her married life. Many a young wife has reni 
dered the after-years of her existence years of bitterness by thinking lightly 
of a miscarriage at this time. The custom, which is still a prevalent one, of 
spending the first few r weeks of married life in a round of "pleasure and gayety, 
in excitement and fatiguing journeys, is one which has been frequently spoken 
against, and which calls loudly for reform. Now it is, perhaps, more than any 
other time, that such things should be as far as possible avoided. The mind is 
already sufficiently excited, and the bodily powers sufficiently strained, without 
any additional mental stimulus or taxation of bodily strength being demanded. 
What is wanted at such a time is quiet, yet quiet away from the prying eyes 
of friends, and for this purpose some short journey should be taken to a place 
where the associations are such as will interest without producing undue ex- 
citement. Here, in each other's society,, the newly-married pair can learn 



904 APPENDIX. 



more, and form a juster estimate of each other's character than they have 
hitherto heen able to do. After a few weeks spent thus, the young wife will 
return to those domestic cares which must henceforth occupy so large a portion 
of her time, but she will do so not jaded and unfit for her duties, as is too fre- 
quently the case, but with a feeling of strength, and able to discharge them 
efficiently. 

If strict attention has been paid prior to marriage to the carrying out of 
those hygienic rules so conducive to the maintenance of health, there is little 
fear that they will be neglected now. 

They should, however, be even more carefully attended to by the young 
wife, as their violation now brings with it more serious consequences than 
formerly it might have done. The avoidance of late hours and of great excite- 
ment are both helpful in maintaining good health. Errors in diet may prove 
hurtful. It should therefore be simple and nutritious. Indigestible articles of 
food should be avoided, as also heavy suppers taken late at night. In regard 
to drink, the strictest temperance should be observed. Alcoholic beverages 
are not as a rule required, and are better done without altogether. Out-of-door 
exercise should be taken daily. This tends to maintain the various organs of 
the body in a state of health, and prevents that listless habit of body being de- 
veloped which is frequently found among the upper ranks of life where atten- 
tion to this is neglected. Strict regard must be paid to the carrying out of 
personal cleanliness. Baths and ablutions are powerful aids to the mainte- 
nance of health, and are as necessary now as they ever were, or even more so. 
It is well that the young wife should know these things, and lay them to heart ; 
that, she should be keenly alive to the necessity there is of doing everything in 
her power to preserve a vigorous habit of body, and be the mother of strong 
and healthy children. By carelessness in regard to the rules of health she not 
only entails suffering upon herself, but she influences materially the condition 
of her offspring; and if the young wife would avoid being the mother of puny 
and delicate children, let her do everything in her power to avoid such an oc- 
currence by attention to those laws which are the only sure safeguard against 
this taking place. 

I. MENSTRUATION. 

The period of puberty in the girl is marked by the appearance of a dis- 
charge of blood at the external organs of generation. This discharge comes 
from the interior of the womb, and recurs in health with great regularity every 
twenty-eight days, or once a month, for a period of thirty years. The cause 
of this discharge is the ripening of what is known as a Graafian follicle, and the 
escape of an ovum or egg into the cavity of the womb. The bodies concerned 
in the maturation or ripening of these follicles are the ovaries, which are two . 
in number, of an almond shape, and situated one on either side of the womb, 
with which they are connected by means of two tubes about four inches long. 
Down these tubes the discharged ovum travels till it reaches the interior of tho 



MATERNAL MANAGEMENT. 905 

womb, from which, unless impregnation occurs, it is washed away in the 
monthly discharge. The time of life when menstruation begins varies ; but 
may be said to occur in temperate climates between the fourteenth and six- 
teenth year. Cases, however, are on record in which children a few years or 
even a few months old have had a bloody discharge from the external organs 
of generation which continued to recur at regular intervals afterwards. These, 
as may be supposed, are cases of extreme rarity ; but in our own country 
many cases are met with in which a girl has begun to menstruate when she 
was ten or twelve years old, and others in which the monthly discharge has 
been delayed till the twentieth year, or even longer. The color of the men- 
strual blood is at first dark, but becomes brighter as the period advances. It 
has this peculiarity as distinguishing it from ordinary blood, that it does not 
coagulate on exposure to the air. The reason of this is that in its passage 
from the womb the blood becomes mixed witli certain secretions which tend 
to prevent this occurring. The amount of blood lost at each monthly period 
varies, but usually it averages from three to four ounces. If the quantity be- 
come excessive, as it sometimes does, the health of the woman suffers. The 
flow is not, as a rule, established at once ; sometimes several months elapse be- 
tween the first and second menstrual period ; but when a few months are over 
it recurs with great regularity, sometimes coming on even to the hour. 

There are several circumstances which operate powerfully in accelerating or 
retarding the menstrual flow. Of these the influence of climate is most marked. 
In India and other countries where the heat is great, girls hegin to menstruate 
earlier than they do in more temperate climates. They arrive at perfection 
sooner, but their beauty is more short-lived, and they soon become aged, while 
those who inhabit more northerly climates, and are exposed to intense cold, 
are longer in coming to maturity, but they retain the charactei'istics of woman- 
hood longer, and their beauty to a comparatively old age. But besides the in- 
fluence which climate exerts, there are other circumstances at work which tend 
to hasten the occurrence of puberty in the girl. Thus anything tending to 
produce effeminacy, — a lazy, listless life; undue mental excitement, caused 
either by the reading of sensational novels, or by conversation or the like, late 
hours, irregular habits of sleep, highly seasoned articles of diet, and stimulants, 
— have all a tendency to accelerate the occurrence of menstruation in the girl. 
Among the upper classes of society, where most or all of these circumstances 
are at work, menstruation occurs earlier than it does in the lower classes, where 
muscular exercise is more frequently taken, where the articles of food are 
plainer, where the mental excitement is not so great, and where the whole 
surroundings are more conducive to the development of a healthier and a hardier 
frame. In towns where all the above influences are at work, girls menstruate 
earlier than they do in the country. It has been said that the monthly periods 
when once established continue to recur at regular intervals in a woman who 
is healthy for about thirty years, during which time she is capable of conceiv- 
ing. When a woman is said to be regular in regard to her courses, it is not 



906 APPENDIX. 



merely meant that she is regular as to time, but that she is regular as to 
quantity and quality as well. 

Menstruation ceases during pregnancy, and generally during the period of 
suckling as well. Diseases which exhaust the strength and impair the vital en- 
ergies of the body generally lead to a stoppage of the monthly discharge. This 
is frequently seen in the case of consumption and other diseases of a debilitat- 
ing nature. The appearance of menstruation in the girl is ushered in by cer- 
tain well-marked symptoms, the significance of which should not be overlooked. 
About this time languor and general unfitness for exertion are complained of ; 
there are dull, aching pains in the region of the pelvis ; a feeling of dragging 
and weight about the small of the back is also complained of. There is a dark 
ring under the eyes. These pass away as the menstrual function becomes 
established. The change which menstruation works upon the girl is great. 
Her frame grows rounder and fuller, the hips broaden, fat becomes deposited 
in various parts of the body, the breasts enlarge, and in her manner she be- 
comes more retiring. It seems as if a great mental change had come over the 
girl, and there had begun to dawn upon her mind the consciousness of that 
important mission she was destined to fulfill. From this time her demeanor 
is altered, and around her person there gathers a sacredness hitherto unknown. 
Her bearing also becomes more dignified ; she exchanges the pursuits of girl- 
hood in which she has so long found pleasure for those of maturer years, and 
consciousness of the position she occupies now fills her mind. 



II. PREGNANCY. 

1. Signs of Pregnancy. 

(1.) Ceasing to be unwell. One of the most presumptive signs that a woman 
has of her being with child is the cessation of the monthly flow ; it is also the 
first to manifest itself. Taken alone, the stoppage of the monthly discharge 
is not' sufficient proof that pregnancy has occurred ; but if a woman who has 
been menstruating regularly up to the time of her marriage ceases to be un- 
well shortly after, it is presumptive of her having conceived. A woman may, 
however, be unwell for one or two periods after conception has occurred ; ofj 
on the other hand, the monthly discharge may be in abeyance from the pres- 
ence of disease, as in a woman suffering from consumption. Again, cold or 
severe mental emotion may produce the same effect. It is also a well-known 
fact that many women conceive while they are nursing, during which time the 
monthly periods are generally absent. A woman may also conceive before 
she has begun to menstruate. Many cases are on record in which young 
women have conceived prior to the development of the menstrual flow, and 
have been the mothers of healthy children ; so that while taken by itself, the 
absence of the monthly discharge cannot be looked upon as sufficient proof of 
the existence of pregnancy, it is, nevertheless, occurring in a healthy woman, 



MATERNAL MANAGEMENT. 907; 

who has menstruated regularly * a sign strongly presumptive of such having 
taken place, and in conjunction with certain others which we shall notice} 
presently is of great assistance in coming to a right conclusion in regard to 
a case. . , 

(2.) Morning sickness. On getting up in the morning from the recumbent 
position, most pregnant women suffer from a certain degree of nausea, or even 
sickness. The period when this symptom manifests itself is generally a few 
weeks after the occurrence of conception. It may, however, appear earlier, in 
some cases coming on immediately after the woman has conceived, or its ap- 
pearance may be delayed till the last few weeks of pregnancy. It may also 
last throughout- the whole period of pregnancy. This morning sickness is due 
to the sympathy which exists between the stomach and the womb, and is en- 
tirely reflex in its nature. It differs from other forms of sickness, such as; 
those which are due to disease of the stomach itself, in this, that so soon as the; 
sickness is over, the patient is perfectly well, and can generally take food im- 
mediately after. Its appearance is generally regarded as favorable, — a sick; 
pregnancy being looked upon as a safe one. The intensity of the sickness 
varies in individual cases ; in some it may only take the form of slight nausea* 
while in others it may continue with great severity, and even endanger life. 
Taken by itself, we may not be able to attach much value to this any more 
than we were able to do to the cessation of the monthly periods, but taken to- 
gether, and considering the period of its occurrence and the nature of the sick T 
ness, it forms undoubtedly valuable proof of the existence of pregnancy. 

(3.) Changes occurring in the breasts. About the second month of pregnancy 
certain well-marked changes may be observed taking place in the breasts* 
The patient generally complains of a feeling of fullness and tightness which 
she has not before experienced, and a sensation of tingling or pricking is also 
felt. If the breasts of a woman who is thus suffering are examined, they will 
be found to be hard and knotty to the touch ; the nipple will be seen to be 
more prominent, and the flesh-colored ring by which it is surrounded, and 
which is called the " areola," will be found to have assumed a much darker, 
hue, and to have increased considerably in size. Upon this darkened ring a 
number of small prominences are now visible. The number of those promi- 
nences present on any single areola varies, but may be said to be from twelve to 
twenty. As pregnancy advances, these little prominences increase both in 
number and in size. The areola also increases, in dimensions, and may be an 
inch or an inch and a half all round. The skin also covering the part be- 
comes moist, and frequently stains the linen in immediate contact with it. As 
pregnancy advances, a number of white spots appear on the outer part of this 
dark circle. Milk also is generally found in the breasts, and the veins are 
marked and prominent. The swelling and increased size of the breasts must 
not be taken as a sign of pregnancy by themselves, as they are frequently 
.manifested in women who have ceased to be unwell from entirely different 
causes. If, however, the swelling of the breasts is due to any other cause than 



908 APPENDIX. 



that of pregnancy, it will be transient in its nature, and they will soon again 
regain their normal size. Again, the dark circle which surrounds the nipple 
may manifest itself, though with nothing like the same intensity of color, in 
cases of enlargement of the womb from other causes. Milk also may be found 
in the breasts apart from pregnancy, and cases are recorded in which it was 
found in the breasts of young girls, and even the male breast has been known 
to secrete a plentiful supply of milk. In the case of women pregnant for the 
first time, these changes which take place in the nipple and breast are of very 
great value, and taken along with other symptoms go far to confirm the fact of 
the existence or non-existence of pregnancy. The color of the ring which 
surrounds the nipple varies much in its shade in different women, being much 
lighter in those who are fair-haired with blue eyes than in those who are 
black-haired with dark eyes. In some, also, this circle may not be present, 
although pregnancy exist ; but when these changes have taken place in a fe- 
male breast, it is strongly presumptive of the existence of pregnancy, especially 
if the woman has not given birth to a child previously. 

(4.) Quickening. The next symptom we shall notice as giving evidence of 
the existence of pregnancy is one which isolated and viewed by itself fails to 
yield any proof beyond that which is presumptive, and consequently occupies 
a place in the same category with those already mentioned when looked at in- 
dividually. The term " quickening " is used to express the time in a preg- 
nancy when a woman first hecomes conscious of the movements of the child in 
the womb. The popular idea, that up to this time the child in the womb is 
dead, and that these movements are the first indications of life, is, it need 
hardly be said, erroneous. The child in the womb is alive from the time of 
conception, but it is only as the womb enlarges and comes into contact with 
the abdominal walls that the movements become appreciable to the woman her- 
self. They may, however, he detected before the woman has felt them by the 
physician pressing his hand on the abdomen. The usual period of the occur- 
rence of quickening is the eighteenth week of pregnancy, but it may occur 
earlier, in some so early as the third month, or it may not be felt till much 
later on. The sensation is described by women as resembling the fluttering 
of a bird ; and on its first coming on the female usually experiences a feeling 
of faintness, and may exhibit symptoms of hysteria. If the child is very fee- 
ble the movements may not be appreciable to the female. This sometimes 
gives rise to an unfounded dread lest the infant should be dead. A woman is 
frequently deceived in regard to this symptom, and many imagine that they 
have felt the movements of the child in tlie womb when all the while they 
have been suffering from flatulence. Again, involuntary contraction of the 
muscles of the abdominal walls may give rise to a sensation which may be 
mistaken for that of quickening, and some women possess the power of jerk- 
ing their muscles, causing movements in them which may simulate the move- 
ments of the child in the womb, so that this symptom is only of value as a 
proof of the existence of pregnancy when taken along with others. 



MATERNAL MANAGEMENT. 909 

(5.) Changes in the abdomen. During the early mouths of pregnancy little 
appreciable enlargement of the abdomen takes place, and iu some cases it i3 
even less prominent than in the unimpregnated state. The reason of this ia 
that the womb being heavier than usual at first sinks in the pelvis instead of 
rising. Alter the third month, however, a swelling manifests itself of a 
rounded form at the lowest part of the belly, which goes on increasing until 
it occupies the whole abdominal cavity. As it ascends it pushes the navel be- 
fore it, causing it to be on a level with the surrounding skin, and towards the 
end of pregnancy to project beyond it as a distinct prominence. Silvery liues 
may be seen extending over the abdomen from the stretching of the skin to 
which the growing womb gives rise. As the abdomen may enlarge from other 
causes, too much importance must not be placed upon the mere increase in size. 
Thus, collections of fluid in cases of dropsy may give rise to enlargement of 
the abdomen, and so also may gaseous accumulations in the intestines. In the 
case of the former the swelling will be found to alter its position according to 
the attitude assumed by the patient, from the fact that the fluid gravitates to 
the most dependent part of the body. Thus, when erect, the swelling will be 
found to project most at the lower part of the abdomen, while on assuming the 
recumbent position the anterior part which appeared most prominent when 
standing will now be found to have a flattened aspect, and the fluid will be 
observed to cause a bulging on either side. The softness of the swelling due 
to flatulent accumulations in the intestines will serve to distinguish this con- 
dition from a case of enlargement of the abdomen, the result of pregnancy, in 
which case it is hard, tense, and elastic to the feel. Towards the close of the 
child-bearing period,- and when menstruation is beginning to cease upon a 
woman, a deposit of fat frequently takes place in the abdomen, which may 
lead the female to imagine that she is pregnant. Especially is this the case 
with those who have never had children, and who are anxious to become 
mothers. The time of its occurrence, along with the absence of other symp- 
toms, will preclude the possibility of error from this Source. 

(C>.) Longings. By this term is popularly understood that craving for un- 
natural and unsuitable articles of diet, such as slate pencil, charcoal, and the 
like, which many women experience at this time. These longings are often of 
the most fanciful kind, a case being recorded by Smollett in which a woman 
desired a hair from her husband's beard, which she wished to pluck herself. 
These longings when present will require considerable self-control on the part 
of the female who may happen to be the subject of them in order to overcome 
them, but they must be firmly resisted and fought against, the mind being 
meanwhile thoroughly occupied, and the food and daily exercise being carefully 
attended to. 

(7.) Mental peculiarities. Certain mental peculiarities are far from un- 
common in the pregnant female. Thus, many women who exhibited the 
mildest and most amiable of tempers before marriage, on becoming pregnant 
undergo a remarkable change in this respect, becoming at these times passionate, 



910 APPENDIX. 



fretful, and irritable. On the other hand, pregnancy may exert a beneficial 
influence upon a woman, and many who before were fractious and ill to do with 
have their tempers frequently altered for the better on being with child. There 
are other symptoms which might be enumerated among the " signs of preg- 
nancy," such as an unnatural flow of saliva, palpitation of the heart, tooth- 
ache, sleepiness, heart-burn, etc., which, however, are neither so constant in their 
occurrence nor of such importance as those already mentioned. Taken sepa- 
rately, these, like those we have just been considering, may not be of much value 
as proofs of the existence of pregnancy ; but taken together, or in conjunction 
with those already mentioned, as signs of greater certainty, the woman may be 
sure that she is with child. There are other signs which are of very great 
value to the physician in ascertaining the existence of pregnancy ; but as these 
require medical skill for their appreciation, they do not fall within the scope 
Of the present work. 

2. Duration of Pregnancy. 

When a woman becomes pregnant, she is naturally anxious to know when 
she may expect her confinement. The usual methods of calculation are based 
Upon the average duration of human gestation, which is 280 days, or forty 
weeks. As, however, a woman may carry beyond the 280th day, or may be 
delivered short of it, any method of calculation is necessarily only to be re- 
garded as approximate, it being perfectly impossible to fix the time of delivery 
to any one day. Frequently, also, a woman forgets the date of her last monthly 
illness ; and in the case of those who become pregnant while nursing, and iu 
whom menstruation has not yet returned, we are deprived of a very important 
factor in calculating the time when a confinement may be expected to take 
place. In such cases the calculation must be made from the time of quickening. 
It would be well if every married woman were to register her monthly periods 
in a book kept for the purpose, entering the day on which she began to be 
unwell, and the day on which she ceased to be unwell. This would be found 
very useful, would save the possibility of forgetfuluess ; and as the time oc- 
cupied in making the necessary entries is so short, it should commend itself to 
all. Usually the period of gestation terminates a day or two short of the 280 
days, the confinement occurring in most cases on the 278th day after the cessa- 
tion of menstruation. 

Many different methods of calculation are. in use among medical men, of 
which two only shall be mentioned here. The first is the one which goes by 
the name of Naegele's method, and consists in adding seven days to the com- 
mencement of the last menstrual period and counting back three months. 
. Thus, suppose a woman ceased to menstruate on March 3d, by adding seven 
days and subtracting three months we get the 10th of December of the same 
year as the probable clay of confinement. The second method is that recom- 
mended by Dr. Matthews Duncan, and consists in ascertaining the day on which 
the female ceased to be unwell, or the first day of her being again well, and is 



MATERNAL MANAGEMENT. 911 

described in his own words, as follows : " Taking that day nine months forward 
as 275, unless February is included, in which case it is taken as 273. To this 
add three days in the former case, or live, if February is in the count, to make 
up the 278. This 278th day should then be fixed as the middle of the week, 
or, to make the prediction more accurate, of the fortnight in which the confine- 
ment is likely to occur." 

3. Management of the Health during Pregnancy. 
(1.) Food and Drink. Many women, when they become pregnant, forget- 
ting that they have at the same time ceased to be unwell, imagine that the 
system requires an increased amount of nourishment ; and acting upon this er- 
roneous idea, they overload the stomach and do themselves an injury. If a 
woman has been careful previous to her marriage in regard to her diet, she will 
find little now to alter. The food taken during the early months of pregnancy 
should be light and wholesome, while being at' the same time easy of digestion. 
Owing to the irritable state of the stomach which prevails at this time, great 
caution should be exercised in avoiding those thrngs which are likely to dis- 
agree ; such as pastry, made dishes, etc. Simplicity in diet combined with 
nutrition should be aimed at rather than a gratification of the palate. The 
amount of food taken during the early months of pregnancy need not be greater 
than formerly. In the later months the irritability of the stomach passes away, 
and the demands of the system become greater ; but at this time, owing to the 
patient being restricted in her exercise, the expenditure of energy is less. The 
quantity of food taken at any one time should not be increased, but the intervals 
which elapse between one meal and another may be diminished. Fish, eggs, 
chicken, a moderate allowance of meat, light puddings, milk, vegetables, and 
ripe fruit, are all suitable articles of diet during the period of pregnancy. Espe- 
cially towards the close a woman will find stewed prunes and figs, roasted apples, 
oranges, etc., very wholesome and agreeable ; and, in addition, having a gentle 
laxative effect upon the bowels, they greatly assist in overcoming that tendency 
to constipation which is frequently so troublesome at this time. If the preg- 
nant female has longings for particular articles of diet, unless these are likely 
to prove injurious, they may be gratified; but all such longings for what is 
simply absurd, and could not if gratified prove other than prejudicial, must not 
be yielded to. A cup of coffee taken in the morning some time before rising 
will often prove of great use in removing that disagreeable feeling of nausea 
from which females are so liable to suffer during the earty months of pregnancy. 
It should be remembered by all that every error in diet which proves hurtful 
to them is not confined in its effect to themselves, but is shared in equally by 
Hhe infant in the womb ; and if young females desire to be the mothers of strong 
and healthy children, they must endeavor to avoid everything that is calculated 
to prevent the attainment of this end. 

There is a practice which, it is to be regretted, is only too prevalent among 
pregnant women, and that is the indulging in alcoholic drinks and stimulants 



912 APPENDIX. 



of various kinds under the impression that their condition demands it. They 
are under the belief that they will assist in relieving the irritability of stomach 
fiom which they suffer during the early months, or the feeling of faintness, 
debility, and languor that attacks them later on. It may be said, however, 
that the less the pregnant female has to do with stimulants of any kind the 
better will it be both for herself and her offspring. Many cases, indeed, might 
be adduced to show how habits of drinking have been formed in this way, and 
to prove the injurious influence which this indulgence has upon the children 
that are born. These matters should receive the careful consideration of every 
female, and should not be passed over lightly as if they were too trivial to en- 
gage attention. 

(2.) Clothing. Throughout the whole period of pregnancy the clothing 
must be warm. More danger is likely to result at this time from insufficiency 
than from excess. But while the clothing must be warm, it should, as far as 
possible, combine the quality of lightness as well. For this purpose no material 
answers so well as flannel, and with it the pregnant female should be clothed 
from head to foot. The power which it possesses of keeping out the cold, while 
at the same time retaining the heat of the body, particularly recommends it at 
this time, and specially towards the later months, when the looseness of the gar- 
ments renders the female particularly liable to suffer from rheumatism and the 
like. The clothing of the pregnant woman must be adapted to her state, and 
the various articles of dress worn must be made sufficiently loose to admit of 
the free expansion of the growing womb, and must not press injuriously upon 
the breasts. If stays are worn, they should be made so as to admit of perfect 
freedom of movement, and anything like an attempt at making them lit neatly, 
at all times hurtful, will prove much more injurious now. So great a necessity 
was it deemed by the Romans to have the garments loose at this time, that 
they compelled their women when they became pregnant to lay aside the girdle. 
Tight clothing during pregnancy, by pressing injuriously upon the womb, leads 
to the imperfect development of the child, and may give rise to miscarriage. 
Depression of the nipples, and a consequent inability to suckle, is a frequent 
consequence in those women who have subjected their breasts to pressure 
throughout pregnancy. Garters and such like must be worn quite loose. It 
may seem strange, but there are not wanting those, especially among women 
pregnant for the first time, who, from a false modesty, wear their dresses tight 
in order to conceal their state. This, it need hardly be said, should never be 
allowed to influence the mind of any right-thinking woman, especially when by 
so doing she is jeopardizing both her own health and that of her offspring. Let, 
therefore, the articles of clothing worn at this time be made so as to adapt 
themselves comfortably to the body without pressing injuriously upon any part. 
By so doing a woman renders her present condition one of as little departure 
from health as it is possible for it to be, and takes the surest means of* securing 
a safe and easy delivery. 

(3.) Exercise. For the maintenance of good health during the period of 



MATERNAL MANAGEMENT. 913 

pregnancy fresh air and exercise are necessary. Out-of-door exercise should 
be taken daily, and continued till as late a period of pregnancy as can con- 
veniently be done. The best form of exercise is walking, but this must not 
be indulged in to excess. A woman must not fatigue herself at this time 
by taking too long walks ; she should rather go a less distance and more fre- 
quently in a day than go so far that she is unfit for anything on her return 
home. As the later months of pregnancy are reached, and specially towards 
the close, the female naturally feels unable for much active exercise, and the 
amount should then diminish to suit her requirements ; but as long as it is 
practicable she should be in the open air some part of every day. In regard 
to the amount of exercise which it is necessary for a woman to take when she 
becomes pregnant, no rule can be laid down ; it will vary in different constitu- 
tions, one woman being able to walk a considerable distance without feeling 
fatigue, while another is easily tired. Each woman must therefore act inde- 
pendently, and should always stop ere she experiences a feeling of fatigue. If 
walking exercise cannot be undertaken with any degree of comfort, which will 
frequently happen towards the end of pregnancy, moderate carriage exercise 
should be had recourse to instead. Exercise of this kind, to be productive of 
a beneficial effect, ought to be taken in an open carriage, and must be done 
slowly, and anything like a desire to get rapidly over the ground must be ban- 
ished from the mind. The drive should be taken along a level piece of road, 
as all jolting is bad at such times. Exercise on horseback, dancing, lifting of 
heavy weights, and anything that demands an unusual expenditure of energy 
must be scrupulously avoided, as they are pernicious in the highest degree. 
Crowded assemblies, theatres, ball-rooms, and the like are injurious to the 
pregnant female, and should be avoided. Anything that greatly excites the 
mind, such as public spectacles of every kind, ought also to be avoided. 
From what has been said it will be seen that there are many things which 
formerly were indulged in and proved harmless which are now fraught with 
danger, and which it. behooves every woman who values her health strictly to 
guard against. 

(4.) Ablutions. When the young female has become pregnant she natu- 
rally asks herself the question whether it will be advisable for her to con- 
tinue her baths as heretofore. This question we shall endeavor to an- 
swer for her in our remarks upon this subject. At no time is strict atten- 
tion to personal cleanliness more necessary than it is now, but certain pre- 
cautions had better be observed. Any form of bathing that gives rise to 
severe shock is apt to prove hurtful, especially during the later months of 
pregnancy. For this reason it will be necessary to avoid bathing in the sea, 
although change to the seaside and daily sponging with salt water at home are 
highly beneficial at this time. For the same reason the shower-bath must not 
be employed. The best kind of bathing, and that which ought to be made 
use of by every pregnant female, is the daily sponging of the body with water. 
Especially during winter is this form of ablution to be recommended beyond 



914 APPENDIX. 



all others, and the water employed at this season had better be made tepid. 
The surface of the body should be rapidly dried, sufficient friction being used 
in the process to cause a glow over the surface. If the female has been 
accustomed to a cold bath daily she may continue to sponge the body with 
cold water every morning during summer and autumn, but tepid should be 
substituted for cold during the winter months. While drying the body it is 
well to protect it from the air, which may be effectually done by enveloping it 
in a sheet. "Warm baths are too relaxing, and should not be employed at this 
time. 

(5.) Sleep. A pregnant woman generally requires more sleep than usual, 
and owing to the naturally irritable state of her nervous system at this time it 
exercises a soothing influence upon her. Should difficulty in breathing com- 
fortably be experienced on lying down, or should she suffer from a feeling of 
suffocation, as frequently happens during the later months of pregnancy, the 
shoulders and back ought to be well supported with pillows, and if this does 
not suffice a bed-chair may be employed. Late hours should be avoided as 
much as possible, and everything done to keep the mind calm and cheerful 
before retiring to rest. The amount of sleep at this time must not be stinted. 
Most women require eight hours, and are frequently the better, towards the 
close of pregnancy, for an afternoon's nap in addition. Of course it is not 
intended by this that a woman indulge in sleep to excess. Moderation in 
everything is always best, and those who pass eight hours in bed during the 
night, and spend the greater part of the day lolling upon sofas, will very soon 
develop a feeble habit of body, which it is most desirable to guard against. 
The bed upon which the pregnant female sleeps should be free from curtains, 
should not be too abundantly supplied with bed-clothes, and should have a 
light hair mattress, not a feather one. Feather beds are too heating, and have 
an enervating influence upon a woman, and ought on that account never to be 
employed. 

(6.) Ventilation. Too much care cannot be taken to see that the bedroom 
occupied by the pregnant female be properly ventilated. If this is disre- 
garded the sleep obtained will be unrefreshing, and the influence upon the 
body will be of a most unhealthy kind. The windows should be thrown wide 
open as soon as the sleeping apartment is left in the morning, and the mat- 
tress and blankets should be thoroughly exposed to the air. Frequently on 
going into a badly ventilated bedroom from the outer air one is conscious of 
a close, stuffy smell, far from agreeable, and anything but healthy, and yet 
those who occupy the room are unconscious of it, and we, if we remain suffi- 
ciently long in it, have our sense of smell so blunted that we fail to perceive 
the objectionable odor that arrested our attention at the first. If the precau- 
tion were taken of keeping the window open an inch or so at the top this 
would be entirely obviated, the apartments would then be properly ventilated, 
and in the morning the atmosphere would be as sweet and fresh as it was on 
the previous evening. Should the current of air so admitted be too strong it 



MATERNAL MANAGEMENT. 915 

may be divided by placing a piece of perforated zinc along the upper part of 
the window. It is very essential to have in every room an open fire-place, 
and the chimney should on no account be stuffed with straw, etc., as is fre- 
quently done. 

(7.) Tlie mind. Much might be said under this heading as to the supposed 
influence which the mind exerts upon the child in the womb in producing 
flesh-marks and malformations of different kinds ; but the most patient -re- 
searches go to prove that these occur freemen tly in the children of those 
who are quite unable to account in any way for their appearance, who can 
recollect no mental impression to which their occurrence might be attributed, 
while, on the other hand, women who have been haunted by the idea that 
their children would be born with certain defects and blemishes, in conse- 
quence of having seen during their pregnancy these defects and blemishes 
upon others, have been both surprised and delighted to find themselves the 
mothers of healthy children, free from all those defects and blemishes they 
so much dreaded. One thing, however, is certain, and demands our more im- 
mediate attention in the present instance, and that is that anything which causes 
a state of mental depression in the mother will operate injuriously upon the 
health of the child. Thus constant worry and anxiety are hurtful, and so 
are all of those sights which strongly impress the mind. They are bad for 
the pregnant woman, and alike bad for the child in her womb. A calm and 
equal frame of mind is greatly to be desired at such a time, and anything that 
is known to operate in the way of causing mental shock, mental depression, or 
excitement should be scrupulously avoided. Hence, also, the necessity there 
is for those at home doing everything in their power to prevent the occurrence 
of anything which they know would have an irritating influence upon the preg- 
nant female. Let everything also be done by the woman herself to maintain a 
cheerful state of mind ; let her banish every gloomy thought and fear as to 
the issue, and let her look forward to her approaching confinement hopefully. 
Let not the present condition be regarded as one of disease, and the period of 
delivery be regarded with gloomy forebodings, but look rather upon pregnancy 
and labor as parts of a natural process, and anticipate the best results. If a 
woman has been careful to attend to such ordinary hygienic rules as have 
already been laid down, if she suffers from no deformity, if she enjoys good 
health, and has not married either too early or too late in life, she may look 
forward to the time of her confinement hopefully, and anticipate both for her- 
self and her offspring a happy issue. 

4. Diseases of Pregnancy. 
(1.) Excessive vomiting. Mention was made when speaking of the signs of 
pregnancy of nausea or sickness being an ordinary symptom by which, along 
with others, the presence of pregnancy might be determined, and it was then 
pointed out that its occurrence was more to be desired than its absence, since 
a sick pregnancy was generally regarded as a safe one. Occasionally, how- 



916 APPENDIX. 



ever, instead of the morning sickness as ordinarily understood, the pregnant 
female is the subject of excessive vomiting, which, if allowed to go on un- 
checked, may seriously impair her general health and give rise to symptoms 
of impending miscarriage. The cause of the sickness, as was then pointed 
out, was sympathy between the stomach and the womb, the irritable state of 
the latter organ being shared in by the former. Sometimes, however, the 
symptoms are aggravated and the patient's misery increased by the stomach 
being allowed to get into a disordered state, and from the bowels having be- 
come constipated. These conditions manifest themselves by furred tongue 
and foul breath, and whenever these exist along with the vomiting, recourse 
should be had to gentle aperients, such as the confection of senna, of which a 
teaspoonful may be taken for a dose in a little water. Morning sickness may 
frequently be greatly relieved by the patient taking a cup of coffee the first 
thing when she awakes in the morning, and before she leaves bed. Instead 
of this a cup of milk with some soda-water added may be given, and frequently 
proves very beneficial. A walk before breakfast is also to be recommended 
as useful for this purpose. Usually this condition calls for little active inter- 
ference beyond the simple means that have just been recommended. It gen- 
erally passes off, in those cases where nothing has been done, about the period 
of quickening, and leaving the patient as it does, about midday or earlier, 
permits of her obtaining sufficient nourishment throughout the remainder of 
the day not to cause any appreciable effect to be produced upon her system in 
consequence. The cases which demand prompt attention are those in which 
the nausea and vomiting, instead of passing off about noon, persist throughout 
the whole day. When this occurs, uidess it is attended to, a serious state of 
inanition will be developed from want of nourishment, and unless means are 
employed to relieve the sickness the health of the female will become greatly 
impaired. If the sickness in the morning be great, generally fluid tinged with 
bile is vomited ; while if it occur later on, more solid matters from the food 
that has been taken are brought up. If the vomiting continue the counte- 
nance becomes pale and haggard and the breath offensive, and feverish symp- 
toms manifest themselves, which, unless relieved, may pass on to a fatal ter- 
mination. In the simpler cases of vomiting no medicinal treatment is re- 
quired ; it will pass away in due time, leaving the digestive powers unimpaired. 
.Should the vomiting, however, be more severe, and should bile be present in 
the vomited matters, indicating a deranged state of the digestive system in 
addition to the irritability of the stomach, the employment of soda and bis- 
muth may be had recourse to, ten to fifteen grains of each being taken three 
times a day, or the confection of senna mentioned above in doses of a tea- 
spoonful. Should there be much pain over the stomach, the application of a 
few leeches, and after their removal of strips of cloth dipped in laudanum, will 
generally give great relief. The greatest attention must be paid to the diet, 
which should be light and nourishing. If, however, the pregnant woman ex- 
press a desire for any particular article of diet, it may be given her by way of 



MATERNAL MANAGEMENT. 917 

experiment, as not unfrequently the most unlikely articles are digested at this 
time. Should the vomiting be severe, and fail to be relieved by means such . 
as have been already indicated, no time should be lost in sending for medical 
assistance. 

(2.) Heart-burn. During pregnancy many females suffer from what is 
known as heart-burn. This disagreeable affection is caused by the accumula- 
tion of an acid secretion in the stomach, and is greatly favored by the emplo}'- 
ment of rich and heavy articles of diet, especially such as contain much butter 
or lard. Many remedies are in use for the relief of this condition. Of these 
the principal are, soda, bismuth, aromatic spirits of ammonia or sal volatile, 
and alkaline aperients. Fifteen grains each of soda and bismuth may be 
taken three times a day, and should this fail a teaspoonful of the aromatic 
spirit of ammonia in a wineglassful of water repeated every four hours till re- 
lief is obtained. The bowels should also be attended to, and a black draught 
be taken occasionally when required, or a teaspoonful of Epsom salts in water 
taken the first thing in the morning. Better, however, than all medicinal 
treatment will it be for every pregnant female to attend to her diet and avoid 
such articles as are likely to produce this state of acidity and heart-burn that 
is so distressing. 

(8.) Constipation. A very common condition from wliich the pregnant 
female suffers, is a constipated state of the bowels. It is a very troublesome 
affection, and is due partly to the mechanical pressure which the enlarged 
womb exercises upon the bowel, and partly to " defective innervation of the 
bowels resulting from the altered state of the blood." Women are, however, 
very careless in regard to the state of their bowels, and frequently allow days, 
and even a week, to elapse without making any effort to have them moved. 
By a little attention of a preventive kind, this disagreeable and sometimes dis- 
tressing condition may be obviated. Whenever a pregnant female finds the 
ordinary calls to stool less urgent, and when the motions assume a more con- 
stipated character than formerly, these premonitory symptoms should not be. 
disregarded. They are warnings which, if unheeded, may soon give way to 
more obstinate forms of constipation. Whenever the bowels become sluggish 
let attention be paid to the diet and the daily exercise. If the diet has been 
faulty, let it be remedied, and let such articles as oatmeal porridge, ripe fruits, 
stewed apples, prunes, figs, and the like be taken. If the daily amount of 
exercise has not been taken for some time, let it be resumed, unless there be 
anything to prevent this being done : let her move actively about the house, 
doing a moderate amount of work daily, and let out-of-door exercise be taken. 
Many cases of commencing constipation may be checked by attention to these 
things. If, however, the condition of the patient is more advanced, and 
the bowels have not been moved for several days, diet and exercise alone 
may prove insufficient to remedy the disorder ; and when this is the case re- 
course must be had to the employment of certain medicines. Of these, the 
best are such as cause least irritation. All violent medicines must be care- 



918 APPENDIX. 



fully guarded against during pregnancy, as they tend, from the disturbance to 
which they give rise, to produce miscarriage. One of the best medicines to 
which recourse may be had during pregnancy is castor oil. In its action it is 
certain, and as it causes no irritation it is free from an objection which attaches 
to many medicines, rendering them unfit to be taken at this time. The dose 
may vary from a dessertspoonful to a tablespoonful. Many people, owing to 
its disagreeable taste, have an aversion to castor oil. This, however, may be 
greatly lessened if the oil be floated upon warm milk, coffee, or orange juice. 
It may also be made into an emulsion with yolk of egg or mucilage. Another 
mild aperient medicine, and one which answers very well during pregnancy, 
is the Frederichshall water, a small quantity of which, taken the first thing 
in the morning, will gently move the bowels. A teaspoouful of the con- 
fection of sulphur, prepared according to the Pharmacopoeia, taken occasion- 
ally when required in a little milk or water, will prove very useful as a mild 
laxative. 

Better, perhaps, than medicine for the cure of constipation is an occasional 
enema of simple soap and water or gruel, with one or two tablespoonfuls of 
castor oil in it. The quantity should be sufficiently large to stimulate the 
bowel, and for this purpose a pint of fluid is necessary. Many women have 
an objection to the employment of the enema for the relief of constipation, 
and will rather hurt themselves with purgative medicines than have recourse 
to it. This objection is altogether unfounded. If a proper instrument is 
used, it will give rise to little trouble ; it can be employed by the patient her- 
self, and in its action it is painless. Besides, when purgative medicines have 
been taken by the mouth for some time, they lose their effect, and the dose 
requires to be increased. Frequently when the bowels have been allowed to 
get into a constipated state, hardened masses of faecal matter accumulate in 
the gut, and by causing irritation of the mucous membrane give rise to in- 
creased secretion when the patient supposes she is suffering from diarrhoea, 
and frequently employs astringent medicines for the purpose of checking it. 
She also suffers from headache, a feeling of fullness over the abdomen, and 
indigestion. An enema of soap and water or a tablespoonful of castor oil 
with fifteen drops of laudanum, will answer best for the correction of this con- 
dition. Frequently, when the patient is careless in regard to the state of her 
bowels during pregnancy, and fa?ces are allowed to accumulate, they form 
hardened masses, which give rise to the spurious pains from which many 
women suffer for some time previous to their confinement, and which prove 
very annoying to them. Besides, labor may be greatly retarded by an over- 
loaded state of the bowels, and as the dinger both to mother and child in- 
creases with delay, the risks become greater. That pregnancy will be a state 
of least departure from health, and that labor will in all probability be short- 
est and safest, where, along with attention to other things, the patient has not 
been negligent of the state of her bowels. 

(4.) Diarrhoea. Although much less frequently met with in the pregnant 



MATEliNAL MANAGEMENT. 919 

female than constipation, diarrhoea is nevertheless occasionally an accompani- 
ment of this condition, and if severe and allowed to go unchecked it may lead 
to miscarriage. When diarrhoea thus attacks the pregnant female, attention 
should at once be directed to the diet, and only those things taken which are 
mild and unirritating. The quantity of food taken should not be large. Of 
those articles of diet suitable in such cases, milk must be placed first. It may 
be given either alone, or with rice, sago, arrowroot, or tapioca. When the 
irritation has partly subsided some chicken-tea may be given, or an egg lightly 
boiled. Later on a piece of chicken with bread may be given with advantage, 
and gradually the ordinary diet be resumed. Should the diarrhoea be of the 
kind mentioned as occurring with an overloaded state of the bowels, a different 
line of treatment must of course be adopted. It would be useless endeavoring 
to check the diarrhoea in such a case so long as the cause which gave rise to it 
remained in operation, so that the first thing which requires to be done is to 
have the bowels thoroughly cleared out by means of an aperient. For this 
purpose nothing will answer better than a dose of castor oil along with fifteen 
or twenty drops of laudanum, or an enema of soap and water. When the 
bowels have in this way been relieved, the diarrhoea will generally be found 
to cease of itself. The diet should be mild and unstimulating, and all irritating 
articles of food must be carefully avoided. When from the state of the tongue 
the stomach appears to be deranged, a few powders of rhubarb and magnesia 
will prove useful. No attack of diarrhoea should be passed over lightly by 
the pregnant female ; and if it is not checked by careful regulation of the diet, 
and by the administration of such articles, as we have mentioned, medical 
assistance must be sought. During the continuance of diarrhoea warmth is 
very essential, and for this purpose flannel should be worn next the skin. A 
flannel roller wound round the abdomen will answer well. The feet also must 
be attended to and kept warm. 

(5.) Piles. Another affection from which the pregnant female is liable to 
suffer, and one which gives rise to considerable pain and annoyance, is an en- 
largement of the veins at the lower part of the bowel to which the name of 
piles or haemorrhoids has been applied. This condition is one which results 
from pressure upon the haemorrhoidal veins. A congested state of these vessels 
is first set up, which, unless relieved, will ultimately give rise to piles. The 
mechanical pressure exerted by the enlarging womb is thus a frequent cause 
of this condition. Piles sometimes occur during the early months of preg- 
nancy, while the womb is yet in the pelvic cavity, and disappear about the 
fourth or fifth month, when it rises into the abdomen. Another frequent cause 
of piles is the accumulation of hardened fasces in the lower boweh When the 
condition of the bowels has been neglected for some time, the hardened masses 
which accumulate in the lower part of the gut give rise to irritation, and by 
the congested state of the vessels to which this irritation gives rise, piles are 
produced. Their presence occasions a disagreeable feeling of heat and pain, 
and much uneasiness is caused on the patient attempting to walk, from the 



920 APPENDIX. 



irritation to which the movements of walking give rise. They frequently be- 
come congested and very painful. On their presence being detected, no time 
should be lost in endeavoring to get them removed. If the bowels have been 
acting sluggishly, attention must be paid to them ; and if hardened masses 
have been allowed to accumulate in the lower bowel, no relief will be afforded 
till they are removed. For this purpose a gentle dose of castor oil may be 
taken, or the patient may use instead an enema of soap and water or gruel, 
with one or two tables poonfuls of castor oil added. A very good preparation 
to administer as a laxative when piles are present is the compound licorice pow- 
der of the Pharmacopoeia. Of this one teaspoouful should be taken for a dose. 
The confection of sulphur given in similar doses is another preparation of much 
value in this condition. If the piles are very painful, they should be fomented 
with warm water every night at bed-time, or with an infusion of chamomile 
flowers and poppy heads. If they are greatly congested, much relief may be 
given by the application of a few leeches in the immediate neighborhood, ap- 
plying on their removal a bread poultice or one made of linseed meal. A 
very good preparation as an external application for the removal of pain is the 
ordinary gall and opium ointment, which may be smeared over the parts night 
and morning. The diet must also be attended to. It ought to be light and 
nutritious, and as free as possible from anything that would be likely to give 
rise to much accumulation in the lower bowel. 

(G.) Salivation. The discharge of a large quantity of saliva from the 
mouth is an occasional accompaniment of pregnancy. It is most generally 
met with during the early months, but is not confined to these, and may some- 
times cause annoyance to a patient throughout the whole period of pregnancy, 
only ceasing when labor is over. The quantity discharged varies, in some 
cases amounting to pints or even quarts in a single day. As mercury gives 
rise to a profuse discharge from the salivary glands, it may be as well to dis- 
tinguish between the two. That due to the administration of a mercurial is 
accompanied by tenderness of the gums and a peculiar fetor of the breath. 
These are both absent in that form of salivation which occurs during preg- 
nancy. The gums remain perfectly normal, and the breath has no fetor. 
Frequently this excessive flow of saliva is attended by acidity of the stomach. 
Various forms of treatment are had recourse to, many of which, however, 
prove futile in checking it. Astringent gargles may be tried, such as those 
which contain tannin. Glycerine of borax and rose-water mixed together 
form a useful preparation. Ices given to suck may also be tried, and so may 
counter-irritation by means of tincture of iodine over the glands. If the pa- 
tient suffers from acidity, fifteen grains of bismuth or magnesia may be taken 
three times a day. Should the discharge be excessive, and the patient's health 
be suffering in consequence, medical advice should be sought without further 
delay. 

(7.) Toothache. Another frequent accompaniment of pregnancy, and one 
which gives rise to considerable pain and annoyance, is toothache. It is not 



MATERNAL MANAGEMENT. 921 

so much real toothache as a rule from which the patient suffers, as a kind of 
neuralgia depending upon an irritable condition of the nerves of the teeth, 
these nerves sharing in the general irritability of the whole system. It ma}', 
however, be dependent upon a decayed state of the teeth themselves. It is a 
well-known fact that during pregnancy the teeth are peculiarly liable to un- 
dergo caries, and decay in consequence. This appears to be due in great part 
to the acidity of the stomach from which females are so apt to suffer at this 
time. If the teeth are good, small doses of quinine should be administered, 
such as one grain two or three times a day. It may be advantageously com- 
bined with steel drops, ten drops being given with each dose of quinine. This 
tonic treatment generally answers well in those cases which are of neural- 
gic origin ; but when the teeth are themselves decayed they must be attended 
to. There is a great dread in many people's minds of interfering with the 
teeth during pregnancy, but this dread is unfounded. There is nothing to 
hinder the pregnant female getting her teeth filled, and if she be strong 
enough, and it be deemed necessary, nothing to prevent her having a tooth ex- 
tracted. ( 

(8.) Palpitation. Frequently during pregnancy a female becomes greatly 
alarmed by finding herself the subject of occasional attacks of palpitation or 
beating at the heart. There will be little cause for anxiety if this condition 
has not been suffered from before, and only attacks the patient for the first 
time now. It may be due to one or other of the following causes : (1) to the 
heart sharing sympathetically in the general disturbance of the system ; (2) 
to the pressure of the enlarged womb interfering with the proper action of the 
heart. During the attack, should it be sufficiently severe to require treatment, 
the best thing to give will be a teaspoonful of sal volatile in a little water, 
which may be repeated in four hours if necessary. Sometimes a patient is 
wakened up during the night with a feeling of impending suffocation. She 
feels as if sufficient air were not entering the room, and requests that the 
windows be thrown open that more may be admitted. Everything must be 
done in such cases to sooth the patient. It is quite a mistake to fly to stimu- 
lants and administer them in the reckless manner that is frequently done when 
a female is thus seized. They are quite unnecessary, and will generally do 
more harm than good. What is wanted is to keep her quiet and as free from 
excitement as possible, when the attack will gradually pass off and leave the 
patient quite well again. If the general health be at all impaired, and the pa- 
tient appear anaemic, much good will result from the exhibition of tonics. . 
The tonics best suited to such cases are the various preparations of iron. Care- 
ful regulation of the diet must also be attended to. 

(9.) Fainting. During the early months of pregnancy this troublesome 
condition is not of unfrequent occurrence ; but the time of all others when it 
is more particularly, met with is about the period of quickening. It may 
occur with greater or less frequency; in some giving rise to little annoyance, 
while in others, by recurring several times during the same day, it proves a 



922 APPENDIX. 



source of great trouble to the patient. The duration of the fit varies; it may 
pass off in a few minutes, or the patient may remain in it for half an hour or 
even longer. It may come on while she is lying quietly, undisturbed by any- 
thing, or, what is more usual, it may manifest itself after undue fatigue or ex- 
citement. During the continuance of the paroxysm the patient should be 
placed in the recumbent position, her head being kept low, and such stimulants 
as the aromatic spirit of ammonia in water may be given in doses of a tea- 
spoonful. Smelling-salts may be applied to the nostrils, and the face may be 
sprinkled with cold water and freely exposed to the air. AVhen the attack is 
over, the condition of the patient's health should engage attention, and a gen- 
eral tonic treatment adopted for some time will generally prove of great benefit. 
The best kind of tonics are those which contain iron. Bitter infusions are 
also very useful, such as the infusion of calumba. All undue excitement must 
be avoided. Crowded assemblies and heated rooms are injurious. Constric- 
tion of any part of the body by tight clothes is bad, and should be avoided. 
The diet must also be attended to. It should be plain and unstimulating in 
character. The bowels should be kept freely acting, a mild laxative, such as 
a dose of castor oil, being taken when necessary. 

(10.) Headache. When the stomach and bowels have been neglected, the 
patient frequently suffers from headache. In such cases the tongue will be 
found foul and loaded, and there will generally be acidity as well. This con- 
dition is to be remedied by attending to the cause which has given rise to it. 
Some mild aperient must be administered until the tongue becomes again 
clear, when the headache will generally be found to disappear as the state of 
the stomach and bowels improves. It may, however, be more neuralgic in its 
nature ; and if so, a different line of treatment will be called for. In this 
case, tonics must be given, such as quinine and iron. Should the headache 
persist, and not yield to such treatment, medical advice had better be obtained. 

(11.) Sleeplessness. Sometimes during pregnancy females are troubled 
with sleeplessness, which, if allowed to go on long without being relieved, may 
seriously impair the health. Every means should be taken to remove any 
cause that may be at work in preventing the patient obtaining sleep ; thus late 
hours and all undue excitement must be avoided, and the mind kept as cheer- 
ful and equable as possible, particularly before retiring to rest. Should it be 
found, after attending to these things, that the patient still continues wakeful, 
twenty or thirty grains of bromide of potassium should be administered in a 
little water at bed-time. 

(12.) Swelling 'of feet and legs and varicose veins. By the pressure of the 
enlarged womb upon the venous trunks the free circulation of the blood in the 
veins of the lower extremities is hindered. This is frequently seen during 
the later months of pregnancy. The return of the blood being thus impeded 
the veins of the legs enlarge and become varicose. This condition most fre- 
quently manifests itself in those who have borne many children. In conse- 
quence also of this mechanical pressure the feet and ankles are occasionally 






MATERNAL MANAGEMENT. 923 

found to swell. This usually occurs towards night, and generally disappears 
before morning. When the enlargement of the veins of the legs is not very 
great, and when the vessels are not hard and lumpy, the administration of mild 
aperients and the application of a calico bandage to the limb will generally 
suffice. The bandage should extend from the foot, and must be applied with 
equal pressure over every part of the limb. When the veins are hard and 
lumpy, and present a knotty character, this treatment may be insufficient, and 
thus recourse must be had to the elastic stocking, and to occasional rest in the 
recumbent position. Should the veius become painful and inflamed, the patient 
must at once resume the horizontal position, apply warm fomentations to the 
part, and send for medical advice. An occasional and very troublesome con- 
dition is met with in the form of an enlargement of the veins of the external 
parts. This affection is not confined to those who have already given birth to 
children, but may also be met with in those who are pregnant for the first 
time. They complain of a swelling at one or other side, which goes on enlarg- 
ing as pregnancy advances, and ultimately becomes very troublesome to them, 
interfering with progression, and in other ways giving rise to annoyance. 
When a woman suffers from this condition she should take frequent rest in 
the recumbent position, and should wear an abdominal belt. Beyond this lit- 
tle can be done, and the condition will pass away of its own accord so soon as 
labor is over, and the pressure which gave rise to it has been removed. Care 
must be taken not to expose these varicose veins to the risk of external in- 
jury, as when ruptured they bleed most profusely, and the bleeding thus set 
up, unless checked, may cause the patient's death. 

(13.) Pain in the side. Among the many neuralgic affections from which 
the pregnant female is apt to suffer, frequent pain in the side is not the least 
annoying. It does not come on till the later months of pregnancy, and is 
due to the pressure of the gravid uterus upon the liver. The pain generally 
comes on in the after part of the day, and may be so severe as to make the 
patient think she is suffering from some inflammatory attack. The state of 
the pulse and temperature, however, point to the true nature of the affection. 
In this case both pulse and temperature will be found normal, whereas if the 
pain were inflammatory in its nature the pulse would be quickened and the 
temperature raised. It is frequently very difficult to alleviate this distressing 
symptom. The patient should apply hot fomentations to the part. A bella- 
donna plaster will frequently give relief. Friction with liniments containing 
opiates is also very valuable. 

(14.) Leucorrhcea or Whites. During pregnancy many women suffer from 
a troublesome discharge which goes by the name of leucorrhcea or " whites." 
This discharge, although it may exist during the early months of pregnancy, 
most frequently proves a source of annoyance to the patient in the later 
months. Like so many of the affections from which the pregnant female 
suffers, it is produced by the pressure of the enlarged womb, and is the result 
of the congested state of the parts to which that pressure gives rise. It mani- 



924 APPENDIX. 



fests itself most severely in the case of those who have had their children rap- 
idly, and whose constitutions are not of the most robust kind. If small in 
quantity it may not call for much attention, but if the discharge is great and 
allowed to go on unchecked, it gives rise to disagreeable excoriation of the ex- 
ternal parts from its irritating nature. If it is not very excessive, the em- 
ployment of a daily injection of tepid water, of water to which some Condy's 
fluid has been added, or with the addition of one or two teaspoonfuls of pow- 
dered alum will generally serve to keep it in abeyance and relieve the patient 
of annoyance. Should the discharge be more excessive the injection must 
be repeated more frequently, thus night and morning, or three times a day. 
When the discharge is very profuse the patient must frequently assume the 
recumbent position, lying every day for two or three hours upon a hair mat- 
tress or a sofa, and sleeping at night upon a horse-hair mattress in preference 
to a feather bed. There must be no overloading with blankets when in bed ; 
rather have too few than too many. The injections must of course be em- 
ployed as in the' less severe forms, and in all cases they must be administered 
gently, no force being employed, as it might prove dangerous. The utmost 
attention to cleanliness is of paramount importance to any one who is suffer- 
ing from this affection. Should such remedies as have been mentioned, after 
receiving a fair trial, prove unavailing in checking the discharge, medical ad- 
vice should be sought, as a predisposition to miscarriage may be induced if it 
be allowed to go on unchecked. Attention must also be paid to the general 
health. The diet should be light, nourishing, and unstimulating. Stimulants 
of every kind should be avoided. The patient should retire to rest early. 
The condition of the bowels must also be attended to, and if constipated they 
must be regulated by the administration of some mild laxative. 

(15.) Pruritus. Along with the leucorrhoeal discharge there sometimes ex- 
ists a very painful and distressing condition of irritation of the external parts, 
to which the name of "pruritus" has been given. This irritation may, how- 
ever, come on independently of any discharge, and by the itching to which it 
gives rise is a source of great annoyance to the patient. It sometimes ap- 
pears to be neuralgic in its origin, while at other times it may be traced to the 
presence of small thread-worms in the lower bowel. If due to the latter cause 
suitable means must be employed for their removal, such as enemata of salt 
and water every morning. Frequently, however, there is no cause that can 
be discovered to account for the itching. The treatment consists in the main- 
tenance of strict cleanliness and the application of such lotions as Goulard's 
extract largely diluted with water. Should this not answer, a lotion composed 
of powdered borax and water, in the proportion of two drachms of the former 
to ten ounces of the latter, should be employed. When the irritation is great 
and the patient unable to obtain sleep in consequence, bromide of potassium, 
given in twenty or thirty grain doses at bed-time, will frequently lessen the 
irritability and soothe the patient to sleep. The diet must be light and nutri- 
tious. Stimulants must be avoided, and the bowels regulated by the adminis- 
tration of mild laxatives when necessary. 



MATERNAL MANAGEMENT. 925 

(16.) Bladder affections. The bladder affections from which the pregnant 
female is liable to suffer are (1) irritability, (2) incontinence, (3) retention. 
Irritability. This distressing condition is of frequent occurrence during preg- 
nancy. In the early months it appears to be of sympathetic origin, while 
later on it is the result of the mechanical pressure exerted by the enlarged 
womb upon the bladder. If allowed to go unrelieved, it may seriously impair 
the general health by the continual disturbance of rest to which it gives rise. 
Much relief will be afforded to those who suffer from this affection by the free 
use of barley-water as a drink, and by taking at bed-time a pill composed of 
three grains of the extract of henbane and two of extract of gentian. Other 
means may be employed ; but should these fail, medical advice had better be 
sought. Mild laxatives must be administered from time to time, so as to keep 
the bowels acting freely. Incontinence. Many women, on coughing, or even 
on the slightest movement, are subject to a disagreeable dribbling away, or in- 
voluntary passing of small quantities of urine. This disagreeable affection is 
the result of pressure by the enlarged womb upon the bladder. It may be 
relieved by wearing an abdominal belt, or by rest in the recumbent position. 
Should the urine give rise to excoriation of the external parts they should be 
smeared over with cold cream or spermaceti ointment. Retention. Instead of 
incontinence of urine the pregnant female may suffer from retention. This 
condition when present must not be neglected, as if allowed to go on it may 
lead to inflammatory affections of the bladder, which may prove very trouble- 
some to the female afterwards. Care must be taken to prevent the bladder 
becoming over-distended, and for this purpose efforts should be made to pass 
water every few hours. 

(17.) Cramps in the legs, etc. From the pressure which the enlarged womb 
makes upon the nerves which pass to the legs, disagreeable cramps are experi- 
enced by the patient. To relieve this painful condition apply friction with the 
naked hand, with camphorated oil, or with a liniment composed of laudanum 
and opodeldoc, in the proportion of one part of the former to two of the latter. 
Movement also may remove it, so that the patient should endeavor to walk 
about -the room when the spasm- comes upon her. Sometimes, instead of 
cramps in the legs, the patient suffers from a similar affection of the stomach 
and bowels. In this case the treatment to be adopted is to immerse the feet in 
hot water and administer a draught consisting of twenty drops of laudanum in 
some camphor water. Hot fomentations should also be applied to the affected 
part. Should this affection prove troublesome by its frequent occurrence, much 
benefit may be derived by the employment every night before going to bed of 
a warm sitz bath. The patient should remain in it for ten or fifteen minutes. 

5. Miscarriage. 

The number of lives that are annually sacrificed by miscarriage alone is 
very great. There are few women the mothers of several children who have 
not miscarried at some period or other of their married life. It is therefore 



926 APPENDIX. 



desirable that the young female should make herself familiar with this subject, 
and thus be in possession of that knowledge which shall enable her to "carry " 
safely through the period of pregnancy, guarding against the occurrence of 
what has proved to many a thoughtless and ignorant one before her the be- 
ginning of a life of suffering and misery. The necessity for every female 
becoming intelligently acquainted with those causes of miscarriage over which 
she. herself exercises so much control will be apparent when it is remembered 
that after one or two miscarriages a woman is apt to get into that condition in 
which it becomes a " habit" with her to miscarry. Nothing is more desirable 
than to prevent the young female contracting this habit; for when once it has 
been formed it may be an extremely difficult thing to get the woman to carry 
to the full time. It is our desire to present this subject in the serious light in 
which it ought to be viewed, and ask that it receive that careful consideration 
which its gravity demands. Unfortunately at the present day the occurrence 
of a miscarriage is lightly regarded by many women ; it is spoken of as if it 
were nothing, and treated with contempt. Now. it is this very light in which 
it is regarded that renders a miscarriage so fraught with danger. Were it 
looked upon more seriously, more care would be taken both to prevent its oc- 
currence, and, having once occurred, to do everything to prevent it recurring. 
It seems difficult to impress upon the female the necessity there is for abso- 
lute rest for several days after miscarriage. Many women leave bed a day 
or two after, and some scarcely think it worth while remaining in bed at all. 
Need it be said that the majority who thus act live to repent of their folly ? 
Miscarriage is not confined to any one period of pregnancy. It may occur 
all through; but the time of its most frequent occurrence is generally be- 
tween the eighth and twelfth week of pregnancy. It has a greater tendency 
to come on at certain times than others ; thus, a woman is more apt to mis- 
carry at the time she would have been unwell if she had not been pregnant, so 
that at these times she ought to be kept as free from excitement and every 
disturbing influence as possible. Miscarriage occurs most frequently towards 
the close of sexual activity, and perhaps next in frequency in the newly- 
married. Hence the necessity for vigilance on the part of the young female. 
The causes which may produce miscarriage are as follows: Anything which 
gives rise to severe mental shock may bring it on ; thus sudden fright, great 
mental anxiety. Anything which taxes the patient's strength severely, such 
as the lifting of heavy weights, excessive exercise either on foot, on horseback, 
driving, or on the railway. Falls also act injuriously, and are frequently the 
exciting cause of a miscarriage. Blows also may produce it. Any undue ex- 
citement may cause it ; hence the necessity there is for the young married 
woman being on her guard. The amount of gayety to which the newly-married 
female is exposed, and the unnatural mode of life inseparable from it, are fer- 
tile sources of miscarriage during the early months of pregnancy. Luxurious 
living also predisposes to this ; scarlet fever, small-pox, and other of the dis- 
eases called " exanthematous " operate as powerful causes in the production of 



MATERNAL MANAGEMENT. 927 

miscarriage. Some women of a naturally delicate constitution are more prone 
to miscarry than others. The exhibition of strong purgative medicines is very 
apt to act injuriously upon the pregnant female, and may bring about miscar- 
riage. Their use at this time should therefore be carefully guarded against. 
Indeed, none but the mildest forms of aperient medicine should be given to 
the pregnant female. Many substances are employed criminally for the pur- 
pose of bringing on miscarriage. Of these, rue, savin, cantharides, and mus- 
tard may be taken as examples; but, as they have no direct influence upon 
the womb itself, they can only act by reason of the irritation to which they 
give rise ; but frequently the unhappy creatures who make use of such means 
bring about their own destruction, — the end they had in view never being 
attained. Severe and excessive sickness may bring about miscarriage, as was 
before mentioned when speaking of the sickness of pregnancy, so that if the 
natural sickness should be excessive the pregnant female should at once consult 
her medical attendant, that means may be employed to keep it in moderation. All 
emetics during pregnancy are dangerous, being apt to bring about miscarriage. 
Their administration must therefore be guarded against at this time. There 
are other causes which, operating upon the nervous system, give rise to irrita- 
tion, and if allowed to go on unchecked may ultimately bring about miscarriage. 
Of this nature are the small thread-worms which frequently infest the lower 
bowel. Constipation is often a source of irritation, and if not attended to may 
at last lead to miscarriage. The irritation also of toothache is occasionally so 
severe as to threaten the patient with miscarriage. It will be seen from what 
has just been said that the causes which may bring about this condition present 
a formidable array ; but, as many of them are under the patient's own control, 
much may be done to obviate its occurrence. 

Symptoms: Having enumerated the "causes," we now pass on to consider 
the symptoms of miscarriage. If, in th£ course of her pregnancy, a woman 
begins to experience feelings of languor, debility, and general depression, and 
if in addition to these she experience an uneasy sensation about the thighs, 
loins, and hips, with pains coming and going, she should be upon her guard, as 
these, although frequently unsatisfactory symptoms, may be regarded as pre- 
monitory of miscarriage. Shortly after, however, if miscarriage is threatened, 
these symptoms will be succeeded by a discharge of blood. This discharge may 
be small in quantity, and after lasting for a short time it may pass off to be 
renewed after the lapse of a brief interval. Instead of a discharge small in 
quantity, there may be a considerable gush of blood occurring quite unexpect- 
edly. Should the bleeding be succeeded by no aggravation of the pains al- 
ready referred to as occurring in the loins and hips, there is hope that by proper 
treatment the threatened miscarriage may be averted; but if, instead, the 
bleeding be followed by pains increasing in strength, and having more of a 
bearing down or expulsive character about them, the probability is that the 
threatened miscarriage will not pass off, but that the pains will go on increas- 
ing in strength until the womb has emptied itself of its contents. 



928 APPENDIX. 



Treatment : The treatment of this condition naturally divides itself into three 
parts : (1) that which is necessary prior to the occurrence of miscarriage, and 
with a view to prevent it ; (2) that which must be adopted after it has oc- 
curred ; and (3) the treatment which it is desirable to pursue after it has 
occurred, with a view to prevent its recurrence. (1.) To prevent its occur- 
rence: If the patient is suffering from weakness, debility, and the other symp- 
toms mentioned above as premonitory of miscarriage, she should immediately 
co to bed. It is useless attempting to pursue any line of treatment as long as 
the erect posture is maintained. What is wanted most imperatively is rest in 
the recumbent position. The head must be kept low ; it ought on no account 
to be propped up with a number of pillows. The patient must be kept cool. 
.She must not be encumbered with bed-clothes, only sufficient being put over 
her to prevent her being chilled. All articles of food and drink must be given 
nearly cold. The room in which she lies should be well ventilated, and if 
there is a fire in the apartment it must not be allowed to overheat the room. 
The patient should be made to sleep on a mattress, and there should be no 
curtains about the bed. The diet should consist of milk food ; it should be 
light and nourishing. Sago, arrowroot, tapioca may be given, a lightly-boiled 
egg, a little gruel, toast and water, and the like. No stimulants must be ad- 
ministered. The medical attendant should be sent for without delay, as this is 
the time when by far the most can be done to prevent the occurrence of a mis- 
carriage. Should it have gone beyond this stage, and should the first thing to 
attract the attention of the pregnant female be a discharge of blood, the same 
rules must be observed. Send without delay for the medical attendant, and 
meanwhile let the recumbent position be maintained. Attend to the rules 
already laid down in regard to the bed and the ventilation of the room. The 
diet must be light and as unstimulating as possible. On the arrival of the 
medical attendant means will be taken, to prevent the occurrence of miscarriage 
by allaying the uterine contractions, and every direction which he lays down 
must be rigidly adhered to. Should the discharge of blood be accompanied by 
pains of a bearing-down or expulsive character, the probability is that the case 
has proceeded too far, and that miscarriage is inevitable. Should this be so, 
the patient must be strictly guided in all she does by her medical attendant, 
who now takes charge of the case. (2.) The after-treatment: As was before 
observed, the occurrence of miscarriage is by many women regarded as a mat- 
ter of little or no consequence, and, as might be expected, the after-treatment 
is often grossly neglected. It is, perhaps, only after the lapse of years 
that the suffering which this neglect has given rise to causes the truth to dawn 
upon the mind. When a miscarriage has occurred, as great care is necessary 
as after a delivery at the full time. If a woman rise a day or two after she 
has miscarried, especially if it be beyond the third month, the womb, which 
was increased in size, has no time to regain its normal dimensions, so that 
when she begins to move about again the ligaments which maintain it in 
position are no longer able to support the increased weight thus put upon 



MATERNAL MANAGEMENT. 929 



them ; they therefore yield to the excessive strain, and the womb falls down, 
as it is called, or becomes displaced. When this occurs it may give rise to 
trouble at the time; more frequently, however, little present annoyance is 
experienced, although the foundation of future misery has been assuredly laid. 
After miscarriage the recumbent position should be maintained for a week or 
ten days, — the diet for the first few days being light and easy of digestion. 
The room must be kept cool and well ventilated. On leaving bed the patient 
should be careful to guard against maintaining the erect posture too long at 
a time. She should, for a week or so longer, rest upon a sofa or couch for 
several hours each day. (3.) To -prevent its recurrence : When a woman has 
once been the subject of miscarriage the question naturally arises, What must 
she do to prevent it happening again ? If it has occurred in a woman who 
appears to be at the time in an enfeebled state of health, attention must be 
directed to its improvement before she becomes again pregnant. For this 
purpose nothing seems to answer so well as change of air. This is a power- 
ful restorative means, and frequently is one of the first things to repair a 
debilitated constitution. The change should be to some quiet country spot, or 
to the seaside ; if the latter be chosen, fashionable watering-places had better 
be avoided, and a place free from bustle and excitement selected. This will 
frequently do much to restore vital energy and bring back health and vigor to 
the exhausted frame, but it may not accomplish all ; hence the necessity there 
is in such cases of bringing the patient under medical influence as well. For 
this purpose a well-directed course of tonic treatment should be begun, and no 
preparations will be found so useful as those of quinine and iron. These two 
substances may be had in the form of pills, or combined in the citrate of iron 
and quinine, of which five grains may be taken in water three times a day. 
The diet should also be attended to. It must be light and nourishing. Milk, 
eggs lightly boiled, and farinaceous substances, such as arrowroot, sago, tapioca, 
corn-flour, and the like, may be given. Bread, brown or white, may also be 
eaten, the latter agreeing better when toasted. Animal food may also be 
taken, but only that which is more easy of digestion, veal, pork, and such like 
being avoided. All pastry and made dishes, or those which are highly 
seasoned, must be forbidden for a time. A moderate quantity of tea, coffee, 
or cocoa may also be taken daily. The sleeping apartment should be well 
ventilated. A horse-hair mattress is preferable to sleep upon, and is more 
conducive to the maintenance. of health than a feather bed. There should be 
no curtains about the bed. The patient should be regular in her hours of 
sleep, and ought to retire to bed early. Irregular hours, sitting up late at 
night, and engaging the mind with what is 'calculated to produce excitement, 
are fruitful sources of disturbed and restless nights. The mind should be kept, 
as far as possible, calm and tranquil, especially before retiring to rest. A 
moderate amount of exercise should be taken daily. It is as bad for the patient 
to remain constantly indoors as it is for her to fatigue herself while taking 
exercise. The best time for taking exercise is between breakfast and dinner, 



930 APPENDIX. 



and that kiud of exercise which answers best is walking. Of course this must 
never be carried so far as to fatigue the patient. Should she be too weak at 
first for this kind of exercise, a drive in an open carriage should be taken daily 
till she is able to go on foot. The state of the bowels ought also to be attended 
to, and should be carefully regulated by diet, so far as that is able to do so, 
and that failing, recourse must be had to the milder laxative medicines, such 
as castor oil, compound licorice powder, or pills of colocynth and hyoscyamus. 
No severe purgative medicines are to be made use of; they are quite unneces- 
sary, and are frequently productive of harm. A little Pullna water taken the 
first thing in the morning will often answer admirably for this purpose. A 
remedy, powerful alike in restoring the debilitated constitution and in causing 
the womb to regain its tone, will be found in baths. In summer the sponge 
bath or the shower bath may be employed, and cold water used ; in winter the 
same baths will prove of great service, but tepid water should be employed 
instead of cold, at least to begin with. Great benefit will be derived from the 
daily employment of the sitz bath. The water should be slightly tepid. This 
bath has a powerful and invigorating action upon the womb. A coarse towel 
should be employed for the purpose of drying the body. During her absence 
in the country, and for several months after the occurrence of a miscarriage, 
the marital relationship should cease. If the woman has miscarried several 
times, and has got into that state in which she is described as having acquired 
a "habit of miscarrying," she should be very careful of her health when again 
pregnant. When she has again become pregnant, she must sleep apart from 
her husband. This is absolutely necessary to secure her carrying to the full 
time. She should rest frequently during the day, and the amount of exercise 
taken must never be such as to produce fatigue. The diet must be plain, 
nourishing without being stimulating, and all alcoholic beverages must be 
avoided. The state of the bowels must also be attended to. They must never 
be allowed to become constipated, and for this purpose an enema of simple 
soap and water or gruel, with or without the addition of castor oil, may require 
to be administered from time to time. Should the enema be objected to, some 
mild laxative must be taken by the mouth. When the time at which she 
formerly miscarried approaches, great care requires to be exercised. She 
should rest in the recumbent position for several hours daily, and if symptoms 
of impending miscarriage manifest themselves notwithstanding these precau- 
tions, she must at once go to bed and send for medical assistance. At the 
approach of each menstrual period, that is to say, at the approach of the times 
at which she would have been unwell had she not been in the family way, 
the utmost vigilance is necessary. At these times the tendency to miscarry is 
always greater than at others ; hence the necessity for increased precaution. 
The amount of exercise should now be diminished. The baths may be con- 
tinued with advantage, except the shower bath, which is apt to prove too 
severe at this time. The rules that have been already laid down in regard to 
ventilation and the kind of bed upon which the female should sleep are to be 






MATERNAL MANAGEMENT. 931 

carried out in their utmost stringency. After the lapse of six weeks or two 
months beyond this date the pregnant female may consider herself ; ' out of 
danger," and may look forward hopefully to the termination of her pregnancy. 

6. False Pains. 
Many women, especially those who are pregnant for the first time, are 
troubled with what are called false pains. They may come on several days, 
or even more, before the actual labor pains are felt. From true labor pains 
they may be distinguished by the uncertainty of their position. They may at- 
tack the belly, the loins, or the hack. They recur perfectly irregularly, and 
have no influence whatever in causing the expulsion of the child. They may, 
however, if they continue long enough, merge into the true pains of labor, and 
only terminate in these. "When a female is the subject of these pains towards 
the close of pregnancy, attention should at once be directed to the stomach and 
bowels, which frequently, when disordered, give rise to pains of this description. 
If the bowels are confined a gentle dose of castor oil should be taken, and if 
the stomach appears to be at fault the diet should be regulated. After the 
stomach and bowels, have been attended to, should the pains still continue un- 
abated, and the patient's nights be thereby rendered sleepless, medical advice 
should be sought. It is necessary not to allow these pains to go on long un- 
checked, as the patient's strength may become exhausted as the true pains of 
labor are setting in, and her confinement in consequence be increased in dan- 
ger. 

III. CONFINEMENT. 

There are certain symptoms which manifest themselves towards the close of 
pregnancy, and warn the female that her confinement is now not very far off. 
One of the first of these symptoms to attract the patient's attention will be a 
perceptible alteration in the size of the abdomen. It will appear to her that 
she is less now than she was perhaps a month before ; and whereas during the 
last few weeks she felt perfectly incapacitated for active exercise, she now 
feels able to move about Math comparative ease, and experiences a greater de- 
sire for walking than she has done for some time past. The breathing, too, 
which before was affected on the slightest exertion, is now free and performed 
without difficulty. The reason of the abatement of these symptoms is this, 
namely, that the womb has now sunk lower down in the pelvis, causing a cor- 
responding diminution in size, and in so doing the pressure which it kept up 
upon the lower part of the chest is removed, and the breathing, which from 
this cause was performed with difficulty, is now easy and natural. But while 
these symptoms, which formerly proved so troublesome, are passing away, 
their place is being taken by others no less annoying to the patient. While 
the womb was high up, the organs in the chest were those which suffered, the 
pelvic organs being meanwhile unaffected ; now, however, the contents of the 
pelvis are subjected to pressure, and fresh symptoms begin to manifest them- 



932 APPENDIX. 



selves. The bowels and bladder begin now to give the patient trouble ; she 
experiences a frequent desire to enqity the bladder and evacuate the bowels. 
This is a wise provision of nature to keep the channel through which the child 
has to descend as free as possible from anything that would impede it in its 
course when labor has begun. The indications thus given should put the fe- 
male upon her guard to prevent the bowels becoming constipated ; and if they 
are at all confined, a gentle dose of castor oil must be administered, so as to 
have them thoroughly evacuated. The frequent calls to make water at this 
time must also not be disregarded, as an inflammatory state of the bladder may 
be set up. Besides those symptoms already enumerated, a discharge now 
makes its appearance, called in popular language "the show." This discharge 
consists of mucus, and is of a whitish color, or may be mixed with blood. 
Along with this slight pains are now experienced, which increase in severity 
and in the regularity with which they occur until the contents of the womb are 
expelled. The character of these pains may be described as "grinding ; " and 
whenever they are felt, and the " show " has made its appearance, the med- 
ical attendant should be sent for, or at least communicated with, that he may 
not be out of the way. The pains are at first slight and* irregular ; but as 
labor advances they assume a more bearing-down character, and the intervals 
between each pain become less. 

1. Preparations for Labor. 
(1.) The breasts, for about six weeks previous to the time the woman expects 
to be confined she should attend to the condition of her breasts. Many women 
by neglecting this precaution suffer from excoriated nipples, which give rise to 
great pain and irritation every time the infant is put to the breast ; and, in- 
deed, so acute may be the suffering during the time the child is at the breast, 
that the periods of suckling are looked forward to with dread. By a little 
previous care and management all such disagreeable complications may be 
avoided, and the act of suckling be attended with pleasure instead of pain. 
When the nipples are thus excoriated, the irritation to which the excoriations 
or cracks give rise frequently causes the formation of abscesses in the breast, 
which may entail upon a mother weeks or months of sore suffering. About 
six weeks, then, before she expects to be confined, the pregnant female should 
begin to bathe her nipples with a little brandy and water or eau de Cologne 
and water, in equal proportions, or with a little tincture of myrrh ; she should 
then expose them for five or ten minutes to the air. By so doing the nipples 
will be hardened and rendered fit for suckling. It sometimes happens that 
when a female has been neglectful of these precautions previous to delivery, 
it is found, on putting the infant to the breast, that owing to the retracted state 
of the nipples it is unable to suckle. The possibility of such a disagreeable 
occurrence should be borne in mind ; and when it is noticed to have takei 
place no time should be lost in employing adequate means to remedy it. F 
this purpose nothing answers so well as a good nipple shield, which can easily 



te 
>le 
en 

z 



MATERNAL MANAGEMENT. 933 

be obtained. It ought to be worn both day and night. This retracted state 
of the nipples is generally brought about by the pressure of the corset when 
the breasts have begun to enlarge. Sometimes the nipples are noticed to have 
a rough or nodulated appearance, and as cracks are more apt to occur when 
this condition is present than when it is absent, it must not be overlooked. On 
being noticed, the nipples should be bathed two or three times a day with a lo- 
tion consisting of sulphate of zinc and rose-water of the strength of two grains 
to the ounce. When fissures or cracks already exist, a good remedy will be 
found in a little powdered borax, mixed up with glycerine and water. A lo- 
tion, consisting of half an ounce of sulphurous acid, half an ounce of glycerine 
of tannin, and an ounce of water, is recommended by Professor Playfair in his 
work on midwifery as of great value in these cases. When the breasts are 
hard and nodulated, the dress must not be allowed to press uncomfortably upon 
them. By a little care and attention on the part of the female these disagree- 
able affections may be altogether prevented. 

(2.) Attendants. Some months before a woman is expected to be confined 
she should consult with her friends, or with her medical attendant, and engage 
the monthly nurse. Should she undertake this duty without consulting the 
doctor, she should inquire amongst her friends, and select as nurse a person 
who is thoroughly qualified for the work. There is nothing more annoying to 
the female who has been recently confined than to be obliged to tell the woman 
who has come to nurse her what her duties are, and, perhaps, teach her how they 
are to be performed. Instead of being a comfort and relief, a nurse of this de- 
scription is a source of endless annoyance, and there is nothing more likely to 
retard recovery than to be worried in this maimer. The woman who is chosen 
as nurse should be one who has bodily strength sufficient for the duties of her 
post. She should be a woman of a kind and loving disposition, and one in whom 
the utmost dependence can be placed for the carrying out of the directions of 
the medical attendant. She must be no gossip. Nurses are only too apt to 
become such ; but especially is this objectionahle in the monthly nurse, as she, 
in recounting her experience during confinements, is almost sure to introduce 
all manner of objectionable cases,, which can have no other than a prejudicial 
influence upon the patient's mind, rendering her uneasy and apprehensive as 
to the successful termination of her confinement. A nurse, then, having such 
qualifications as we have alluded to, having been selected, it is well to have 
her in the house a few days before the expected date of confinement. < 

In addition to the nurse, the only other attendants that should be found in 
the lying-in room are the doctor and a female friend. Generally the patient's 
mother is the one who is chosen to wait upon her at the time ; hut there are 
cases in which it would be better and greatly to the patient's advantage were 
some other person chosen for this office. Especially is this the case if the 
mother is a woman of an excitable and nervous disposition, and, by her anx- 
ious looks and serious utterances, is likely to disturb that mental calm in the 
patient so necessary to the successful termination of her confinement. If, 



934 APPENDIX. 



however, the mother is a woman who can command her feelings, the young 
female will derive much comfort from her presence ; and whether she he the 
person chosen to be present with her during her confinement or not, it will be 
as well for her to be in the house. If from any cause the patient's mother 
cannot be in attendance upon her at this time, a friend should be selected who 
is able to act calmly and lovingly. She should be herself a mother, and will 
thus be able to sympathize with her in her suffering, and cheer her with the 
assurance of speedy relief, which her own experience enables her to give. 
Anything like a congregating of individuals in the lying-in room must be 
avoided. It is necessary for the patient's safety that the apartment be kept 
cool ; but if, instead of attending to this, the room is crowded with neighbors 
and friends, as is frequently the case among the poorer classes, it is perfectly 
impossible to keep the apartment in anything like a hygienic condition. The 
consequence of this crowding and overheating of the apartment is that the 
patient becomes feverish and restless, and lahor is retarded. Let every one, 
therefore, who is not absolutely required, be kept out of the room ; and when 
labor has begun, let only the medical attendant, one friend, and the nurse, be 
found there. The conversation should he light and interesting, and of such a 
nature as to engage the patient's attention, and keep her mind cheerful and free 
from anxiety. Especially is this desirable in the case of those whose first con- 
finement it is, and in whose mind there naturally exists a certain amount of fear 
and anxiety. Every fear in the young female should be, as far as possible, 
allayed ; she should he reminded by those round about her that the process is 
a natural one, that the results are such as to enable her to look forward to the 
satisfactory termination of her suffering, and that after a short time every- 
thing will be over. It is necessary for those in attendance thus to cheer the 
patient ; inasmuch as anything which tends to depress her mentally tends also 
to retard labor. Let it be again repeated that the nurse must not be allowed 
to talk of bad cases in the patient's hearing. Whatever she has got that is 
cheerful, and such as may be comforting to the patient, let her communicate. 
That, however, from which the female will be likely to derive most comfort 
will be the testimony of the medical attendant, so that if after making an ex- 
amination he declare everything to be going on well, her mind should be at 
once set at rest. The medical attendant should be sent for whenever the female 
becomes conscious of the presence of actual labor pains. In those who have 
already borne children, we would especially advise that this be not delayed, 
because in such cases nature is frequently working quietly for some time, and 
on the occurrence of a few severe pains the child has been born. It is, at any 
rate, always safer to call in medical aid too soon than too late, and, besides, 
the doctor will be the best judge as to the length of time labor is likely to oc- 
cupy, and so can go or remain, as he may think fit. 

(3.) The bedroom. The room in which the female intends being confined 
should not be chosen without previous thought. As regards size, the room 
should be ample, and one which will permit of thorough and efficient ventilation 



MATERNAL MANAGEMENT. 935 

being carried out during the lying-in month. For this purpose it must be pro- 
vided with an open fire-place. Without this it is quite impossible to carry out 
any efficient system of ventilation. If the confinement take place in summer 
there will be no necessity to keep a fire burning throughout the lying-in month, 
unless the weather be cold and damp ; but if there is no fire, care must be 
taken to see that the chimney is not stuffed up, as is frequently done, to pre- 
vent the entrance of so much air. In winter it will be necessary to keep a 
fire burning in the room ; it must not, however, be kept large, as the apartment 
will soon become overheated, and the woman get feverish and restless in con- 
sequence. Care should also be taken to keep the fire burning equally ; if al- 
lowed to get low, and then suddenly heaped up with coals, a draught is produced, 
which may give the patient cold and retard her recovery. The window in the 
room should be freely movable, and may be kept open an inch or so at the top, 
which will secure a plentiful supply of air entering the room at all times, and 
keep it cool and fresh. Should the patient complain of cold, the perforated 
zinc bar formerly made mention of should be employed, by which means the 
air will be divided, and perhaps rendered less objectionable to the patient's feel- 
ings. The temperature of the apartment should be maintained as uniform as 
possible, and must not be permitted to rise too high. In order to insure this 
being thoroughly attended to there ought to be a thermometer in every lying- 
in room, and the temperature must never be allowed to be above 60° Fahr., 
otherwise the patient will become feverish and restless. The position of the 
room in the house should be such as to secure for the patient as much quiet at 
this time as possible. For this reason, if situated in a street, the back of the 
house will be preferable to the front. The utmost care must be taken during 
the lying-in month to prevent anything remaining in the room that would be 
likely to prove a source of atmospheric contamination. The air of an apart- 
ment is frequently polluted from the carelessness of nurses in attending to 
this, and the patient's life is in consequence endangered. Everything that is 
likely to be wanted at this time should be provided : thus there should be a 
pair of scissors, pieces of tape, not very broad, a ball of worsted, and some 
whity-brown thread. These should all be at hand, as, unless the patient is 
already familiar with what the medical attendant is in the habit of using for 
the purpose of tying the cord, any of these may be required. There should also 
be an ample supply of towels, a flannel receiver, soap, violet powder, or other 
unirritating powder, a pot of lard without salt. The infant's clothes and the 
bath for washing the child should also be in readiness. 

(4.) The bed. The best kind of bed to have in the lying-in room is one made 
of iron. It should not stand above three feet from the ground, and the mattress 
should be of horse-hair. The fewer curtains there are about the bed the better. 
A large sheet of mackintosh or other waterproof material should be placed 
above the mattress to protect it, and above this a blanket and then a sheet. 
Next there should be a folded sheet to place under the patient as a draw-sheet, 
which is to be removed when labor is over. A sheet or large towel should also 



936 APPENDIX. 



be taken and folded so as to form a kind of rope for the patient to pull by 
when the pains assume a bearing-down character. This should be fastened 
to the foot of- the bed, to one or the other side, or it may be fixed to the far 
corner of the head of the bed if preferred. A small cushion should be pro- 
vided, against which the patient may press her feet during the presence of a 
pain. Neither the towel nor the cushion should be made use of till the pains 
have become bearing-down ; otherwise the patient may exhaust her strength 
needlessly, because at a time when such can be of no use. 

(5.) The dress of the female. This should consist of a chemise, from which 
on going to bed the patient will withdraw her arms, so that it may be slipped 
off without difficulty on the completion of labor; a petticoat, which also is to 
be removed when labor is over. A clean chemise should also be put on when 
the patient goes to bed. This is to be folded well up under the arm-pits, so 
that it may not be soiled during delivery, and may be clean and comfortable 
when drawn down afterwards. Over this the bedgown should be placed, and 
folded up in the same manner as the chemise. Over all a dressing-gown may 
be worn during the early part of labor, but this had better he dispensed with 
when the patient goes to bed. Some women wear their stays during labor for 
the purpose of giving themselves support ; but as they are useless, and fre- 
quently in the way. they should not be kept on. 

(6.) Position during labor. If now the medical attendant has arrived, or if 
the pains have become so severe that the patient is unable to remain up longer, 
she should go to bed. The position she is to occupy is the one in which she 
will be delivered, and ought to be upon the left side, with the head and shoulders 
nearly in the centre of the bed and the hips about a foot's distance from the 
edge. The knees should be drawn up. The patient when placing herself in 
bed must be careful to attend to these rules ; they will add materially to her 
own comfort and to that of the medical attendant. The patient being now in 
bed, and occupying the position already described, the doctor will request that 
an examination be made, or that he be allowed to "try a pain," as it is called. 
As many young females, from feelings of false delicacy, object to this examina- 
tion being made, and place their medical attendant in a very awkward posi- 
tion, a few words of caution may be needful in regard to it. To make such an 
examination is necessary for the following reasons: (1.) It enables the med- 
ical attendant to ascertain whether or not labor is actually begun, and if it is 
begun to what length it has proceeded. (2.) It enables him to know whether 
or not everything is right, — that is to say, whether the child is presenting h 
the most favorable manner, and should anything be wrong this may be the 
best opportunity to rectify it ; at any rate it will be the best time for the med- 
ical attendant to make up his mind as to what he thinks necessary to be done. 
(3.) If everything is right, and labor has already advanced a considerable way, 
it will give the medical attendant the pleasure of communicating this to the 
patient, and so relieve her mind of much anxiety. Should the patient, however, 
refuse to be examined, what is the result ? The doctor does not know whether 



MATERNAL MANAGEMENT. 937 

labor has commenced, and whether he can leave with safety to visit some one 
in the immediate neighborhood. He does not know whether any active inter- 
ference is necessary now or is likely to be. He cannot assure the patient that 
everything is right, and cheer her with that assurance. He must remain in 
doubt and uncertainty, and she in distress and anxiety. By calmly submitting 
to what she should look upon as a necessity her mind may be greatly relieved, 
her fears may be dispelled, her courage strengthened, and her labor soon brought 
to a successful termination. Let every woman be assured of this, that the ut- 
most regard will be paid to her feelings in the conducting of every such ex- 
amination, that the greatest possible gentleness will alone be experienced. Let 
her confide entirely in her medical attendant, trust to him, and be implicitly 
under his control in whatever he deems it necessary to do. The examination 
then having been made, the doctor is able to assure his patient in regard to her 
condition, to relieve her mind of much anxiety, and, it may be, he is able to tell 
her how long she is yet likely to be. He is also able now to tell her whether 
it is necessary for her to remain in bed, or whether she may not be up and 
moving about, and the longer she can thus keep upon her feet the shorter will 
the period of actual labor appear. 

2. The Period of Actual Labor. 
Actual labor having now set in, and the medical attendant having deemed it 
necessary that she should remain in bed, the patient must take up her position 
on the left side, in the manner already indicated. If, till now, she has had her 
dressing-gown on, it should be laid aside. About this time also — that is, be- 
fore labor has advanced very far — there will frequently be experienced a con- 
stant desire to pass water, and with the occurrence of each pain a small quantity 
may be forced from the bladder. These calls to micturition must not be dis- 
regarded, and for this purpose the medical attendant will occasionally leave the 
room. Should this desire to make water not be present, as sometimes occurs 
when the ordinary duration of labor has been exceeded, the medical attendant 
•should be told of the circumstance, as it may be necessary for him to interfere 
actively in order to relieve the bladder. If the calls to pass water are unheeded 
it accumulates in the bladder, which, becoming distended, may act as a serious 
obstacle to the progress of labor. In addition to this, however, there is the 
possibility that by such neglect an inflammatory state of the bladder may be 
lighted up, and the foundation of much after-suffering be thus laid. By press- 
ure of the head upon the nerves which pass to the lower extremities severe 
cramps of the leg and thigh are apt to be set up as labor advances. They are 
a source of great annoyance to the patient by reason of the suffering to which 
they give rise. When this painful condition is present, friction with the warm 
hand, or by means of a piece of flannel heated at the fire, will generally give 
relief. Should these fail, friction by means of a little soap liniment may be 
employed instead. Sometimes, also, during the early part of labor a woman 
may be troubled with sickness, and often vomits. Unless the vomiting be ac- 



938 APPENDIX. 



companied by collapse and a cessation of the labor pains, its effect will be 
beneficial rather than otherwise. 

(1.) Duration of labor. "How long will it be till labor is over?" is a 
question that is frequently put by'the lying-in woman to her medical attendant. 
As this question is one which it is almost impossible to answer except eva- 
sively, it should not be pressed. The duration of labor varies greatly, almost 
no two cases being exactly alike, and about the most that can be said is that 
first labors are generally considerably longer in their duration than others. If 
the patient has been assured by her medical attendant that everything is go- 
ing on well, and if the pains continue good, it may not be long before all is 
over. 

( 2.) Food during labor. During the first part of labor no restriction need 
be put upon the diet; the patient may take any ordinary article of food for 
which she has a desire without hesitancy ; but as labor advances, it will be 
advisable to refrain from solid food altogether. Articles of diet of a fluid 
nature will now answer much better, and nourishment may be administered 
from time to time in the form of a little milk or beef-tea. Beyond these there 
will be nothing else required unless the patient should complain of thirst, in 
which case a little cold water, toast-water, or gruel, may be given, and will 
be found very serviceable for this purpose. Some people are afraid to give 
cold water during labor, lest it should do the patient harm. They may, how- 
ever, have no scruple in this respect; it frequently answers better than any- 
thing else for quenching the thirst, and is generally very grateful to the pa- 
tient. A large quantity need not be given at a time, — a teaspoonful or a 
tablespoonful will frequently go as far to slake the thirst as the most hearty 
draught. 

(3.) Character of the pains. Labor pains may be said to be of two kinds : 
First, those which occur during the early part of labor, and are described as 
being tearing or cutting in their nature. During the continuance of these 
pains, the woman generally cries out, and is very restless, tossing about thej 
bed in an uneasy manner. The bag of membranes, in which the child is con- 
tained, and which is generally spoken of as the " waters," is generally intact 
during this period, and is occupied in opening out the mouth of the womb. 
When by any chance the waters break before this is accomplished, the work 
has to be undertaken by the head of the child, and is attended with consider- 
ably more pain than if it had been by the soft wedge formed by the bag of 
membranes. During the latter part of labor the pains become altered in 
character; they have now more or less of an expulsive power about them 
which they did not possess while the dilatation of the mouth of the womb was 
going on. They are now spoken of as bearing-doivn pains, and while they 
last the muscles of the abdomen are brought into play, and the female, catch- 
ing hold of something with her hands, and pressing against a fixed point with 
her feet, bears down, and so assists the expulsive efforts of the womb. These 
pains are further distinguished from the early pains of labor in this that, as a 



MATERNAL MANAGEMENT. 939 

rule, during the greater part of their continuance, the patient remains silent, 
only giving utterance to expressions of suffering as the pains pass off. The 
period of most intense suffering is when the head presses against the external 
parts ; but after it has pressed sufficiently long to stretch them fully, with a 
pain of unusual severity, and with a throe of agony, the head is born, and re- 
lief immediately experienced. 

3. Hints to Attendants should the Doctor not be present. 

As it sometimes happens, especially in the case of those who reside in the 
country, and at some distance from medical assistance, that the child is born 
before the doctor has time to be sent for, it will be well that those who are in 
attendance should know how to act in the mean time. We shall therefore lay 
down a few plain rules for the guidance of those who may at any time be thus 
awkwardly placed. As the head is being born, one of the attendants should 
place her left hand upon the patient's belly and grasp the womb. The object 
of this is that she may be able to follow it as it contracts and expels the child, 
and when the infant is born that she may keep hold of it until the arrival of 
the doctor, or, at any rate, till the afterbirth has come away. Unless this 
simple precaution is attended to, the patient may suffer from flooding, and her 
life be thus endangered. When the head is born one of the attendants should 
place her hand upon the child's neck and feel if there be any coil of cord 
round it ; and if there be it ought to be gently pulled upon so as to loosen it, 
or it maybe removed from the neck altogether. It is very important that this 
should be attended to without delay, as the child may be very easily strangu- 
lated if the cord is wound tightly round the neck. Having ascertained that 
everything is right, and there is no coil of cord about the neck of the child, 
the right hand of the attendant should be placed under the infant's head to 
direct it forwards as the body is born, which will generally be in a few seconds 
after. In case there should be anything lodging in the child's mouth which 
would be likely to interfere with the breathing, the finger of the atttendant 
should be introduced into it, and anything that may be there removed. Fre- 
quently the mouth of the infant is filled with mucus, which may prevent it 
breathing freely ; but if this simple proceeding be resorted to, the mucus may 
be at once removed. 

On the child being born, if strong and healthy, it will generally begin to 
cry. If, however, instead of crying, it remain in an apparently lifeless condi- 
tion, efforts must be made as speedily as possible to cause it to breathe. For 
this purpose the child should be smartly tapped upon the buttocks, back, or 
chest, which will, in many instances, have the desired effect of bringing it 
round. Should this procedure, however, not have the desired effect, what is 
called artificial respiration must be had recourse to. It may be performed as 
follows : The hands of the infant are seized by the attendant and raised 
from the side until they are lifted above the child's head as far as they will go, 
by doing which the act of inspiration or drawing of air into the chest is imi- 



940 APPENDIX. 



tated, after which the hands and arms are to be depressed until they are 
brought to the side again, by which the air will be driven from the chest, and 
the act of expiration be thus imitated. Should this fail in causing the child 
to breathe, another method may be tried. It may be briefly described thus : 
The mouth of the attendant being placed close to that of the infant, she is 
to breathe slowly, as in expiration, emptying the chest of its contained air, and 
filling with the air thus expelled the lungs of the child. During this process 
the child's nose must be compressed by the fingers. When this is done the 
open hand should be laid flatly upon the client, and pressure made, at the same 
time removing the pressure from the nose. By this means the lungs will be 
emptied of their contained air, when the process may be again repeated. 
Should it be found, after the employment of these various means, that the 
child is not restored to animation, the cord must be divided, and the infant put 
into a warm bath — that is to say, a bath having a temperature of about 98° 
Fahr. It may be as well to remark here that an ample supply of warm water 
should always be at hand, especially if the labor has been at all tedious. Rub- 
bing the chest and back with equal parts of brandy and water may also 
be tried in cases of this kind. Suppose, however, the child has been born, and 
that so soon as it comes into the world it begins to struggle and kick violently 
and cry loudly, what is to be done ? If the medical attendant is likely to 
arrive presently, the infant's head should be turned towards the edge of the 
bed, so as to be away from the discharges, and the hed-clothes so arranged as 
to admit a plentiful supply of air. Beyond this nothing need be done in such 
cases. 

If, however, it be uncertain when the doctor may arrive, or if it be in the 
country, where the presence of skilled assistance cannot always be calculated 
upon when wanted, it will generally be necessary to divide the cord, and thus 
sever the child from its connection with the parent. This may be done in the 
following manner : The cord being taken up in the left hand, a piece of 
tape, several strands of whity-brown thread, or two or three thicknesses of 
yarn are passed around it, and tied in a double knot about the distance of 
three fingers' breath from the navel. A second ligature should then be placed 
about an inch and a half nearer to the mother, and midway between these two 
ligatures the cord is to be divided. The application of this second ligature is 
not absolutely necessary in the great majority of cases, but it is always better 
to apply it. 

This having been done, the child is to be placed in the flannel receiver and 
removed to a secure place. This should not be an arm-chair, or other place of 
a like nature, where the child runs a risk of being injured through the care- 
lessness or forgetfulness of those in the room. Further attention must now 
be directed to the mother. The first question which naturally suggests itself 
on turning again to her is, " What of the after-birth? Is it to be removed, 
or should it be allowed to remain ? " The answer to this is that " the less 
the attendants interfere with the after-birth the better." Any rash attempts at 



MATERNAL MANAGEMENT. 941 

removing it by pulling upon the cord may be followed by severe flooding, or by 
breaking of the cord, the after-birth remaining in the womb. Frequently, 
indeed, the after-birth comes away a short time after the child is born, the 
same pain that brings about the expulsion of the latter giving rise to loosening 
of the former, so that on the recurrence of the pains after a short period of 
rest it is frequently expelled. Sometimes, also, the same pain which caused 
the birth of the child expels the after -birth, which follows upon the infant's 
heels. Should it not come away by the normal contractions of the womb, no 
attempt is to be made to remove it. The hand of the attendant, which has 
been grasping the womb, must not be relaxed, but should be kept there in- 
cessantly until the arrival of the medical attendant. This pressure by the 
hand over the lower part of the belly upon the womb is a great safeguard 
against the occurrence of flooding, and frequently will be found of as'sistance 
in causing the expulsion of the after -birth. Care must be taken in removing 
the child from the bed, that in lifting it a sufficient hold is obtained. Tt some- 
times happens that by the careless manner in which children are lifted they 
fall, and are seriously bruised and injured. The way in which a child can be 
best lifted is by taking the back of its neck between the thumb and forefinger 
of the right hand, and allowing the buttocks to rest upon the palm of the left. 
In this manner the child may be lifted with perfect security and placed in the 
receiver. 

4. The Mother. 
On the removal of the after-birth the mother ought to be allowed to remain 
just as she is for about an hour, after which time the immediate risk of bleed- 
ing will be in great measure over, and the soiled linen can then be taken 
away. Should any attempt be made to do this immediately after the expul- 
sion of the after-birth it may be attended with severe haemorrhage, and may 
even cost the patient her life. Too much caution cannot be given in regard 
to this, and my readers would do well to bear it in mind. It frequently hap- 
pens that when, from any cause, attendants are left to do this themselves they 
are extremely careless in regard to what they allow the patient to do, and it is 
well if, in allowing this self-assistance, they do not bring upon the woman a 
severe flooding. An hour, however, having elapsed, the draw-sheet should be 
removed along with the soiled garments. This must be done with as little 
disturbance to the patient as possible, and when the removal of the soiled 
articles is completed the clean chemise, which, if previous injunctions have 
been followed, will be folded up under the arm-pits, should now be brought 
down. After this a warm napkin should be placed to the external parts, or, 
preferably, placed not in immediate contact with the parts, but under the hips 
laid flat out. A clean sheet, well aired, should now be placed under the 
patient, and the binder applied. The binder is generally made of a piece 
of calico about two yards long and eighteen inches deep. Frequently, how- 
ever, a bolster-slip is used for this purpose, and answers very well. Perhaps 
the best kind of binder that can be used is one made of unbleached calico, 



942 APPENDIX. 



about a yard and a half long and eighteen inches deep, with the upper part 
cut away so as to render the top narrower than the bottom, which enables it 
to be applied more regularly, and if made slightly narrower immediately 
above the lower edge than a few inches above it will the better maintain its 
position. The binder ought always to be made so that it will extend below 
the fullness of the hips, and embrace the upper part of the thighs. It must 
not be applied too tightly, as is sometimes done, a moderately firm support 
being all that is required. It was formerly the custom to place some more 
solid article, such as a book, a pincushion, or a folded towel under the binder 
and over the womb to compress it, and so prevent flooding. Such things had, 
however, better not be introduced, as they are apt to interfere"with the proper 
contractions of the womb,' and so prove obnoxious. While the binder is being 
applied, and, indeed, while everything is being done to the patient at this 
time, she must be kept as passive as possible. The fewer the efforts she 
makes on her own behalf the better. The most serious risk of dangerous 
haemorrhage, or even of immediate death, is sometimes incurred by women 
raising themselves to the sitting posture at this time, and they cannot be too 
strongly impressed with the necessity there is for them to remain both recum- 
bent and passive. 

All necessary changes having been accomplished, the patient should now be 
raised a little higher in bed, and for this purpose two assistants will be re- 
quired. They should stand one at each side of the bed and draw the patient J 
carefully up. The bed-clothes should now also be arranged about the patient, | 
and if she feel chilly some extra covering may be required, and a petticoat 
warmed before the fire may be wrapped round her feet. She must on no ac- 
count be overburdened with bed-clothes, as too great heat at this time may act 
injuriously upon her. The changing of the patient being now finished, and 
everything about the bed being arranged comfortably, she may be given some- 
thing to eat. The best thing to give her at this time will be a cupful of tea 
and milk, about equal parts, or some milk and bread. If preferred, a little 
beef-tea may be given instead. No stimulants of any kind must be given to 
the patient unless they have been specially ordered by the medical attendant. 
When the patient has had something to eat, the room should be rendered per- 
fectly quiet, and she should be induced to sleep. 

Rest after delivery. There is nothing likely to prove more injurious to a 
young woman after her first confinement than to allow a great number of " 
people to come into the room beside her. Amongst the lower classes it fre- 
quently happens that a confinement is scarcely over before the apartment in 
which she is lying becomes thronged with neighbors and friends, whose inten- 
tions may be laudable enough, but whose company she had much better be 
without. In the upper classes, also, the young mother is subjected to a like 
influence, and owing to the greater susceptibility of her nervous system she 
becomes excited, grows feverish and restless, and frequently has, if nothing 
more serious ensues, a protracted recovery in consequence. Too much care, 



MATERNAL MANAGEMENT. 943 

therefore, cannot be taken to keep the young mother perfectly quiet after her 
labor is over, and to keep her free from all those disturbing influences which 
operate so injuriously upon her. The requests of well-intentioned friends must 
be calmly yet firmly refused until such time as the medical attendant shall see 
fit to admit visitors into her apartment. Those who fail to insure tranquillity 
to the young mother at this time incur a great risk of doing her harm. The 
noisy talk of those who are well is ill borne by the patient at this time, so that 
everything should be done to secure mental as well as bodily rest. The room, 
then, having been darkened, only one attendant should remain with the 
patient. The presence of more than one in the apartment is unnecessary, 
and only tends to render its atmosphere impure. Care must be taken to keep 
the room cool. If the fire be kept burning too high the apartment will soon 
become overheated, and the probability is that the patient will become fever- 
ish and restless, and unable to sleep. If the patient express a desire to make 
water before going to sleep there is nothing to prevent her doing so, but there 
is, at the same time, no necessity that she do so if she feel perfectly comfort- 
able without. 

5. The Child. 
Washing, putting up the navel string, and dressing. We must now return 
to the child. When we left it, it had just been severed from the mother by 
the division of the cord, and was carried away in the flannel receiver, and 
placed in a position free from danger. Provided there is nothing to hinder it, 
so soon as the child is removed the process of washing and dressing may be at 
once begun. Should the condition of the mother, however, require the services 
of both nurse and attendant, or should there be anything in the condition of 
the child to forbid it, the washing and dressing may be deferred. Where, 
however, there is nothing to prevent it, it should be proceeded with at once. 
The various articles of clothing which are destined for the child should be 
hung upon a chair at the commencement of labor, in proximity to the- fire, and 
will therefore be thoroughly aired, and ready to put on as soon as the child is 
washed. The way in which the child should be washed may appear to many 
trivial and unimportant, but it is in reality not so, and it frequently makes all 
the difference whether the child is ill or well washed. The child is generally 
washed upon the nurse's knee, the basin with soap and water being placed 
upon the floor, but there are good reasons why such a method of procedure 
should not be adopted. It should not be adopted, first, because during the 
washing the child is apt to be lifted by some part of the body by which it may 
be injured; and second, because* the same water that is used to wash the 
child's body is also used to wash its face. This is a frequent cause of an 
inflammatory state being set up in the eyes. The best thing to use for the 
purpose of washing the child is a wooden bath, oval in shape, and having a 
place scooped out at one end which allows of the child's head being effi- 
ciently supported during the process. The bath should be sufficiently filled 
with warm water to cover the child's body, by which means it will not be ex- 






944 APPENDIX. 



posed to the influence of the atmosphere till ready to be dried. The bead and 
face will in this way be alone exposed to the air. The soap that is employed 
to wash the child's face with should be of the most unirritating kind, and 
great care must be taken that none of it be allowed to enter the infant's eyes. 
Many of the inflammatory affections of the eyes occurring in young children 
may be traced to carelessness in this respect, but as there are many who are 
totally ignorant of this fact, it is mentioned here to caution them in regard 
to it. 

The infant's body, at birth, is covered to a greater or less degree with a 
soft, cheesy-looking substance, upon which neither tepid water alone, nor that 
and soap, have influence in the way of causing its removal. The best thing 
to use for the purpose of facilitating its removal is lard, and before the child 
is placed in the bath the whole body should be smeared over with it, when it 
will be found that the cheesy substance then readily yields, and is removed by 
the sponge or flannel and warm water. As some do not care to use lard for 
this purpose, another excellent application, and one which will be found to an- 
swer equally well, is an egg. This should be beaten up in a bowl, and the 
surface of the body rubbed with it, just as in the case of the lard, and the pro- 
cess of washing thereafter proceeded with as before. Should portions of this 
cheesy matter still be found adhering to different parts of the body when the 
process of washing is completed, there is no necessity to be over-anxious for 
its removal. It will dry up in a short time and come off of its own accord, or 
at some subsequent washing. Indeed, it occasionally happens that when a 
nurse is over-anxious to remove the whole of this cheesy material at first the 
amount of rubbing which has to be resorted to for this purpose causes the 
bringing away of the child's skin, so that care requires to be exercised in this 
as in every other work pertaining to the child. 

The child, having now been washed, should be carefully removed from the 
bath and placed on a pillow covered with warm cloths upon the nurse's knee, 
and dried by means of warm, soft towels. The washing and drying being now 
at an end, the putting up of the navel string should engage attention. For 
this purpose a piece of soft old linen should be taken and a hole cut in the 
centre. Through this hole the navel string should be drawn (notice being 
taken while doing so that there is no bleeding from the end), and the lower 
part folded up against the other, so as to be brought into contact with the 
child's abdomen. The cord will thus lie between the two folds of the linen. 
It is maintained in position by means of the flannel binder, which should now 
be applied. This binder should be made about five inches deep, and of suffi- 
cient length to encircle the child's body once and a half. It must on no ac- 
count be drawn too tight, as the action of the internal organs may be interfered 
with, and the liver, which in the infant is large, may be unduly pressed upon 
and injured. It has this further disadvantage when made very tight, that it 
interferes with the free action of the lungs. Care must therefore be taken in 
applying the binder that it does not press injuriously upon any part, and in 



MATERNAL MANAGEMENT. 945 

order to insure this there ought always to be sufficient space left after it is ap- 
plied to permit of the finger being insinuated between it and the skin. It is 
better to retain it in position by means of a few stitches. If pins are used the 
ordinary ones should be avoided, and safety pins employed instead. Unless 
great care be taken in introducing them, ordinary pins are very apt to prick 
the child, and rather than run any risk they had better not be used. Next to 
the flannel binder is placed a shirt, which preferably should be made of wool, 
as it will then afford the child both more warmth and greater protection against 
cold. Above this the petticoat should be placed, and then the infant's frock 
or slip. A shawl or piece of flannel should also be provided to throw over the 
infant's shoulders. The head is better to be kept bare. Caps are apt to prove 
overheating, and as it is necessary to have an infant's head kept cool it will 
be better to allow it to remain uncovered. A linen diaper should now be ap- 
plied, which having been done the dressing of the child will be finished. It 
should now be taken and placed in its crib, or laid upon a pillow and allowed 
to l'emain in a place free from draughts, and sufficiently warm, until the mother 
has rested, when it may be removed and placed in her bed. 

6. After-Pains. 

Pains, usually more severe in those who have already borne children than in 
those whose first confinement it is, frequently set in shortly after the termina- 
tion of labor. They go by the name of "after-pains," and are caused by the 
contractions of the womb. Their influence is one of a salutary nature, although 
they may give rise to much suffering. They continue with greater or less se- 
verity for a day and a half or two days. With each contraction the amount 
of discharge generally increases, and there may come away from the womb at 
such times clots of blood which have accumulated in the interior. Unless 
these pains are very severe, and give rise to much suffering, they do not call 
for interference. If, however, by their continuance, they deprive the woman 
of sleep and cause her much pain and annoyance, the medical attendant should 
be communicated with, when adequate treatment can at once be resorted to, 
as these pains are perfectly under medicinal control. 

7. Cleansings. 

For about three Weeks after delivery the lying-in woman has a discharge 
from the interior of the womb. This discharge, as it at first issues from the 
external parts, consists almost entirely of pure blood, and in quantity it is 
sufficient to soil about twelve napkins during the first twenty-four hours. The 
quantity gradually diminishes till about the fifth day, when it is only sufficient 
in amount to soil two. From being of a red color, as at first, the discharge 
gradually grows paler until it assumes a green color, when it receives the name 
of the " green waters." When this stage is reached the discharge has a dis- 
agreeable, sickly odor. From being green in color it comes to have the ap- 
pearance of soiled water, which character it maintains throughout. As already 



946 APPENDIX. 



stated, the duration of the discharge is generally about three weeks, but there 
are cases in which it continues a much shorter time without giving rise to any- 
evil consequences. Especially is this the case in women who have been de- 
livered of dead children, in some of whom it ceases after a few days without 
the woman suffering in the slightest degree. If, however, the discharge has 
been of ordinary amount, and suddenly ceases, this circumstance must not be 
regarded slightingly, nor passed over as too trivial for notice. It should be at 
once attended to, as it may be indicative of a serious febrile condition setting 
in upon the woman. Should it therefore be found, on the cessation of the dis- 
charge, that the patient begins to exhibit symptoms of feverishness, increase 
of pulse, and general restlessness, the medical attendant should be at once com- 
municated with, when proper means will be employed to again establish the 
discharge. 

While the lochial discharge, as the cleansings are also called, continues, the 
most scrupulous attention should be paid to cleanliness. The external parts 
should be bathed every five or six hours with tepid water, a soft sponge being 
used for the purpose. Attention to this cannot be too strongly insisted upon. 
Cleanliness now is absolutely necessary to insure a safe recovery, and those 
who neglect it cause a patient to run a very serious risk. It might indeed 
seem almost superfluous to insist on this, were it not a matter of every-day ex- 
perience that there is nothing in regard to which people are more negligent; 
and amongst the poor, where the greatest necessity for cleanliness exists, least 
attention is paid to it. There are many who are deterred from performing 
these daily ablutions under the impression that the patient will suffer from the 
exposure. There need, however, be no scruple in the mind of any in regard 
to this, inasmuch as no exposure is necessary. The process of washing and 
drying can all be accomplished by the hand under the bed-clothes, and if the 
water is sufficiently warm the patient need suffer no shock — need experience 
no chill. Should the external parts be very painful, they may be anointed 
with goose-grease finely prepared, which will exert a healing influence upon 
them. Instead of this some milk may be added to the water with which the 
parts are bathed, or they may be bathed with oatmeal gruel. Either of these 
will be found a useful application in such cases, and will answer admirably in 
place of the goose-grease. They are both bland and unirritating, and will 
generally be very grateful to the patient. Should these fail to give relief, a 
warm poultice may be applied to the external parts. The discharge naturally 
has a peculiar odor, which can be better perceived by the sense of smell than 
described in words. It sometimes happeus, however, that it becomes very of- 
fensive and irritating, and when this is the case about a teaspoon ful of Condy's 
fluid should be added to a pint of tepid water, and used as an injection two or 
three times a day. Whether the discharge be irritating and offensive or not, 
the same amount of Condy's fluid may be added with advautage to the water 
with which the parts are bathed. 



MATERNAL MANAGEMENT. 947 

8. Treatment after Delivery. 

(1.) Rest. The necessity for rest in the horizontal position after delivery 
cannot be too strongly insisted upon, and the fact that so little regard is paid 
to it renders it all the more necessary to impress every female with right views 
regarding its importance. Among the poorer classes of society, where — from 
circumstances which need not be mentioned, as they will readily suggest them- 
selves to the reader's mind — a woman is unable to obtain that amount of rest 
which is so necessary for her recovery, the frequent occurrence of womb dis- 
eases in after-life points to this as the cause. In the case of those, however, 
whose circumstances remove them above the necessities of the poorer classes, 
who have nurses and attendants to minister to their every want ; who, if they 
have already a family, are relieved of all anxiety in regard to it by having 
kind friends or relatives acting for them, by whom they know the comfort and 
the happiness of their little ones will be as carefully attended to as by them- 
selves, — in the case of such there can surely be no adequate excuse if they are 
neglectful in this respect. But it is difficult to make people understand why 
there should be this necessity for prolonged rest after confinement. They will 
tell you they feel quite well ; feel strong and able to be up and moving about, 
and not unfrequently, in spite of all the earnest entreaties of their medical at- 
tendant, they leave the horizontal position after three or four days, sometimes 
even sooner, and may be found by him sitting in a chair at the fireside. 

The reason why a great many women act in this way is because the effects 
to which such carelessness on their part gives rise are not, at first sight, very 
apparent. They will tell you that many of their most intimate friends have 
left their bed on the fourth or fifth day after delivery, and in a few days more 
have been seen walking about outside, and they ask, " Why may I not ? " Be- 
sides, there is an undoubted tendency among many women to regard the indi- 
vidual who can thus early leave her bed and her apartment as " clever," and 
they praise her for what she has done. The present obscures the future, and 
in consideration of it all after-consequences are lost sight of. They do not look 
beyond ; and into the history of such of their acquaintance as may be already 
suffering from carelessness in this respect they do not care to inquire. Could 
they see the present in the light in which the future would reveal it, they would 
pity rather than praise her who thus acts. Could they see the picture of a life 
rendered miserable, of years passed in sorrow and bitterness, the result of care- 
lessness at the time of some confinement perhaps long since forgotten, they 
would doubtless take warning. But as they do not see these things, they re- 
main unimpressed with the necessity there is for rest, believing it merely to be 
a precaution of an over-scrupulous nature on the part of the medical attendant. 
Many women also labor under the impression that when the doctor enjoins 
upon them prolonged rest in the recumbent posture he imagines them to be ill, 
and they think if he only knew how strong they felt themselves he would not 
hesitate in permitting them to leave bed before the eighth or tenth day. Now, 



948 APPENDIX. 



in the great majority of cases, this is not the reason why the medical attendant 
keeps them in the horizontal position for this length of time at all. His whole 
object in keeping a patient recumbent is to permit of the womb regaining, to 
a great extent, its normal dimensions. After delivery it is always large, and 
when it is remembered that six weeks or two months have to elapse ere its nat- 
ural size is regained, the necessity for long rest in the horizontal position will 
perhaps be more apparent. The great danger, therefore, which the patient runs 
in thus leaving the horizontal position too soon is that the proper involution, or 
contraction of the womb to its normal size, may be interfered with. "When 
this is the case, the ligaments which retain the womb in its natural position are 
unable to sustain its increased weight ; they become relaxed, and in consequence 
of this various displacements may occur. The patient then begins to suffer from 
a feeling of dragging and weight about the loins. When these symptoms 
manifest themselves thus early it is well, for then the patient has warning of 
her danger, and by again resuming the horizontal position for a week or so 
longer she may prevent the occurrence of more serious mischief. More fre- 
quently, however, the changes which take place are more insidious in their 
nature, and do not manifest themselves at the time, and hence arises the great 
necessity for careful after-treatment. 

It will be a good rule for every woman to observe not to leave her bed after 
confinement till the ninth or tenth day. She may then be allowed to lie upon 
a couch or sofa till the expiration of a fortnight, when she may be allowed 
to move about upon the same landing for another week. If there be another 
room immediately adjoining the one in which she is confined, with a door of 
communication between them, there is nothing to prevent her being removed 
into it during the second week. This will be a pleasant change to the patient, 
and will at the same time permit, during her absence, of the other apartment 
being more thoroughly ventilated. If this change can be accomplished in the 
manner indicated, advantage should be taken of the patient's temporary absence 
from the room to have the bed-clothes and the mattress thoroughly exposed to 
the air. At the end of the third week she may be allowed to come down-stairs 
and move about; but even now care must be taken that she does not remain 
too long in the standing or sitting posture, but that she recline upon a couch 
or sofa during some part of each day. Provided the weather be not too cold, 
she may also now begin to take exercise in the open air. For the first a drive 
in a carriage will perhaps be best, or if it be preferred she may take a turn in 
the garden. Gradually, as the patient's strength permits of it, the time devoted 
to exercise may be increased ; but it should always be moderate for some time 
after confinement. In cold weather, or in those cases in which confinement 
has occurred during winter, the woman had better not venture out-of-doors 
till the expiration of the month. By carefulness in regulating the exercise 
thus begun, a woman will be enabled to recover favorably without the occur- 
rence of anything of an untoward nature ; but by recklessness at this time a 
woman may throw herself back, rendering her recovery more tedious, and con- 



949 




Fig. CL.XXXL 



Fig clxxxiii- 



Fig CLxxxir. 



PLATE XXXI. 



MATERNAL MANAGEMENT. 951 

sequently impairing the state of her health. For the patient's first outing after 
confinement it will be necessary to choose a good day, — not one in which the 
wind is keen and cutting, — and tlie best part of the day should be selected. 
If carriage exercise be taken, only a short distance should be traversed; if on 
foot, the patient must return home free from anything like fatigue. In these 
drives or walks the woman should be accompanied by an agreeable companion, 
who will keep up a pleasant conversation, and thus render them more service- 
able in restoring the patient's health. By attention to such rules as we have 
here laid down a good recovery will in general be secured, and the female's 
health will be thoroughly restored. 

(2.) Diet. For the first two days after confinement the diet should be for 
the most part fluid, and may consist of a basin of milk and bread for breakfast, 
or a cup of tea or coffee with toast ; a basin of good beef-tea with bread crumb 
or toast may be taken for dinner. Tea may be again taken in the afternoon 
along with bread or toast, as may be preferred ; and for supper the patient may 
take a basin of arrowroot and milk. A light-boiled egg is a very nourishing 
article of diet, and will rarely be productive of harm, however soon after con- 
finement it may be given. It must on no account be boiled hard, as it then 
becomes much less digestible. It is preferably taken at breakfast-time. This 
diet may be slightly varied: thus, instead of giving exactly the same on the 
second day as on the first, some sago and milk or rice and milk may be given 
along with the beef-tea for dinner. On the third day a piece of chicken may 
be given at dinner-time, or a piece of white fish, such as sole or haddock. On 
the fourth day, provided everything has been going on well, the patient may be 
allowed a mutton-chop, or piece of steak, or roast beef, of which, however, she 
must not partake too freely. After this date she may return to her ordinary 
diet, care being taken at the same time to avoid everything of an indigestible 
nature — such as pastry-stuffs, salted meat, pork, veal, etc. ; only those articles 
being taken which she knows to be nourishing and easy of digestion. Owing 
to the absence of active exercise at this period the stomach is unable to digest 
heavy meals of solid food ; hence the necessity there is of keeping the diet plain 
and light, while at the same time of a kind sufficiently nourishing. Light pud- 
dings may be given ; they are wholesome, and of easy digestion. 

Formerly it was the custom in this country to allow the lying-in woman to 
live almost entirely upon slops. This pernicious system of dieting was the 
direct result of the light in which labor was then viewed. Being regarded as 
a disease, and not a natural process, it was thought necessary to keep the 
patient's diet low and of an antiphlogistic nature, in order to ward off attacks 
of inliammation. The effect of this practice was the direct opposite of what it 
was intended to be ; and the very diseases which they sought by so acting to 
guard against were found to supervene with far greater frequency than at the 
present day, when a more rational system is everywhere adopted. A woman 
upon whom the system of slop-dieting is practiced will be found much more 
likely to suffer from inflammatory and febrile attacks than one to whom a light 



952 APPENDIX. 



but nutritive diet is given. Of course the opposite extreme of over-feeding 
the patient must also he guarded against. The thirst of the patient may be 
relieved by giving her bailey-water to drink, of which she may partake freely, 
without fear of doing herself injury. It may be given alone, or equal parts of 
barley-water and milk may be given instead. A little cold water may also be 
administered, or toast-water, or soda-water. Any of these may be given to 
the lying-in woman without hesitancy, and will generally be found serviceable 
in relieving the thirst from which she suffers at this time. No mention has 
been made among the beverages suitable for the lying-in woman of beer, wine, 
or indeed stimulants of any kind ; and the reason for this is that in by far the 
great majority of cases the recovery of the patient will be rendered a thing of 
greater certainty if she refrain altogether from their use, so that unless specially 
ordered by the medical attendant no stimulant of any kind ought to be taken. 
If stimulants are taken, as they sometimes are, upon the recommendation of 
a friend, and perhaps contrary to, or at any rate without the sanction of, the 
medical attendant, they are frequently productive of harm, so that the lying-in 
woman who refrains from their use, unless ordered by her medical attendant 
to act differently, will be doing that which is calculated, generally speaking, to 
bring about a speedy and a safe recovery. 

IV. NURSING. 

As this part of maternal management is one of very great importance, and 
yet one that is but little understood, we would direct our readers to a careful 
perusal of the few practical hints that may be thrown out in connection with 
it here, believing that if acted upon they will be the means of conferring last- 
ing benefit upon their offspring, and will tend to maintain their own health 
strong and vigorous. There are those in our country, however sad the thought 
may be, who, for the sake of self-gratification, or in order that their own pleas- 
ure may not be broken in upon, forego one of the greatest privileges which 
any right-thinking mother can enjoy, namely, that of suckling her own offspring. 
Surely no motive of this sort ought for a moment to weigh with the true 
mother in the discharge of what is plainly a part of the sacred duty that de- 
volves upon her. In the performance of the tender office of nurse, the mother 
engenders those strong feelings of affection and love in her child which are 
apt to be conspicuous by their absence in the case of those in whom this 
sacred duty has been foregone. Let it then be understood that we regard it 
as plainly a part of every mother's duty to bring up her child at the breast, 
unless, of course, there are obstacles in the way which prevent her doing so. 
That the breast was intended by nature to be the fountain of nourishment, for 
a certain period, of every animal's existence, cannot be doubted after the most 
superficial study of the habits of the lower animals ; and while creatures, by 
nature fierce and cruel, do not forego what instinct tells them to be a part of 
their duty to their young, shall woman, with her infinitely superior capacities 



MATERNAL MANAGEMENT. 953 

of knowing, act differently ? If, however, a woman undertake the duties of 
nurse, she must not do so to suit her own convenience. The only considera- 
tion that ought to weigh with her should be the welfare of her child, and if she 
enter upon her duties with the notion that she may continue them or give them 
up just as it may prove convenient to her, or with the intention of only giving 
her child the breast at such times as she may find it suitable without interfer- 
ing with her pleasure or society, she had better not undertake the duty at all. 
There are, however, many women who are not sufficiently alive to their duty 
in this respect. They either fail to perceive the evident design of nature iu 
regard to it, or they close their eyes to the fact. If it should not appear to 
any reader of these pages to be a part of her duty to her offspring to nurse it 
herself, and even should it appear to be so, but should she not be prepared to 
undertake the work with the firm determination that nothing shall be allowed 
to interfere with her in the discharge of it, she should not undertake to suckle 
it at all. It need hardly be said that to give a child the breast only when it is 
convenient to the parent will prove most injurious to it, will undermine its 
health, and may cause its death. Let every mother, therefore, in undertaking 
the suckling of her child, be fully alive to the importance of the duty she thus 
undertakes ; and let her make up her mind that as far as possible nothing 
shall prevent her faithful discharge of it. And need it be added that if thus 
undertaken, instead of being an annoyance, or proving irksome in the smallest 
degree, it would be a source of real pleasure and enjoyment to the parent? 
These remarks are of course only intended for those cases in which there is 
nothing to prevent the parent undertaking the office of nurse. There are 
many women who, however anxious they may be to suckle their offspring, are 
prohibited from so doing either on account of physical debility or from some 
other cause. Of these we make no mention at present. Further on we shall 
notice those conditions which render it necessary for a woman not to under- 
take the nursing of her child ; but in what we say at present, no reference is 
made to cases of this sort. The importance of children being nursed will be 
apparent by considering two things: (1) the admirable manner in which, 
from its constitution, milk is adapted to give support and nourishment to the 
child ; and (2) by reflecting upon the enormous mortality in the case of children 
who are dry-nursed. United in its substance, milk contains oleaginous, albu- 
minous, and saccharine constituents, which are all that the system requires, 
and in this one article are combined those principles which in after years man 
requires to take a number of different kinds of food to yield. In considering 
the second point, let us compare the mortality of children brought up upon the 
breast with that of those who are dry-nursed. This we are enabled to do by 
referring to the case of children who are foundlings in our large cities. In 
some of the large cities where the foundlings are wet-nursed from the time 
they are received, the mortality is from 33.7 to 35 per cent., while in the 
case of other large towns where the children are brought up altogether arti- 
ficially from the first, the mortality is from 50.3 to 63.9, or even 80 per: 



954 APPENDIX. 



cent. Now a consideration of these figures must prove to every one the ad- 
vantages to be derived from nursing, and seeing that the sacrifice of human 
life is so great, this duty ought neither to be lightly thought of, nor given up 
without due consideration. 

(1.) Nursing during the first few days. In those who have already borne 
children it is frequently noticed that towards the close of pregnancy the breasts 
begin to enlarge very considerably, become swollen, and often contain milk. 
Usually, however, the milk does not make its appearance till the second or 
third day ; especially in first cases. Its appearance in the breasts generally gives 
rise to some constitutional disturbance, causing slight chills, feverishness, etc., 
which symptoms, however, speedily pass off. The breasts enlarge and become 
knotty to the feel, and blue veins are seen to traverse the surface. The nipples 
become erect, and pain and uneasiness are experienced by the mother, the pain 
sometimes passing up towards the arm-pits. All these uncomfortable symptoms 
speedily pass away when the milk which is secreted is drawn off by the child. 
The first milk which is secreted is darker than that which follows it. In color 
it is yellowish. It is called colostrum, and is supposed to have a purgative 
effect upon the child. In the case of those who have not already borne chil- 
dren, and those in whose breasts the milk has not begun to be secreted towards 
the close of pregnancy, it would be unwise to put the child too frequently to 
the breast, because if it is frequently put to the breast and receives nothing, 
the child at last becomes disappointed, and may afterwards refuse to take (he 
breast at all. In attending to this, however, the opposite extreme of not put- 
ting the infant to the breast even once during the first day or two must be 
avoided, inasmuch as the occasional application of the child to the breast exer- 
cises a stimulating influence upon it, and by increasing the quantity of blood 
which flows to it tends to hasten the " draught," as the secretion of milk it 
quantity by the breast is called. In the case of those, then, who have nc 
borne children already, and those in whom the milk has not yet made its ap- 
pearance in the breasts, the child should be applied not more frequently than 
once every six hours, and in order to satisfy its hunger till the milk appear, 
a little ass's milk may be given it, or what is of more general employment, 
because more within the reach of all, a little cow's milk, diluted with boiling 
water, and slightly sweetened with loaf sugar. The proportion which will 
answer best will be equal parts of cow's milk and boiling water. This should 
be given to the child every two hours, and the proper quantity will be best as- 
certained by putting it into a feeding bottle and allowing the child to suck it. 
The child will take no more at a time than is necessary, and its appetite is our 
best guide at this early age. It frequently happens that when food-feeding is 
resorted to during the first day or too, the child's stomach is overloaded, and 
it is made unwell almost before it is put to the breast at all. 

(2.) Nursing during the fiist month. When the milk has come to the 
breasts, all artificial nourishment must cease, and the child be put to the breast 
regularly. It is now that so many mistakes are made, that so many bad 



MATERNAL MANAGEMENT. 955 

habits are formed ; now that the health of the child frequently begins to suffer, 
and derangements of the stomach are so often met with. There are many 
mothers who, by their irregular habits in suckling their children, overload the 
stomach, and when the child cries, as it frequently will do when the stomach 
is in this state, they give it the breast, under the impression that it will cure 
everything. The following case, which recently came under my observation, 
will serve to show the necessity there is for careful regulation of the infant's 
diet at this time. Being called into the country late one night to see a child 
about five weeks old, supposed to be seriously ill, and thought by some of 
the friends to be dying, on getting to the house the mother was found sit- 
ting at the fireside with the child in her arms, and on asking what she had 
noticed the matter with it she said that it was vomiting everything it took. On 
asking the mother how she had been feeding the child, aud how often she 
would give it the breast in a day, she said that the infant was so frequently 
sick and vomited so often that she had to be almost constantly applying it to 
the breast. It never seemed to have entered her mind that the habitual sys- 
tem of over-feeding which she had been pursuing was the direct cause of the 
infant's suffering, that the pain and vomiting were but the natural results of 
the engorged state of the stomach, and that if the feeding of the child were 
more carefully and systematically conducted these symptoms would soon pass 
away.' On pointing out to her the necessity there was of allowing a certain 
time to elapse between each meal in order to allow of what little was taken 
being thoroughly digested, she appeared quite to understand the folly of the 
method she had been hitherto pursuing, and to see the force of adopting more 
rational principles in the future than those by which she had been guided till 
now. 

When the first few days of the infant's life are over, regularity in feeding 
must be observed, otherwise the health of both parent and child will alike 
suffer. The frequency with which the child should be put to the breast dur- 
ing the first month should be once every two hours during the day, and once 
every three or four hours during the night. To attend to this from the very 
first is absolutely necessary, as a mother's rest should be as undisturbed as 
possible. When this is neglected and her nights are disturbed, her health will 
become impaired ; the milk will deteriorate in quality, and the child will be 
badly nourished, and suffer in consequence. 

The best time to give the child the breast is when it awakes out of sleep, 
and on its hunger being appeased it will generally again fall asleep without 
further trouble. The practice which some have of allowing the child to fall 
asleep with the nipple in its mouth before putting it into its bed is one to be 
avoided. A practice of this kind very soon becomes a habit with the child, 
and the mother herself may be astonished to find how great a hold it has taken 
upon it, and how difficult is the task, even in a short time, of getting the child 
to fall asleep without the nipple in its mouth. 

(3.) Nursing from the first month till the appearance of the teeth. That regu- 



956 APPENDIX. 



larity in nursing which was spoken of as necessary to establish during the 
first month must now be maintained in all its strictness. The frequency, how- 
ever, with which the child is fed need not now be so great as up to this time 
it has been. During the day the breast should not be given more frequently 
than once every two and a half or three hours, and during the night it should 
not be given oftener than once every three or four hours. As the child 
grows older the time which is allowed to intervene between each meal should 
be increased. If such directions as those which have been given are attended 
to, it will soon be found that the child will sleep four or five hours without 
awaking, and the mother will thus be enabled to obtain that amount of sleep 
which is so necessary for her at this time ; but if, instead, her nights are 
broken and disturbed, she will speedily suffer in health. 

Till the appearance of the first or milk teeth, the child should be fed ex- 
clusively upon the breast milk ; after that, which is nature's indication that 
the stomach has become fit to digest other substances, the child may be given 
rusks, tops and bottoms, a little of Hard's farinaceous food, Chapman's entire 
wheat, or Robinson's groats. It may be that several of these may have to be. 
tried before one is found that will agree with the child, but when one that is 
suitable has been got, it should be at once adopted, and should not be readily 
given up. 

Weaning. 

About the ninth or tenth month the mother should begin to wean her child. 
Frequently this is not attended to, and many mothers are found suckling their 
children till they are fifteen or even eighteen months old. This prolonged 
suckling has its origin in the popular notion that so long as the infant is at the 
breast pregnancy cannot occur. This notion is, however, devoid of any scien- 
tific foundation. There is nothing to prevent the occurrence of pregnancy at 
this time, and it may not be unfrequently observed that those women who 
thus unnecessarily prolong the period of suckling are already pregnant, and 
their milk, deteriorating in quality, becomes unfit for the child, while the long-' 
continued suckling is telling upon their own constitution. 

There are difficulties in the way of laying down any hard-and-fast rule as to 
the precise time when weaning should take place. Many circumstances may 
occur to prevent this being done at the usual time ; but while remembering 
these exceptions, it may be safely said that if mother and child are both 
healthy the process of weaning should be begun about the ninth or tenth 
month. If, however, the child appear delicate, and especially if it be born o£ 
consumptive parents, and is being brought up upon the breast by a strong and 
vigorous wet-nurse, it may be as well to prolong the period of suckling till the 
eleventh or twelfth month. Should the woman's health, however, appear to 
suffer, it should at once be discontinued. The artificial feeding begun on the 
appearance of the teeth should now be increased in the frequency of its admin- 
istration, while the breast should be at the same time gradually withdrawn 
The quantity of food necessary to be given to a child at any one time is not 



MATEENAL MANAGEMENT. 957 

very easy of determination, inasmuch as the capacity of the stomach for 
receiving food varies in different children. It may, however, be laid down as 
a rule that not more than about three ounces of fluid should be given at a 
time. 

The Breasts. 

It may happen from the pressure of the corset upon the breasts during the 
period of pregnancy that the nipples have been injured, and that when the 
child is applied to the breast they are so small and depressed that the child is 
unable to get hold of them. The same thing may happen, independently of 
any pressure, from natural defect, and frequently, when the breasts are large 
and the nipple so depressed, great care has to. be taken in putting the child to 
the breast that it is not suffocated, as by burying its face in the breast the 
entrance of air into the lungs may be prevented. The mother should attend 
to this, and endeavor to prevent the occurrence of such an unfortunate acci- 
dent by the exercise of a little care in placing the infant during the time it is 
at the breast. The best position for the mother to suckle the child in when 
lying in bed is by turning upon one or other side, and resting slightly upon 
the corresponding arm. She should not sit up in bed to do this, as it will pro- 
duce weariness and aching about the back, and, besides, has a prejudicial 
effect upon the figure. When out of bed the child should be nursed while the 
mother sits in the erect posture. It must not be done reclining. 

Should any difficulty be experienced in getting the child to take the breast 
from defect in the nipples, such as has been already noticed, they ought to be 
drawn out. This may be accomplished by taking a bottle, such as an ordinary 
pint bottle, and filling it with hot water ; then, pouring the water from it, 
invert it over the nipple to be drawn out, when, as it cools, it will generally 
exercise sufficient suction power to cause elongation of the nipple. Should 
this on being tried prove ineffectual, a nipple shield must be procured, and the 
nipple drawn out by means of this ; or, instead of either, an older infant may 
be put to the breast. The feeling of uneasiness to which the appearance of 
the milk in the breasts gives rise passes off as they are relieved, and the pro- 
cess of suckling, at first attended with pain, is now accompanied by no such 
unpleasant sensation. 

Previously to applying the infant to the breasts they should be sponged 
with, tepid water, and then dried, and this should be done again after the child 
has finished suckling. Besides this sponging with tepid water both before 
and after nursing, the breasts should be sponged with tepid water and soap 
two or three times daily. The influence of the mind upon the secretion of 
the milk is very great, and it not unfrequently happens that a child is rendered 
dangerously ill by a mother giving suck immediately after some outbreak of 
passion or other mental emotion. This should be remembered by mothers, 
and the mind kept as calm and undisturbed as possible while the child is 
•being nursed. 



958 APPENDIX. 



Those who ought not to Suckle. 

However anxious some mothers may be to bring up their offspring at the 
breast, it may be absolutely necessary, both for their own and their child's 
safety, to forego this privilege. Oftentimes, when a parent continues to 
suckle her child after the medical attendant has prohibited her doing so, she 
undermines her own health and induces a weakly habit of body in her infant. 
The first class of those who ought not to suckle their children embraces such 
as are consumptive. The best thing undoubtedly to be done in such a case is 
to procure a strong and vigorous wet-nurse for the child. By so doing advan- 
tage is given the child of obtaining nourishment from a healthy source, which 
will go far to improve its general health, and, by laying the foundation of a 
stronger constitution, may do away in great part with any taint which the 
child may have inherited at birth. 

There is another class of women who ought not to suckle their children, 
embracing those who are nervous and excitable. The influence of the mind, 
as has been already observed, upon the milk secretion is very great, and any- 
thing that exerts a greatly disturbing influence upon the mother will affect 
her milk in such a degree as to cause it to be dangerous, perhaps even fatal, 
to the child. There are women of a naturally delicate constitution who, how- 
ever, may not have inherited any constitutional taint, such as we have men- 
tioned, who ought to give nursing a fair trial. Frequently, instead of their 
health suffering, it is found to improve greatly. 

In addition to the two classes already noticed, there is yet another, includ- 1 
ing those whose nipples are so depressed that they are obliged to give up all 
attempts at nursing. As this is frequently the result of carelessness, every 
female should be on her guard during pregnancy to see that the corset does 
not press injuriously upon the breasts. Of course, when the nipples are so 
depressed, means should be employed to elevate them and render them fit for 
nursing, ere the mother give up all attempts to suckle her child. The means 
usually resorted to in such cases have been already noticed, but should they, 
on being tried, prove ineffectual, a wet-nurse must be sought for the child, or 
it must be hand-fed. Lastly, there are some women who are debarred from 
bringing up their children at the breast owing to some natural defect in the 
nipple, which cannot be overcome by any means that it is within the power of 
the physician to employ. 

It will sometimes happen during the time the child is at the breast that the 
milk, which till now was flowing freely, and whose quality was everything 
that could be desired, will suddenly cease to be secreted. Should this occur, 
it will be better not to put the child to the breast for two or three days, at the 
end of which time, by the rest that has been given, it will generally be found 
that the milk has returned to the breasts, and is flowing again as freely as it 
did before. Any severe mental shock to which the patient may be subjected 
may serve to bring about this temporary cessation of the milk-flow. 



MATERNAL MANAGEMENT. 959 

Management of the Mother's Health during the Period of Suck- 
ling. 

To maintain the mother's health during this period is in great part to main- 
tain the health of the infant unimpaired, and every attention should be paid to 
see that, so far as this lies within the patient's power, no effort is wanting on 
her part to secure it. When the health of the nursing mother is thus maintained 
strong and vigorous, this period will be to her a period of great pleasure ; but 
should her health deteriorate, the child will suffer, and the sufferings of the in- 
fant, recoiling upon the already debilitated frame of the mother, will cause her 
health to be altogether undermined. 

Diet. The diet of the nursing mother should be wholesome and nourishing, 
while, at the same time, it is easy of digestion. There is no necessity to in- 
crease the quantity of food taken, and stimulants are quite unnecessary. It is 
a frequent practice among women who are nursing, whenever they feel faint, 
or suffer from depression of spirits, to betake themselves to stimulants. Now 
it may be quite true that they obtain relief from this momentary feeling of de- 
pression by taking some alcoholic stimulant, but so soon as the effect of the 
spirit has passed off the feeling of depression will in all probability again re- 
turn, and it may be in a worse form than before. Besides, there is a tendency 
that, by this constant repetition of stimulants, the patient may begin to imagine 
that she cannot do without them, and will soon regard them as necessary to 
her existence. Let it then be a rule with every nursing mother, that unless 
alcoholic drinks have been ordered by the medical attendant, they ought to be 
avoided altogether. In good, plain, substantial food there will be everything 
to nourish the body, and there are other remedies which will answer better to 
cause the disappearance of those feelings of depression should the patient suf- 
fer from them. Cheerful occupation and exercise in the open air will do far 
more to relieve these than any amount of stimulants. The nursing mother 
cannot be too careful to live plainly. Everything she eats influences the con- 
dition of her milk, and it will be wholesome or the reverse, according to the 
care or the neglect displayed by her in what she herself eats. A certain 
amount of animal food should be taken daily, preferably beef or mutton, but 
pork and veal had better be avoided, or, at any rate, partaken of sparingly. 
Soups and vegetables may also be taken, and so may fish and the Mesh of 
fowl. Pastry stuffs are generally indigestible, and on that account can only 
be eaten in great moderation, if eaten at all. Made dishes and highly sea- 
soned foods are also difficult of digestion, and so should be avoided at this 
time. 

If the patient suffer much from thirst she will find this relieved by taking a 
little toast-water, barley-water, or the like. It is a popular error, from which 
many women suffer, that a great deal more food is required while they are 
nursing than they are usually in the habit of taking, and so far does this idea 
sometimes go that a woman will force herself to eat, from a sense of duty, a 



960 APPENDIX. 



quantity greater than the stomach can digest, in consequence of which it be- 
comes overtaxed, and considerable suffering results. Let care, therefore, be 
taken to see that the diet is moderate in quantity, plain, substantial, and nour- 
ishing. As already remarked, the infant at the breast is influenced by the food 
taken by the mother. Any article of diet whose tendency is to cause constipa- 
tion in the mother will have a similar effect upon the child, and, in like man- 
ner, that which causes diarrhoea in the parent will be likely to cause a worse 
attack in the infant at her breast. 

Exercise. A moderate amount of out-of-door exercise, at all times an im- 
portant element in the maintenance of health, is now as essential as ever. Ex- 
ercise of this nature tends to develop a healthful habit of body ; it improves 
the general health of the nursing mother; it improves the quality of her milk ; 
and by the change it gives from the routine of household work it tends to 
maintain a more cheerful mental state in the mother, which is very beneficial 
in its action upon the child. The best kind of exercise for the nursing mother 
to take is walking exercise. It should occupy an hour of each day, unless 
the weather is wet and stormy. Besides its bracing effect, out-of-door exer- 
cise is very helpful in securing a good night's rest to the patient, which it is 
most desirable she should have. 

Baths. The question may be asked, "Is it proper for a nursing woman to 
continue her baths as usual?" and the answer must be, " Most assuredly." 
Baths are as necessary now for the maintenance of health as ever they were, 
and should be taken daily. The best kind of bath, and the one which perhaps 
bears most universal application, is the ordinary sponge bath. During summer 
the water employed should be cold ; it may, however, be made tepid in win- 
ter, should the cold be too severe. Instead of the sponge baths the shower 
bath may be used, which will be found very bracing, and will act as an excel- 
lent general tonic to the system. It may be used like the former ; cold water 
in summer, and tepid in winter. 

Clothing. The nursing woman should be warmly clothed without being 
over-burdened, and in order to achieve this a covering of flannel ought always 
to be worn. There is no article of clothing that better combines lightness with 
warmth than flannel, and none that will enable one to resist the changeable- 
ness of a variable climate half so well. The various articles of clothing must; 
be made in such a manner as to permit of the most perfect freedom of move- 
ment, and must on no account embrace the body tightly. 

Occupation. During the period of suckling, light occupation, such as is af- 
forded by attending to ordinary household duties, is very conducive to the 
maintenance of health. The duties undertaken must not be of such a kind as 
to lead to exhaustion, otherwise a weakly habit of body may be developed ; 
but light household work should be undertaken by every mother, and in it will 
be found that which best serves to keep both body and mind in a healthy 
state. 



MATEKNAL MANAGEMENT. 961 

HOW TO DRY UP THE MlLK. 

When a woman has been able to maintain her child at the breast for the 
usual period, — that is to say, for about nine months, — she will generally find 
little difficulty with her breasts when the time for weaning has arrived. Should 
it happen, however, that the breasts become swollen, hard, and distended on 
the child being weaned, recourse must be had to measures calculated to re- 
move these symptoms. For the relief of the tension a certain quantity of milk 
may be withdrawn from the breasts. The amount of milk thus taken away 
must not be excessive, as the glands will immediately begin again to secrete in 
larger quantity than before, and the feeling of pain and distension will return. 
Only sufficient, therefore, must be drawn off to relieve the st. ;o of tension 
from which the patient suffers. When from any of the causes that have been 
already mentioned the mother finds it necessary to discontinue nursing her 
child, or where a woman has given birth to a still-born infant, this condition 
of the breasts is most apt to occur. At the outset, when the breasts become 
swollen and painful, mild saline aperients should be administered, and friction 
of the breasts with warm oil be resorted to several times a day. The saline 
aperients which will answer best are a little Epsom salts or a Seidlitz powder. 
The application to the breasts of plasters, such as belladonna or soap, is fre- 
quently had recourse to, a hole being cut in the centre for the nipples, but a 
lotion, consisting of eau de Cologne and water, will frequently answer better. 
Should these means fail to give relief, the medical attendant should be called 
in. In all cases of this nature the diet must be strictly attended to, as it forms 
a very important item in the treatment. Fluids should be avoided as much as 
possible, and food of a more solid nature given. 

The wet-nurse. For reasons that have been already given under a former 
section, it may be found necessary to obtain the services of a wet-nurse. As 
the choice of a person to fill this position is one of very great importance, and 
as many of the points which determine her being accepted or refused are not 
so apparent to an untrained eye, the selection of a wet-nurse generally devolves 
upon the doctor. The age at which a woman is best suited to perform the du- 
ties of wet nurse is between the twentieth and thirtieth year. The matter of 
age having been settled, it is to be further ascertained whether or not she has 
before given suck, and the woman who has already had one or two children of 
her own is to be preferred to the one who is nursing her first child, for the 
two following reasons ; first, that the milk in those who have already borne 
children is richer and more nourishing than in those who are suckling their 
first infant: and, second, that they are likely to be more experienced. Of 
course we are supposing that the ages of the women have been ascertained 
and are found suitable. 

In regard to the woman's own infant, inquiries must be made as to its age, 
and if there exist a great disproportion between their several ages she must be 
rejected. Great care should be taken to obtain a supply of milk as near the 
61 



962 APPENDIX. 



same age as possible with that to which the child has been accustomed, so that 
the stomach of the infant may not suffer from the change. A matter of the 
utmost importance to inquire into is the state of the nurse's health. This, 
however, can only be satisfactorily done by the medical attendant, inasmuch 
as many of the appearances which indicate unfitness for this duty are only to 
be recognized by those who are skilled. 

In addition to this there are other qualities no less essential. These, however, 
the medical attendant has nothing to do with ; they ought to be seen to by the 
person who is engaging the wet-nurse, and can be more readily ascertained 
by her than by any one else. We refer to the moral qualities of the woman. 
It need scarcely be said that those who are engaged to perform the duties of 
a wet-nurse should be of temperate habits, and anything to the contrary 
existing in an applicant for this situation must at once cause her to be 
rejected. She ought also to be cleanly, and evidence of a contrary nature 
being discovered should prevent her being chosen. In her disposition the 
wet-nurse should be cheerful, willing and obliging, frank and outspoken, 
and where these form part of a woman's character they should always be a 
recommendation in her favor, as their non-existence should be a barrier to her 
being accepted. These various points have been gone over in detail in order 
that every mother may have definitely in her mind those qualities which are 
deemed essential in any one undertaking a wet-nurse's duties; for should the 
selection of a person fit for this position at any time devolve upon herself, 
unless such matters are attended to, the health and future .well-being of the 
child may be seriously interfered with. 

The wet-nurse having been chosen and her duties begun, it may become a 
question with the young mother how she ought to be dieted. Many mothers, 
from ignorance in regard to this matter, allow the wet-nurse both to eat and 
drink far too freely. They seem to think that the wet-nurse cannot well have 
too much given her, and that the more she eats the better will the quality of 
her milk become. Frequently the result of this over-feeding and over- 
drinking is the serious derangement of the digestive faculties of the wet-nurse. 
It should be remembered what the habits of these women were previously to 
their engagement, and if they have been accustomed to one meat meal a day, it 
can be easily understood that if now the}' have the chance of and take three, 
a very great strain is suddenly thrown upon the digestive organs. Moreover, 
the indolent habits into which wet-nurses are only too liable to fall contrib- 
ute to bring about a state of ill-health in these women. The kind of food 
which it is necessary for the wet-nurse to have, and the general l'egulations 
regarding her health, are similar in every particular to those already laid down 
for mothers who are themselves suckling their children. The wet-nurse 
should also be given certain household duties to perform, which will exert a 
very beneficial influence upon her, both bodily and mentally. 

When at any time it may be deemed necessary to change the wet-nurse, 
a certain amount of caution must be observed, otherwise the health of the 



MATERNAL MANAGEMENT. 963 

infant may suffer. Thus by communicating the fact to the nurse that you are 
about to dismiss her for some cause or other, you naturally produce a certain 
amount of agitation in her mind, which influences to a very considerable ex- 
tent the state of the milk iu her breasts, and if the child be allowed to go on 
suckling from day to day until a substitute can be found, depend upon it the 
child will suffer in consequence. Far better will it be for the mother, when 
she has made up her mind to change the wet-nurse, to secure the services of 
the second before a word has been mentioned to the first about it. By atten- 
tion to this the infant will be saved the taking of milk which would in all 
probability have proved hurtful to it. 

Should pregnancy occur in the wet-nurse during the period of suckling, her 
services must be at once discontinued on the discovery being made. The posi- 
tion which the wet-nurse will be expected to occupy in the house among the 
other servants should be pointed out to her at the beginning, when she is just 
entering upon her duties. By so doing much trouble and annoyance may be 
prevented. A strict supervision should be maintained over her, but in such 
a loving and kindly manner that she is unaware of it, until such time as the 
mother feels sure her every command will be obeyed. 

Bringing up by Hand. 

When from one or other of the causes already mentioned the mother is 
unable to nurse her child, and when, as frequently happens, especially among 
the working classes and the poor, the services of a wet-nurse cannot be had 
recourse to, nothing remains but that the infant be brought up artificially, or, 
as it is called, " by hand." As, however, of the three methods by which a 
child may be brought up, namely, nursing by the mother herself, nursing by 
means of a wet-nurse, and that which we are now considering, this last, or 
bringing up by hand, is the most difficult of all to accomplish satisfactorily, it 
is under this system that so many children die, and this it is which, in our 
large cities, is the cause of a great amount of the infant mortality which occurs 
there. 

It will naturally arise in the mind of every mother who intends thus to rear 
her child to inquire as to what food will be best suited to take the place of the 
human breast-milk. To this question the answer is that there are three kinds 
of milk, any one of which may serve as an efficient substitute for the breast-milk. 
These are the milk of the ass, the milk of the goat, and that of the cow, their 
adaptability being in the order in which they are here given. But although 
the milk of the ass, from its greater resemblance to the human milk, is that 
which is most suited to act as its substitute, owing to the difficulty there is to 
procure it, arid its great expense, it is put beyond the reach of many, and can- 
not in consequence ever be of more than the most limited application. Some- 
thing, therefore, that can be more universally employed must be had recourse ■ 
to, and a substitute of this nature is to be found in cow's milk. It is at once 
the cheapest substitute that can be had, and that which comes within readiest 



964 APPENDIX. 



access of all. The milk of the goat, like that of the ass, is sometimes used ; 
but there are many reasons in the case of the former, of a similar nature as 
those we saw to exist in regard to the latter, which preclude the possibility of 
its ever being of general application. Cow's milk, therefore, is that to which 
we naturally direct our attention, and a glance at its composition enables us to 
see how eminently it is fitted to act as a substitute for the milk of the human 
breast. In order, however, that the milk of the cow be brought to resemble 
human milk as nearly as possible, certain alterations require to be made, inas- 
much as the milk of the cow contains more caseine and less butter and sugar 
than that of the human breast. A certain proportion of water must therefore 
be added, varying with the age of the child, and also a little sugar. Till lately 
it was too much the practice to over-dilute the milk, so that the health of 
many infants was impaired through it. For the first ten days or so, equal 
parts of milk and water may be given, after which, till about the third month, 
the proportion should be two-thirds milk and one-third water; the proportion 
of water should then be gradually diminished until the fourth or fifth month, 
when pure milk undiluted should be given. It is necessary that the milk 
given to the child be not given cold. It should have the temperature raised so 
as to resemble as nearly as possible the milk of the human breast. For this 
purpose hot water is added to the milk when it is given to the infant in a di- 
luted form, or when given pure it must be placed in boiling water till the tem- 
perature is raised to about 9G° Fahr., which is the temperature of the human 
breast-milk. The milk should, if it can possibly be so arranged, be from 
one cow. It not unfrequently happens that the milk of a certain dairy dis- 
agrees with the child, and when such is the case different dairies must be tried 
until one has been got the milk of which agrees with the child, when it should 
not be readily given up. 

The quantities given at a time will of course require to be increased with 
the increase of growth in the infant, and may have to be altered in some 
degree to suit the requirements of individual cases; but as a rule, for the 
first few days from six to eight tablespoonfuls will form an amply sufficient 
diet for any child. It may be that in some cases a less amount than this will 
be required. After the first few days are over three or four ounces may be 
given at each meal, till the teeth begin to appear, when other articles of food 
require to be added. The regularity with which the child is fed is another 
matter of great importance, and one well deserving of careful attention. It 
was pointed out when speaking of the suckling of infants that many of the dis- 
orders from which they suffered were in great measure due to the irregularity 
which was so frequently found to prevail in regard to their diet, and the same 
holds true in regard to children brought up by hand. 

For the first month the child may be fed every two and a half or three 
hours during the day, and every four hours during the night. From this time 
onwards the child should be fed at regular intervals of every four hours. 
Many mothers are under the impression that in milk there is not sufficient 



MATERNAL MANAGEMENT. 965 

nourishment to support the child, and acting upon this mistaken idea derange 
the infant's stomach by giving it solid food, such as biscuit and bread panada. 
This ought never to be done. There is in milk all those elements required to 
build up the tissues of the infant, and children that have been given nothing 
else till the teeth have appeared will in all probability be found in a much 
more healthy condition of body than those whose stomachs have been over- 
taxed by the administration of more solid food. 

There are two methods which may be employed in this artificial system of 
feeding : the one is to give the infant its meals from a spoon ; the other is to 
allow it to suck from a bottle. The first of these two methods is one which 
is frequently employed, but against which there are serious objections ; thus 
the feeding of the child may be hurried through the carelessness of the nurse, 
and it is well known that the flow of saliva is much greater during the act of 
sucking than it is when spoon-feeding is adopted, and as saliva is a very im- 
portant aid to digestion, its loss cannot be sustained without ultimate injury to 
the child. The feeding-bottle should therefore be adopted from the first, and 
the child be allowed to take its meals regularly in this way. In regard to the 
bottle that should be employed, little need be said here. The variety of feed- 
ing bottles is so great, and each one is said to be possessed of some little ad- 
vantage over the other, that it is difficult to say which is best. But whatever 
bottle may be selected, one thing is absolutely necessary in regard to it, and 
that is that it be kept scrupulously clean. Too much attention cannot be paid 
to this. A bottle that is not kept in the most perfect state of cleanliness may 
be, and frequently is, productive of the white-mouth, the so-called " thrush," 
from which children, especially those who are thus brought up, are so liable 
to suffer. Every effort should therefore be made to prevent the occurrence 
of this affection. 

No more food should be made than what will serve for one time. To make 
a large quantity sufficient to serve the infant for two or three meals on the 
ground that time and trouble are thereby saved, must never be permitted. 
Each quantity must be made afresh as it is wanted, and by attending to this 
much will be done to keep the- infant in a sound state of health. It some- 
times happens that under the most careful system of dieting the child's health 
gives way ; it appears not to thrive, and recourse must be -had in such cases 
to other articles of food in order to save the infant's life. When such cases 
occur, it will of course be necessary to call in medical aid. 

When the teeth begin to appear, which is usually about the sixth or seventh 
month, the diet will require some alteration ; but if the child be thriving well 
upon the milk alone, there should not be displayed too great a hurry to make 
a change. When, however, it is determined to supplement the infant's diet 
by the administration of articles of a more solid nature, a great many suitable 
for this purpose present themselves to our notice. Of these may be mentioned 
Hard's farinaceous food, Eobinson's groats, Chapman's entire wheat, Nestle's 
milk food, Liebig's infant's food, rusks, tops and bottoms. Two or three of 



96Q APPENDIX. 



these may require to be tried in succession before one is got which suits the 
child in every way; but when that one has been found, its use should not be 
readily abandoned for experimentation witli others. 

Position of the Infant during Feeding. 
Nothing has as yet been said with regard to the position in which the child 
should receive its meals; but as this is a matter of very considerable impor- 
tance, and one which is frequently mismanaged, we devote a few words to it 
now. The manner in which children are fed is frequently in the horizontal 
position, lying upon the nurse's knee. This position, however, is one which 
ought not to be adopted, as the food is apt to pass into the windpipe, and may 
lead to suffocation. The head of the child should be raised so as to recline 
easily upon the nurse's arm, in which position will be found the one best suited 
for giving the infant its food. Held thus the infant can swallow more easily, 
and there need be no fear of the food going the wrong way. After the child 
has been fed, it should be laid quietly in its cradle, or allowed to lie perfectly 
still upon the nurse's knee. All dandling and jolting are bad for the child 
immediately after a meal, and so they must not be allowed. 

Health of the Infant and Young Child. 

When the larger double teeth make their appearance, it is regarded as a 
sign that a further change in the diet is now become necessary, and that the 
child has attained to that age when it is able to partake of animal food of one 
kind or another. Milk should yet, however, form a large part of every child's 
food ; but, in addition, some beef-tea, chicken-tea, or mutton broth, may be 
given once a day in the forenoon. As a change a little meat gravy, with a 
mealy potato mashed up in it, may be given. An egg, lightly boiled, or one 
that has been placed for two minutes in boiling water, forms a very useful 
article of diet for young children, and one that is very nourishing. As before 
said, milk should still form a very large part of the child's diet. A little 
piece of some ripe fruit will not prove hurtful to most children at this age, 
and so may be given sparingly, care being taken to remove all stones. Nuts 
and other husk fruits, which are difficult of digestion, should be avoided. 
They may derange the child's stomach, and had better, on that account, be 
withheld altogether. 

During this time the teeth will be every now and then appearing, and may 
give rise to different degrees of irritation ; some children cutting their teeth 
without almost any trouble, and others suffering much with the appearance of 
every new tooth. Attention must therefore, during the whole of this period, 
be paid to the state of the stomach and bowels; and if the child should suffer 
from diarrhoea, some slight alteration in the diet should be made, as it is 
always better, if it can possibly be accomplished, to remove diarrhoea in this 
way than to have recourse to medicines. For this purpose a little arrowroot 
may be given, first with milk, and if that do not serve to check the diarrhoea, 



MATERNAL MANAGEMENT. 967 

with water. This may be given for a day or two, during which time all ani- 
mal food should be discontinued. The cream of milk may also be used in- 
stead of the milk itself. A little lime-water may also be added with advantage 
to the milk or cream. The proportion should be one tablespoonful of lime- 
water to three of milk or cream. Instead of diarrhoea occurring during the 
period of teething, the child may suffer from constipation. A little calcined 
magnesia will be found a very safe medicine to administer should this prove 
at all troublesome. A small quantity should be lifted upon the small end 
of a teaspoon and added to the milk which is being given to the child. 
Ripe fruit should also be given, as it exercises a laxative influence upon the 
bowels. 

As, during the period of childhood, growth is going on very rapidly, the 
amount of food taken requires to be of larger amount, proportionately, than it 
does in the case of adults. The number of meals given in the day need not 
exceed four; but rather than allow children to be constantly eating between 
times, a fifth regular meal may be introduced. They should be given at regu- 
lar hours, so timed that each shall have time to be thoroughly digested before 
the other is given. Nothing must be allowed the child between these regular 
meals. Pieces of cake and such like given in the intervals are a frequent 
cause of stomach derangement among children, and many parents are greatly 
to blame in this respect. 

Care must also be taken during these early years to see that the child is 
taught to masticate its food thoroughly. Children sometimes get into a habit 
of " bolting " their food, from the mother not paying sufficient attention to 
this at the first ; and when this occurs, owing to the food not being thoroughly 
mingled with saliva, a greater amount of work is entailed upon the stomach. 
Unless this is seen to early and prevented, a disagreeable dyspepsia may re- 
sult, which having its beginnings now may be a source of pain, misery, and 
annoyance in after years. 

Many children, especially those of the poorer classes, have frequently given 
them at this age tea once, twice, or offener in the day. Now such a system 
of dietary is bad. Tea is not a suitable article of diet for young children, and 
milk should always be given instead. The same applies to coffee, and of 
course stimulants of every kind are strictly prohibited. All foods which are 
rich or highly seasoned should form no part of a child's diet. 

Cleanliness. The utmost attention to cleanliness cannot be too strongly 
urged upon those who have the care of children entrusted to them. For the 
first few weeks the infant should be bathed morning and evening in tepid 
water, and afterwards in cold. It is a foolish notion to plunge the newly-born 
infant into cold water under the idea that by so doing it will be hardened and 
made able to resist a greater amount of cold. This practice must never be 
had recourse to. Let the baths during the first few weeks be tepid ; then 
gradually lower the temperature till the water is cold. The evening bath, so 
long as it is continued, should be tepid. The period of immersion should not 



968 APPENDIX. 



exceed three or five minutes at first, but may then be gradually lengthened. 
The influence of baths in developing a healthy habit of body in a child can- 
not be too strongly insisted on. Upon the nervous system of the child they 
exert a soothing influence ; they frequently remove irritation, and by the feel- 
ing of comfort which always follows their use they tend to keep the child 
cheerful and happy. If the child is thus brought up accustomed io daily ablu- 
tions, he will soon take a pleasure in them, and when he grows older will feel 
uncomfortable without them. 

At the morning bath soap should always be employed, which ought to be of 
the blandest kind that can be procured, as the infant's skin is very tender and 
easily irritated. After the first, few months, if the evening bath be still con- 
tinued, the child should be immersed in tepid water, as before directed, and 
soap used only to the lower parts of the body. When cold water is employed, 
the surface of the body should be sponged, or, if the child is put into the bath, 
it should only be a momentary immersion at first. The temperature of the 
room should be attended to while the child is getting its bath, and must on no 
account be cold ; otherwise the child may be liable to suffer from an attack of 
bronchitis or inflammation of the lungs. The daily baths should, if possible, 
be personally superintended by the mother, and from the first every means 
should be employed to make the child feel, pleasure in them. Many children 
have a great dread of the bath, and cry on being put into it. This is very 
frequently the result of the manner in which it has been performed from the 
first. Every effort should therefore be made to engage the attention of the 
child when in the bath, and this may be done by the mother speaking to the 
little one while the nurse gives it its bath. When the bath is over the < 
should be received in a warm blanket, and the surface of the body carefully 
dried. The drying is best done by means of some soft material, such as flan- 
nel, and by employing gentle friction during the process, a healthy glow will 
cover the surface. A bath ought never to be given to a child immediately 
after a meal. Such a practice may prove very injurious ; therefore always 
allow an hour or two to elapse. In young children great care must be taken 
to dry the arm-pits, groins, and buttocks well, so as to avoid that chafing which 
is so apt to occur in these parts, and which frequently proves very annoying. 
Should any redness or excoriation appear, the parts should be gently dusted 
with a little powdered starch, violet powder, or powdered fuller's earth. Great 
care must be taken to remove all soiled linen from the child as soon as pos- 
sible. If this is not attended to, the parts are very apt to become irritatec 
From the first the child should be taught to make known its wants in this 
respect, and can frequently, by a little careful teaching, be early taught habits 
of regularity. By scrupulous attention to cleanliness from the first, the 
mother will be using that precaution which is the greatest preventive against 
the occurrence of those disagreeable skin eruptions which so frequently prove 
a source of annoyance and anxiety to those who have disregarded it. 

Sleep. During infancy and childhood the disposition to sleep is great, the 



MATERNAL MANAGEMENT. 969 

first few weeks of the infant's life being for the most part one long sleep, the 
little one only awaking when the calls of hunger compel it to do so, and again 
dropping off as soon as its hunger has been appeased. Gradually, however, 
the periods of wakefulness will be noticed to lengthen, and the child will be 
found, at the expiration of a month or so, looking about it, and beginning to 
take notice of those things by which it is surrounded. And now is the time to 
begin teaching the infant habits of regularity in sleep. Habits of a contrary 
nature are easily formed during these early months of infant life, which it may 
be very difficult to root out in after years. It is desirable for the first month 
at least that the child should sleep with its mother. This is rendered neces- 
sary for the reason that the power of generating heat is very feeble in young 
infants, and to place them thus early in a crib would be to expose them to a 
trial which might easily prove dangerous. For the first month, therefore, the 
child should sleep with its mother, in whose bosom it can find that warmth 
which is so necessary for it at this time. Bnt care must be taken that the 
child be not overlaid. In the case of an infant, however, that for some 
cause or other is restless, and keeps up a constant crying, it would be unwise 
to allow it to sleep with its mother, inasmuch as her rest would be thereby 
disturbed, and her health, in the long run, be seriously impaired. This also, 
acting upon the milk in her breasts, would produce such a change as would 
speedily render it unwholesome as food for the infant, whose health also would 
soon suffer. The best plan, therefore, in such cases, will be for the mother to 
allow the child to be taken from her at night, and allow it to sleep with the 
nurse. As soon as the crying has ceased and the infant's nights have again 
become peaceful, it may be brought back and allowed to sleep with its mother, 
and no time should be lost in endeavoring to discover the cause of the infant's 
uneasiness. 

The following may be useful as hints to a mother to prevent her child being 
overlaid: "Let the baby, while asleep, have plenty of room in the bed. 
Do not allow him to be too near, or, if this be unavoidable from the small size 
of the bed, let his face be turned to the opposite side. Let him lie fairly 
either on his side or on his back. Be careful to ascertain that his mouth be 
not covered with the bed-clothes. Do not smother his face with clothes, as a 
plentiful supply of pure air is as necessary as when he is awake. Never let 
him lie low in the bed. Let there be no pillow near the one his head is resting 
on, lest he roll to it and bury his head in it. Remember a young child has 
neither the strength nor the sense to get out of clanger ; and if he, unfor- 
tunately, either turn on his face or bury his head in a pillow that is near, the 
chances are that he will be suffocated, more especially as these accidents usually 
occur at night, when the mother or the nui-se is fast asleep. Never entrust 
him at night to a young, giddy, and thoughtless servant. A foolish mother 
sometimes goes to sleep while allowing her child to continue sucking. The 
unconscious babe after a time loses the nipple, and buries his head in the bed- 
clothes. She awakes in the morning, finding, to her horror, a corpse by her 



970 APPENDIX. 



side ! A mother ought, therefore, never to go to sleep until her child has 
ceased sucking." When the first month is over these regular habits in regard 
to sleep must be begun. The infant should then be placed in a crib, which 
ought to occupy such a position in the room as it will exempt it from exposing 
the child to any draught or current of air by which it might be injured. At- 
tention must also be paid to the covering of the child, which should only be 
sufficiently warm to maintain the infant in a moderate degree of heat. By 
carelessness in regard to this many children are unduly heated, are rendered 
irritable and restless, and their sleep in consequence is disturbed. But, while 
attention is paid to see that the child is not overheated, care must also be taken 
lest the opposite extreme be run into of allowing the child to remain without 
a sufficient quantity of clothes to maintain vital heat. The head should be 
kept cool ; no covering should be placed upon it in the form of nightcap or 
shawl, and the pillow ought to be one of horse-hair. The amount of clothing 
above requires to be judged of iu comparison with those articles which serve 
the infant in place of a mattress. Thus if it sleep upon a feather bed, such as 
an eider-down quilt, or the like, this will necessitate, owing to its warmth, less 
clothing being put on above ; whereas if the child sleep upon something else, 
and have a sheet next the skin, this, being colder, will necessitate a warmer 
covering above. Again, a blanket placed underneath the child, being warmer, 
will necessitate less clothing above. Only general observations are made here, 
as the number and variety of methods pursued in regard to these matters are 
so great as to make anything like a dogmatic arrangement out of the question. 
The common sense of the mother must therefore be brought into play, and 
such modifications adopted as may be found necessary to suit the requirements 
of individual cases. Care must be taken to see that the infant's bedding and 
everything that comes in contact with it, be kept perfectly clean and sweet, and 
this can only be done satisfactorily by frequently exposing them to the purify- 
ing influence of the air. 

For the first two years or so the child will generally sleep three times in the 
twenty-four hours, and the two naps during the day must be so timed as not t( 
interfere with the dieting of the infant. Regularity in this should also be ob 
served from the first; thus the noon naps should be taken from about elever 
till one o'clock, and the child should be again encouraged to sleep for about 
an hour after the principal meal of the day. Young infants cannot pass their 
time more profitably than in sleeping at such periods. After the first tut 
years have passed, the afternoon nap may be discontinued, but that at midday 
should not be hurriedly broken off. It may be advantageously continued till 
the fifth or sixth year has been reached. Till about the tenth year a boy will 
generally sleep a round of the clock, and if he do the period of his slumber 
should not be cut short. After this time the hours devoted to sleep may be 
somewhat curtailed, but this ought always to be done cautiously, and the 
growing boy should rather be encouraged to sleep more than is perhaps abso- 
lutely necessary than have his hours of sleep unduly shortened. As the period 



MATEKNAL MANAGEMENT. 971 

of puberty approaches, the necessity for so much sleep diminishes, and the 
hours may be somewhat shortened, about eight hours being allowed for this 
purpose. From this time onwards there can be no reduction of the hours of 
sleep without risk of the health becoming impaired in consequence. A child 
should not be allowed to sleep with lights burning about it. 

Air and exercise. After the first two or three days, if the weather be warm, 
the infant should be taken out for a walk in the nurse's arms. Should the 
infant be born in winter, it had better remain in-doors till spring, when it 
should be taken out-of-doors daily. The habit of regular exercise should be 
thus early begun, and should be continued daily if the state of the weather 
permit. Care must be taken to see that the child is sufficiently clothed when 
out-of-doors, and there, should always be a covering of flannel worn both in 
summer and in winter. 

The time of day when the child is taken out-of-doors must be determined 
by the season of the year. In winter, when the early morning air is cold, and 
when the afternoons are apt to be chill, the brief period of sunshine at midday 
must be taken advantage of, and the walk taken then. During spring and 
summer the early part of the forenoon and the afternoon will be the best time 
to allow the infant out-of-doors. The daily walk must, of course, be subject to 
the state of the weather, and if cold and damp it would be rash to take a child 
out, as bronchitis or inflammation of the lungs may in this way be brought on. 

The following advice upon the manner of carrying an infant in its nurse's 
arms is given by Dr. Eberle : " The spine and its muscles seldom acquire suffi- 
cient strength and firmness before the end of the third month to enable the 
child to support its body in an upright position without inconvenience or risk 
of injury. Until this power is manifestly acquired, the infant should not be 
carried or suffered to sit with its body erect, without supporting it in such a 
manner as to lighten the pressure made on the spine, and aid it in maintaining 
the upright posture of its head and trunk ; therefore, at first (a few days after 
birth), the infant should be taken from its cradle or bed two or three times 
daily, and laid on its back upon a pillow, and carried gently about the chamber. 
After the third or fourth week the child may be carried in a reclining posture 
on the arms of a careful nurse, in such a manner as to afford entire support 
both to body and head. This may be done by reclining the infant upon the 
fore-arm, the hand embracing the upper and posterior part of the thighs, whilst 
its body and head are supported by resting against the breast and arms of the 
nurse. When held in this way it may be gently moved from side to side, or 
up and down, while it is carefully carried through a well-ventilated room." 
The manner in which infants and young people are handled by their nurses 
and by those who daily surround them is one that is productive of mischief to 
the child, and requires to be noticed here. Thus an infant is often rudely 
grasped by one or other arm and lifted from the ground, the weight of the 
body being meanwhile almost entirely supported by the arms, and as the 
joints of an infant are not so deeply excavated as those of the adult, and por- 



972 APPENDIX. 



tions of bone are but imperfectly united to eacb other, the former may be very 
easily dislocated and the latter separated or broken. 

As parents and friends have a practice of lifting children and dandling them 
in the air or swinging them round and round, care must be taken not to over- 
step the bounds of moderation. It should always be borne in mind that chil- 
dren are very apt to suffer from affections of the brain, to congestion and the 
like, and that in consequence caution must be observed. 

After the child is a few months old, the mother should place it on its back 
upon some material, such as an eider-down quilt, spread upon the floor, and 
here it should be allowed to exercise its legs, which it will soon be found to do 
by throwing them about with great energy. By and by it will be seen that 
the infant begins to crawl from one place to another about the room, and 
then, towards the expiration of a year, the little one will be found endeavor- 
ing to raise itself to the upright position by laying hold of a chair, a stool, or 
whatever may be at hand. These efforts should be allowed to go on undis- 
turbed. Nature will herself teach the child if those by whom it is surrounded 
will only refrain from interfering, which it is sometimes difficult for them to 
do. Many children are given lessons in walking by people taking hold of one 
or both hands. This will, however, be better attained by putting the hands 
round the child's waist, and in this manner giving it support when it is neces- 
sary ; for the great lesson that the child has at this time to learn is how to 
maintain its equilibrium, and so soon as this difficult task has been accom- 
plished the little one will walk without difficulty, the muscles strengthening 
by usage, and the legs, which were at first bent and not very well adapted to 
walking, will gradually strengthen, and as they do so less and less difficulty 
will be experienced. After a moderate amount of practice, if the child has 
been left to himself, and not frightened by those about him, he will be able 
to run about with ease. When he begins to walk, he should be provided with 
little boots, so made that the rapidly growing foot shall not be stinted of room 
and suffer in its growth. 

Ventilation. There is no subject more important, and none demanding 
more attention on the part of the mother, than that of ventilation. It 
scarcely possible for any one to overestimate its value in the case of young 
children. The atmosphere of the nursery in which the child at this time passes 
so many hours of each day cannot be maintained in a state of too great purity ; 
but care must be taken to secure this desirable end without exposing the child 
to the pernicious influence of draughts. 

Teething. The period of teething is one which is looked upon by many 
mothers with dread. Owing to the greater irritability of the system usually 
found to exist at this time, there are diseases which are more liable to attack 
the child ; and in order that everything may be done on the mother's part to 
guard against these, it will be well that she be made familiar with the usual 
time of appearance of the teeth, and with a few hints that may be of service in 
maintaining the health of the child during this period. No definite time can 



973 




FIG. CLXXX1V" 




Fig. clxxxvij 



U ElG. CliXXXVIII- 



PLATE XXXII. 



MATERNAL MANAGEMENT. 975 

be stated as that at which the first teeth will make their appearance. Usually 
they clo so between the fifth and eighth month, but the time is subject to much 
variation, some children beginning to cut their teeth earlier than this, and the 
process being delayed in others till a much later period. 

The teeth which first make their appearance are the two central front teeth 
of the lower jaw, called central incisors. Then follow the corresponding teeth 
in the upper jaw. Then follow the lateral incisors, the four anterior molars, 
the four canines, the two upper of which are popularly called eye-teeth, and 
lastly the four posterior molars. These teeth, which are twenty in number, 
are called the temporary or milk teeth. They are afterwards replaced by the 
permanent teeth, which are thirty-two in number. They begin to make their 
appearance between the fifth and sixth years, and the last of this set, the wis- 
dom teeth, do not appear till between the seventeenth and twenty-first years. 
During the cutting of the temporary teeth the infant's head should be kept 
perfectly cool, and for this purpose all caps and wraps of every kind must be 
removed. The clothing should be warm, but the material, while affording 
warmth, should be such that it will combine lightness as well, and thus be easy 
for the child to bear. Anything approaching to tightness in the various articles 
of clothing must be carefully avoided ; the infant should be allowed free play 
of chest, arms, and legs, and everything about the arm-pits and thighs should 
be made so as to admit of the most perfect freedom of action. By combining 
heat with lightness, in an admirable degree flannel recommends itself as an 
article of clothing eminently suited for children, and should be largely made 
use of for that purpose. The apartments occupied by the child should be 
at this time kept cool ; overheated rooms are productive of feverishness, and 
must be avoided while the process of teething is going on. If the infant's 
bowels have a tendency to become confined, the . diet should be altered, as be- 
fore indicated ; and should this fail to give relief, a little calcined magnesia 
will be found the most useful laxative for this purpose. 

Vaccination. One would have thought that the time had arrived when 
every person of unbiassed mind had become fully aware of the great benefit 
that was conferred upon mankind when Jenner discovered in vaccination a 
preventive against small-pox. Daily observation, however, goes to prove that 
there are yet a few persons in our land so ignorant and blinded that they are 
unable to perceive any good that has resulted from it. One would have 
thought that the accumulation of evidence to the contrary had served to con- 
vince people of the necessity there is to have every child vaccinated. It seems 
incredible, if they have bestowed upon the subject the smallest consideration, 
that they should come to the conclusion that vaccination, instead of being a 
blessing, has proved a curse to mankind. 

The number of diseases and disorders that are attributed by the ignorant to 
vaccination can scarcely be credited, — skin diseases of every kind, all kinds 
of eruptions that appear within a sufficiently early date to be included amongst 
the effects of vaccination, progressive wasting, glandular enlargements, and a 



976 APPENDIX. 



host of affections besides, too numerous to mention. It we pause for a mo- 
ment, however, and bring these supposed results of vaccination to the only 
true test, namely, that of statistics, we shall find that skin diseases and erup- 
tions of various kinds, which are ascribed over and over again to the influence 
of vaccination, are more numerous in those children who have never been 
vaccinated at all than in those who have. The fact is that the early period 
of childhood is one in which skin diseases and eruptions of various kinds are 
peculiarly apt to make their appearance ; and the only effect which vaccination 
has upon this class of diseases is to render the child who is the subject of it a 
little less liable to them than it would otherwise be. The best time for vac- 
cination to be performed is three months or under. This time has been fixed 
upon as sufficiently far removed from the commencement of teething in most 
children to render them safe from the constitutional irritation which is apt to 
accompany this process. If vaccination be delayed beyond this period, the 
troubles of teething are apt to be begun, when the child is frequently more 
or less fretful and irritable, and when vaccination is apt to be attended by a 
greater amount of constitutional disturbance than it would have been had it 
been performed earlier. If there is nothing in the infant's state of health to 
prevent this being done, vaccination may be performed before the third month. 
Indeed, it may be performed with safety any time after the sixth week. 

Re-vaccination. The immunity from small-pox is greater in those who have 
been vaccinated a second or third time than in those who have been done only 
in childhood, and although the exemption which results from single vaccination 
is great, and the disease when it does occur is much milder than in those who 
have never been vaccinated at all, yet it would appear that the virus had a 
tendency to exhaust itself, and that the farther removed the attack is from the 
previous vaccination the greater are the risks run by the individual. In order, 
therefore, to secure a greater immunity from this most loathsome disease, let 
every mother have her child vaccinated again about the period of puberty. 

The Nursery. The situation of the room that is to form the nursery is not 
a matter to be disregarded. It should be selected with thoughtfulness and care, 
remembering that for the first few years of the child's life the greater part of 
its time will be spent there, and that its surroundings will exert an influence 
more or less strong upon its mind. Let the nursery, then, be pleasantly situated. 
Let it be so placed as to receive a large share of the sun's rays, so cheering 
and lightsome in their influence. The windows should be large, and if near 
the floor and likely to be a source of danger, must be guarded in such a manner 
as to prevent the occurrence of an accident. The walls of the room should be 
adorned with pictures, which are always pleasing to the eye of a child, and 
which, besides, have a beneficial effect upon the young mind. In keeping with 
what has been already said, the nursery should, as far as possible, have a pleas- 
ant outlook. A garden, or a plot of grass, is always grateful to the eye of a 
child, so that a room with such an outlook should be preferred to one less ad- 
vantageously situated in this respect. There should always be an iron frame 



MATERNAL MANAGEMENT. 977 

fitted on to the fire-place, so as to prevent the risk of the child being burned. 
The furniture of the room should be of the plainest description, chosen with 
regard to its usefulness, and not to its being ornamental. To prevent children 
seriously hurting themselves in the numerous tumbles so intimately associated 
with this period of life, the nursery floor should be carpeted, or something laid 
down which will answer instead. 

Air the nursery thoroughly before the children are put to bed. Do not allow 
the nurse afterwards to sit there with a light burning, stealing the air from the 
helpless children. Let her sit in an adjoining room, or even in the entry. 
Leave the nursery door open at night ; a folding screen about it is all that is 
necessary ; and should it be inexpedient to keep a window open in the nursery, 
it can be open in the entry or adjoining room, and give air through the door. 

Besides securing for the nursery good ventilation through an open chimney 
and open window, provide, wherever it is possible, a separate bed for each child. 
No one thing is so injurious to the lungs as taking into them what has been 
breathed out from them, — that is, carbonic acid, organic matter, and watery 
vapor, with but little oxygen. The blood is dependent for its healthy condi- 
tion on exposure to a sufficient amount of oxygen in the lungs, and deprived 
of it, cannot bring to the tissues the food they require, and the tissues of the 
lungs, being imperfectly and poisonously fed through the impure blood, develop 
tubercles. It is fully admitted that breathing into the lungs again the breath 
just given off is one of the surest and most rapid ways of destroying life by pul- 
monary consumption. It is easy to see how children in a badly ventilated 
room, in the same bed, and breathing into each other's faces eight hours out of 
the twenty-four, poison the air and undermine each other's health. All these 
objections can be urged with still greater force against the practice of allowing 
a child to sleep with its nurse. 

Medicines. During the period of infancy and childhood there cannot be a 
doubt that the employment of medicines is out of all proportion to the require- 
ments of this time, and that much harm results from this practice every one 
who is conversant with it must allow. Many lives are yearly sacrificed in con- 
sequence of this alone. It is a foolish idea of nurses that so soon as a child is 
born it ought to have some medicine given it, and frequently ere the child has 
been long in the world they are found dosing it with castor oil and the like. 
Now, as a rule, there is no necessity for anything of this kind. Nature has 
provided for the child, in the first milk which it draws from its mother's breast, 
a purgative which will answer better than any that can be given it from the 
apothecary's shop. Again, every cry that the little one utters, or any expres- 
sion of uneasiness, is at once attributed to wind. It is said to be " griped," 
and in order to " break " the wind, as it is called, gin is often administered in 
teaspoonful doses. Should this fail, various quack preparations are had re- 
course to, vaunted to hush the cries of the little one and procure for the mother 
an undisturbed night's repose. Thus are mothers led astray, and thus is the 
tender stomach of her infant made a receptacle for every kind of abomination. 



978 APPENDIX. 



And who shall speak of the evil effects that are produced both directly and 
indirectly by such means throughout the whole period of infancy and childhood ? 
The mischief done is one of so gigantic a nature that it cannot be too loudly 
spoken against, and every occasion that affords the medical man an opportunity 
of giving counsel to a mother should be seized to warn her of the danger to 
which such a practice gives rise. 

No medicine ought to be employed by any mother rashly, however simple it 
may be supposed to be, and the fewer drugs that are made use of by those who 
are unskilled in regard to their action the better will it be for the child. Were 
more attention paid to the infant's dietary and to general hygienic arrangements 
there would be found less need for the administration of medicine in any form. 
Let every mother, therefore, attend primarily to these when her child appears 
out of sorts ; let the diet at once be looked to, and if any error is discoverable 
in this let it be put right without further delay. Frequently this alone may 
be sufficient to make the child well again, and. at any rate, should it not, every- 
thing will have been done to pave the way for skilled treatment of the case 
should it be found necessary to call in the aid of the medical attendant after- 
wards. By acting thus no loss of time will be incurred, and the child will be 
saved that repeated physicking which frequently proves hurtful by exhausting 
its strength, and always does harm by causing delay. As there are a few drugs 
which are generally kept in most houses, it will be our duty to mention them 
here, but it will be understood from what has been already said that we do so, 
not with a view to encourage the reckless and indiscriminate giving of them 
to infants and children, but rather to point out those which are least likely to 
do harm in the hands of the unskilled, with the proper dose of each. These 
drugs are castor oil, magnesia, rhubarb, dill-water, lime-water, and sal volatile, 
and for their use we must refer the reader to the dictionary portion of this 
work. 

If a child refuses medicine and cannot in any way be induced to take it, gently 
but firmly hold the nose ; the mouth must be opened for breathing, when the 
medicine must be given in a spoon, which is passed far back in the mouth and 
emptied slowly. 

To feel the pulse of a baby. The only time to feel a baby's pulse is when the 
child is asleep. Keep the finger on the wrist, and if the arm moves accompany 
it. No accuracy can be secured at any other time. During nursing the action 
of the heart is increased ; and no time is more unsuitable than just after waking. 
The regularity, rather than the rapidity of a child's pulse will be the point to 
notice. Respiration must be observed at the same time : the least exertion 
quickens a child's breathing. 

Some of the things you are never to do to a young child. Never pat it hard. 
Never trot it violently, bringing the heel down with force. Never make start- 
ling noises by way of amusing it. Never toss or jump it about. Never swing 
it quickly, either in a cradle or rocking-chair. Never give it an empty feeding- 
bottle to suck, or a rag, or any such thing. Keep it from sucking its own 



MATERNAL MANAGEMENT. 979 

thumbs. Do not put your fingers in its mouth. Do not, in feeding a young 
child, try to make it eat by first putting the spoon in your own mouth. Do not 
blow the food to cool it ; the breath is often impure, and will make the food 
injurious to the child. Never roll the towel up into hard knots, or twist it 
round a pin, to poke at the baby's ears Or nostrils, with the idea of making them 
clean. Great injury is done in this way. Never try to wash farther than you 
can see, and always use the softest cloth. In bathing a child, never let the 
water run into its ears by putting its head too low in the tub. Never on any 
account tickle a child. In general, keep it as sweet and clean and placid as 
possible. 



PRACTICAL SUGGESTIONS, 

FOR USE IN THE SICK-ROOM, IN THE CARE OF THE FAMILY, AND IN 
ALLEVIATING CERTAIN DISEASES. 

The following practical suggestions are here grouped together to facilitate 
reference to them on the part of those who consult this volume. If scattered 
through the body of the work, it might be difficult, when the information here 
given is required, to recall the place where it is to be found ; but by arranging 
them in a body together, they can be referred to easily, through the Tabular 
View. In many cases the names of authorities recommending them are given ; 
but in all cases they are derived from what are deemed trustworthy sources. 

Sand-Bag for the Sick-Room. 

One of the most convenient articles to be used in a sick-room is a sand-bag. 
Get some clean, fine sand, dry it thoroughly in a kettle on the stove ; make a 
bag about eight inches square of flannel, fill it with the dry sand, sew the open- 
ing carefully together, and cover the bag with cotton or linen cloth. This will 
prevent the sand from sifting out, and will also enable you to heat the bag 
quickly by placing it in the oven, or even on top of the stove. After once 
using this you will never again attempt to warm the feet or hands of a sick 
person with a bottle of hot water or a brick. The sand holds the heat a long 
time, and the bag can be tucked up to the back without hurting the invalid. 
It is a good plan to make two or three of the bags and keep them ready for 
use. 

Ready Method for Hot Fomentations. 

Place the flannels in the steamer of an ordinary potato steam-kettle. They 
readily become permeated with the steam when the kettle is placed on the fire, 
and can be changed without any fear of scalded fingers during the attempt to 
wring them sufficiently dry, as in the ordinary method. 

Convenient Remedy for Cuts and Bruises. 
One of the most convenient remedies, usually to be found in every kitchen, 
and which has proved of great value in hundreds of cases of cuts, scratches, 
bruises, and injuries inflicted by tearing the flesh on blunt instruments, rusted 
nails, and the like, is made by dissolving bicarbonate of soda or potash in strong 
cider vinegar, and applying it during the effervescence, or soon after. 

Milk Diet in Heart Disease. 
Professor Potain, in a paper which he read at the meeting of the Association 
Franchise, at Rheims, said : The milk regimen is especially efficacious in sec- 



PRACTICAL SUGGESTIONS. 981 

ondary diseases of the heart, simple hypertrophy, or dilatation, having a renal 
or a stomachal origin. This regimen modifies in the one case the condition of 
the kidney, and in the other that of the stomach, in this sense especially, that 
it imparts to these organs a more complete repose. In order to be really effi- 
cacious it must be absolute and prolonged. It may 'intervene usefully in cases 
of simple reflex palpitations, when this reflex disturbance originates in the 
stomach. Its diuretic action may prove of utility in cases of dropsy, especially, 
and perhaps exclusively, when the dropsy is the consequence of secondary renal 
disturbance, or of a phlogosis of the serous membranes. The regimen can be 
of utility only on condition of its being well tolerated ; that is, of the capability 
of the digestive and assimilative faculties effectually utilizing it. 

An Absolute Remedy for Boils and Carbuncles. 
All cases of boils and carbuncles in their earlier stages can be absolutely 
aborted and cured, whilst even in later stages their further increase can be al- 
most surely prevented. For this purpose a very strong glycerine solution 
should be employed, and it is best conveyed into the interior of the pustule, 
boil, or suppurating spot by a new quill pen dipped into the solution, and in- 
troduced by a rotatory motion through its apex, where a sufficient aperture 
will generally be found. In carbuncles, which are necessarily larger, and have 
often several openings, several such introductions may be necessary, or, at a 
later period, threads of lint soaked in the fluid may be passed with a probe 
well into all the sieve-like openings. Occasionally, as when the mass is large 
and solid, a watery solution of the acid may be injected with a hypodermic 
syringe into various parts of the hardened growth. The same plan of treat- 
ment is often quite effective in cases of sycosis, pustular acne, and festering 
ringworm. 

The Treatment of Burns. 

The London Medical Record says that Dr. J. Troizki, in a Russian medical 
journal, adds his testimony to that already published as to the value of solution 
of bicarbonate of soda as a dressing for burns. He says that during the pre- 
vious year he noticed twenty-five cases of burns, mostly of a severe nature. 
Sixteen of these were received in a fire in a village, during a strong wind, when 
the inhabitants, in order to save their property, were obliged to work in the 
flames. In all these twenty-five cases bicarbonate of soda was exclusively ap- 
plied. The result of this treatment was so favorable that the author considers 
himself justified in pronouncing this remedy the best and most efficient in burns 
of all kinds and degrees. Even in extensive burns of the second and third de- 
grees, the pain was soon alleviated by the application of compresses soaked in 
a solution of bicarbonate of soda ; and the wounds soon healed, leaving but few 
scars, and no impairment of the functions of the affected parts. No evil re- 
sults from this extensive use of bicarbonate of soda, which might suggest the 
reception of carbonic acid into the blood, were noticed. 

As regards the application of bicarbonate of soda in burns, the author dis- 



982 APPENDIX. 



tinguishes three methods : (1.) Powdered bicarbonate of soda is strewn over 
the burned parts. (2.) Liuen rags, sprinkled with a solution of bicarbonate of 
soda (1 in 50) are laid on ; as soon as these rags become dry, they are replaced 
by others, or are moistened again in the solution. (3.) Linen rags are applied 
in the same manner, but are kept constantly upon the burns, and moistened by 
pouring the solution over them. The first method suffices only for burns of 
the first degree. Change of the moistened rags is chiefly adapted for burns of 
the third degree, attended with much suppuration. In exchanging the dry 
rags, the pus which has accumulated underneath them must be carefully washed 
off, that it may not be received into the blood ; and then a fresh rag soaked 
with the solution must be placed upon the clean granulating surface. The third 
method is applied solely in burns of the second degree. Changing the com- 
presses would in these cases only irritate the exposed surface, and, by causing 
a more copious suppuration, delay the healing process. The beneficent effect 
upon burns of the solution of bicarbonate of soda the author considers to be due 
to the anaesthetic, antiseptic, and disinfecting property, which the bicarbonate 
owes to the ready disengagement of carbonic acid from it. Herr Troizki has 
also made experiments with other antiseptic and disinfectant agents, but has 
come to the conclusion that none are so useful as the soda. 

The journal of the Austrian Apothecaries' Society says that if the burned 
part be dipped in water, and then painted, with a camel-hair pencil, with essence 
of peppermint, the pain will be instantly relieved, and no scar will be formed. 

How to make Savory Beef-Tea. 

Very savory beef-tea suitable for a convalescent may be made in the follow- 
ing manner : Take two ounces of butter ; put it in a frying-pan or spider over 
a clear fire; when it is melted throw in two small onions shredded finely; stir 
them until they are a nice brown. Have ready one pound of lean beef cut 
into pieces the size of dice ; put it in the .pan, and let it brown also. Turn the 
contents of the spider into a saucepan ; add one quart of cold water, and let it 
simmer until reduced to a pint. Strain it before using. 

The pure juice may be extracted from beef in two ways : First, by cutting 
the meat in small pieces, putting them in a tightly corked bottle, immersing it 
in hot water, and boiling for several hours. Second, by taking a thick piece 
of juicy steak, broiling it on a gridiron over a clear fire for a few moments, 
then cutting it in strips and pressing it in a lemon squeezer. The juice thus 
obtained may be given either cold or hot. It may be frozen, broken into 
lumps, and given like cracked ice. A little salt should be added before 
using it. 

The Japanese Method of cooking Rice. 
A recent traveler in Japan says : They know how to cook rice here, and 
for the benefit of grocers and consumers in the United States I investigated 
the matter. Only just enough cold water is poured on to prevent the rice 



PRACTICAL SUGGESTIONS. 983 

from burning to the pot, which has a close-fitting cover and is set on a moder- 
ate fire. The rice is steamed, rather than boiled, until it is nearly done ; 
then the cover of the pot is taken off, the surplus steam and moisture are 
allowed to escape, and the rice turns out a mass of snow-white kernels, each 
sepai'ate from the other, and as much superior to the soggy mass we usually 
get in the United States as a fine mealy potato is to the water-soaked article. 
I have seen something approaching this in our Southern States, but I do not 
think even there they do it as skillfully as it is done here ; and in the North- 
ern States but very few persons understand how to cook rice properly. 

HOW TO SERVE THE FOOD OF AN INVALID. 

The way in which things are served for an invalid is a most important mat- 
ter. The trays should be covered with the freshest of cloths, and even be 
rendered bright by a vase of flowers. You should never set a plate before an 
invalid containing the exact quantity of meat, fish, or pudding you want him 
to eat. If you do, he will be sure to leave half, with the complaint that he 
has no appetite. He should always have everything served on small dishes, 
and should be allowed to assist himself. His vegetables and sauces should 
never be heaped on his plate, but should come up in tiny vegetable dishes and 
pretty sauce-boats. Above all, he should never be told beforehand what he 
may expect, so that his meals have all the charm of a surprise. In short, an 
invalid's meals should be so managed that he should look forward to them with 
pleasure as to a break in the day's monotony, instead of turning from them 
with disgust, as from some disagreeable ordeal to be undergone with all the 
resolution he can muster. 

Boracic Acid in Erysipelas. 
The advantages of a saturated solution of boracic acid over other local ap- 
plications are : (1.) It is soothing rather than irritating to an inflamed skin. 
(2.) It is as bland and devoid of smell or staining qualities as water. (3.) It 
is not poisonous in any quantity, so no harm can be done with it. (4.) It is 
a powerful disinfectant, and the inflamed skin will take on a natural hue in a 
few days under its constant use. (5.) It can be used around the eyes with 
no fear of injuring them, as is the case with carbolic acid or copperas. It is 
a specific for erysipelas, if used in time and persistently. Of course tonics 
should be exhibited also. 

HOW TO MAKE A SpiCE-BAG. 

Take half an ounce each of cloves, allspice, cinnamon, and anise-seeds, 
bruised, but not powdered, in a mortar ; put these between two layers of coarse 
flannel about six inches square, and quilt them in. Soak this for a few min- 
utes in hot spirits — brandy, whiskey, or alcohol — and water, equal parts. 
It is to be applied while warm ; renewing it when it gets cool. Used in the 
diarrhoea of infants and children, it has not only the effects of a poultice, but 
also the sedative and antiseptic effects of the spices. 



98 1 APPENDIX. 



The Diaukhcea of Infants. 

M. Jules Guerin stated, in a discussion on the alimentation and diseases of 
infants, that the addition of a little charcoal — about half a teaspoonful of 
Belluc's or other finely powdered charcoal — to a nursing-bottle full of milk 
exerts a most remarkable curative effect upon the diarrhoea of infants. He 
has repeatedly seen children who had become exhausted by seven or eight 
days' duration of an obstinate diarrhoea regain all the appearance of health in 
two or three days. At the same time that the charcoal is added, the milk 
should also be diluted with a half or a third of sugared water, the children 
taking the mixture without any repugnance, and no vomiting being induced. 

Turpentine Vapor in Whooping-Cough. 
According to a French medical journal, whooping-cough has been success- 
fully treated by Dr. Barety, of Nice, by turpentine vapor. By accident, a 
child, severely affected, was allowed to sleep in a room recently painted and 
redolent with turpentine odor, when noticeable improvement took place. Dr. 
Barety has since employed this drug, placed in plates, and allowed to stand in 
the rooms occupied by whooping-cough patients. He holds that the disease is 
mitigated and its duration lessened by this simple expedient. 

Chloroform Vapor in Earache. 

At a meeting of the Medical Society of the District of Columbia, Dr. James 
E. Morgan stated, during a discussion on otitis, that he had often promptly 
relieved the distressing earache of children by filling the bowl of a common 
new clay pipe with cotton-wool, upon which he dropped a few drops of chlo- 
roform, and inserting the stem carefully into the external canal, and adjusting 
his lips over the bowl, blew through the pipe, — forcing the chloroform vapor 
upon the tympanum. Dr. J. Ford Thompson had also accomplished the same 
relief upon similar principles. 

How to relieve the Pain of Cancer. 
M. Auger, in L' Union Medicale, prescribes a lotion of one part of sulphate 
of atropia to 1000 parts of distilled water. Compresses wetted with this solu- 
tion are applied to the painful part, and covered with oiled silk or gutta percha, 
renewing them three or four times daily. They give material relief to pain 
without causing symptoms of absorption, such as dilatation of pupils or dry- 
ness of throat. The action seems to be entirely local, consisting in contraction 
of the vessels with diminution of sensibility. 

Black Walnut Leaves as a Remedy in Diphtheria. 

A writer in the Boston Medical and Surgical Journal reports the results of 
the local use of a decoction of leaves of Juglans nigra in diphtheria. The 
remedy was chiefly employed as a gargle, or applied with a swab to the throat 



PRACTICAL SUGGESTIONS. 985 

and fauces. A poultice of the leaves was also resorted to in some instances. 
The practice was adopted in consequence of the recommendation by Professor 
Nelaton — in his Elements de Pathologie Chirurgicale — of the Juylans nigra 
as a remedy in malignant pustule. The use of the gargle was unattended by 
discomfort, no patient objecting to it ; and improvement in each instance was 
rapid, the oedema subsiding, the ash-colored spots disappearing. 

To prevent Pitting in Small-Pox. 
A method commended in the Gazette des Hopitaux is as follows: A mask 
is made of very pliable linen cloth, leaving apertures for the eyes, nose, and 
mouth. The inside of this is to be smeared with one of the following lini- 
ments : (1.) Carbolic acid, 4 to 10; olive oil, 40; and prepared chalk, 60 
parts. (2.) Carbolic acid, 5 ; olive oil and pure starch, of each 40 parts. 
(3.) Thymol 2 ; linseed oil 40 ; and chalk in powder, 60 parts. The mask 
should be renewed every 12 hours. Compresses impregnated with one of 
these mixtures may also be placed on the hands, and on any parts of the face 
with which the mask does not come into exact contact. 

A Remedy for Ska-Sickness. 

A writer in the Lancet remarks : As every contribution towards the treat- 
ment of mal de mer is generally welcomed, I beg to state the result of two 
years' experience, for the most part in the tropics. The best remedy I have 
found is a combination of small doses of bromide of potassium and hydrate of 
chloral taken with the citrate of magnesia during effervescence. Spirits of 
sulphuric ether may be added sometimes if there be much prostration. 

A Cure for Hiccough. 

Le Scalpel gives a very easy cure for a continued singultus, sometimes com- 
plicated with spasm of the glottis, introduced by Rostau and highly recom- 
mended by Deghillaye, of Mons. It consists in placing the hand flat upon the 
epigastrium, immediately below the ensiform cartilage, and making firm press- 
ure. Should this prove unsuccessful, place a firm roll of muslin on the same 
place, securing it by a napkin bound tightly around. In an hour this may be 
removed, and it will be found that the hiccough has entirely disappeared. 

Formula for making Koumiss. 
McKelway, of Philadelphia, gives this formula for making koumiss of cow's 
milk : Best unskimmed milk, one quart ; yeast — brewer's or old baker's — 
gr. c. ; cane sugar, gr. cc. Keep the mixture at 80° Fahr. until fermentation 
is brisk, stirring frequently ; then bottle, and secure corks with wire or stout 
twine. In twenty-four hours it is fit for use. Dr. Pepper recommends this 
preparation in a variety of bodily conditions. It is often prescribed for weak 
or irritable stomachs ; and as the taste is agreeable to many persons, it is sold 
in some of the large cities as a refreshing summer drink. 



APPENDIX. 



Simple Plan for the Preservation of Ice in the Sick-Room. 

Cut a piece of flannel about nine inches square, and secure it by a ligature 
round the mouth of an ordinary tumbler, so as to leave a cup-shaped depression 
of flannel within the tumbler to about half its depth. In the flannel cup so 
constructed pieces of ice may be preserved many hours ; all the longer if a 
piece of flannel from four to five inches square be used as a loose cover to the 
ice cup. Cheap flannel, with comparatively open meshes, is preferable, as the 
water easily drains through it, and the ice is thus kept quite dry. When good 
flannel with close texture is employed, a small hole must be made in the bot- 
tom of the flannel cup ; otherwise it holds the water, and facilitates the melt- 
ing of the ice, which is nevertheless preserved much longer than iu the naked 
cup or tumbler. 

To arrest the Vomiting of Cholera Infantum. 
The St. Louis Courier of Medicine is responsible for the following : It is 
asserted that strong coffee, without sugar or milk, given in teaspoonful doses 
every ten minutes, will arrest the vomiting of cholera infantum ; and that a 
tablespoonful, given as frequently to adults, will relieve the vomiting of cholera 
morbus. 



APPENDIX III. 



ILLUSTRATIONS. 



III. ILLUSTRATIONS. 

The Following Matter is Explanatory and Illustrative of 
Plates L-XXXII. 

Plate I. — Fig. I. The human skull : a, the frontal bone ; b, the pari- 
etal ; c, the temporal ; d, the inferior maxillary or lower jawbone ; e, the 
superior maxillary bone ; f, the malar bone ; g, mastoid process of temporal 
bone. — Fig. II. The trunk: a, the atlas vertebra; b, the axis vertebra; c, 
the seventh or last cervical vertebra ; d, the first dorsal vertebra ; e, the last 
dorsal vertebra ; f, the first lumbar vertebra ; g, the last lumbar vertebra ; h, 
the sternum or breast-bone ; i, the first rib ; k, the eleventh rib ; I, the twelfth 
or last rib ; m, the costal cartilages ; n, the clavicle or collar bone ; o, the 
acromion process of the scapula ; p, the glenoid cavity of the scapula for ar- 
ticulation with the head of the humerus. — Fig. III. Front view of the pelvis 
with the upper part of the thigh bones in position : a, the sacrum ; b, the in- 
ternal surface of the ilium called the iliac fossa; c, the crest of the ilium ; d, 
the os pubis ; e, the ischium ; f, the tuberosity of the ischium ; g, the head of 
the femur or thigh bone ; h, the capsular ligament of the hip-joint. — Fig. IV. 
The first cervical or atlas vertebra looked at from above. — Fig. V. A lum- 
bar vertebra. — Fig. VI. The upper limb in its articulation with the shoulder- 
blade looked at from before : a, the subscapular fossa ; b, the acromion process 
of the scapula ; c, the superior articular surface of the humerus in articulation 
witb the glenoid cavity of the scapula ; d, the shaft or body ; e, the inferior 
extremity of the humerus articulating with the bones of the fore-arm ; f, the 
ulna or inner of the two bones of the fore-arm ; g, the radius or outer of the 
two bones ; h, the carpus or wrist ; i, the metacarpus ; k, the fingers. — Fig. 
VII. The inferior extremity : a, the shaft of the femur or thigh bone ; b, the 
articular head ; c, the neck ; d, the great trochanter ; e, the inferior articular 
surface ; /, the patella or knee-pan ; g, the tibia or shin bone, the inner of the 
two bones forming the leg ; h, the fibula or outer bone of the leg ; k, the in- 
ternal malleolus ; i, the external malleolus. — Fig. VIII. The knee-joint 
looked at from behind. — Fig. IX. The right foot looked at from above : a, 
the os calcis ; b, the astragalus ; c, the scaphoid ; d, the cuboid ; e, the three 
cuneiform bones ; f, the metatarsus ; g, the toes. 

Plate II. — Fig. X. The human skeleton : a, the frontal bone ; b, the 
orbit ; c, the teeth ; d, the temporoparietal suture ; e, zygomatic arch ; f, the 
cervical vertebra; ; g. the shoulder girdle ; h, the coracoid process of scapula ; 
k, the sternum or breast bone ; /, the six lower ribs ; m, the humerus ; n, the 
ulna; o, the radius; p, the carpus or wrist; q, the fingers; r, the lumbar 
vertebra? ; s, the sacrum ; t, the crest of the ilium ; u, the great trochanter of 



990 APPENDIX. 



the femur or thigh bone ; v, the shaft of the femur ; to, the tibia or shin bone ; 
x, the fibula ; y, the patella or knee-pan ; z, the heel ; 1, the tarsus ; 2, the 
metatarsus. — Fig. XI. Right humerus looked at from before : a, the lesser 
tuberosity ; b, the articular head ; c, the inferior articular surface ; d, the 
V-shaped mark for the insertion of the deltoid muscle ; e, the inferior articu- 
lar surface ; /, the spiral groove ; g, the bicipital groove ; k, the surgical neck ; 
h — k, the external and internal ridge of the bicipital groove ; t, the greater 
tuberosity ; m, the capitellum, or smaller of the two surfaces into which the 
inferior articular extremity of the humerus is divided. It articulates with the 
head of the radius ; n, the furrow separating the capitellum from the trochlea 
or larger articulating surface ; e, the trochlea for articulating with the head of 
the ulna ; o, the coronoid depression for receiving the coronoid process of the 
ulna; p, nutritive foramen for the passage of a vessel into the interior of the 
bone to supply it with nourishment ; p — r, internal edge of humerus ; d — I, 
external edge ; h — i, anterior edge ; s, anatomical neck ; /, external supracon- 
dyloid eminence; r, internal' supracondyloid eminence. — Fig. XII. The ar- 
ticulations of the bones of the fore-arm seen from before : a, the external 
lateral ligament ; b, the internal lateral ligament ; c, the anterior ligament ; e, 
the orbicular ligament of the radius ; /, the anterior ligament of the inferior 
radio-ulnar articulation ; i, triangular cartilage; I, interosseous membrane. — 
Fig. XIII. The same viewed from behind : a, b, and c as in Fig. XII. ; d, 
posterior ligament ; n, oblique ligament; g, posterior radio-ulnar ligament. — 
Fig. XIV. The left foot viewed from above. — Fig. XV. The same display- 
ing the under surface : or, the astragalus ; b, the os calcis ; c, i, f, the tarsus ; 
g, the scaphoid; i, g, I, the internal, middle, and external cuneiform; m, m, 
the metatarsus ; », o, r, the toes. 

Plate III. — Fig. XVI. This figure is intended to represent the most 
common form of lever met with in the human body, namely, a lever of the 
third order. In this form of lever the power p acts between the fulcrum/ 
and the resistance r. — Fig. XVII. The human pelvis looked at from before : 
y, y', the symphysis pubis ; k, descending ramus of pubis ; h, the obturator 
foramen ; m, n, o, the horizontal ridge which constitutes the lower boundary 
of the internal iliac fossa. The space circumscribed by this line has been 
called the brim or superior strait of the pelvis ; u, y\ u, the notch presented 
by the great pelvis ; d, the promontory of the sacrum; i and t, the internal 
iliac fossa? which form an inclined plane on each side fitted to direct the weight 
of the viscera, which rests upon them, upwards and forwards. The circum- 
ference or the pelvic brim is represented by^, d; the anterior edge of the base 
of the sacrum by m, n : the horizontal ridge by n, o, the pectineal line, and o, 
the spine of the pubis. Its length is four inches. In the transverse direction, 
ni, it measures five inches. The two oblique diameters of the pelvis, n, g, 
measure four and a half inches. In the female all the diameters of the upper 
strait are greater than in the male, x, y, z, the arch of the pubis. The trans- 
verse diameter, x, z, of the lower part of the pubic arch measures three inches. 



ILLUSTRATIONS. 991 



The superior circumference or base of the pelvis presents a great notch, u, u, 
in front, in the median line of which is the symphysis pubis, y ; o, the spine of 
the pubis ; o, n, the pectineal surface ; n, n, the ilio-pectineal eminence ; n, u, 
groove for psoas and iliacus muscles ; n, anterior superior spinous process of 
ilium, at which point it terminates ; u, v, crest of the ilium. — Fig. XVIII. 
Deep layer of muscles : n, the posterior surface of the fore-arm ; g, the an- 
coneus muscle ; i, the extensor ossis metacarpi pollicis ; /, the extensor primi 
internodii pollicis ; m, extensor secundi internodii pollicis and extensor inclicis ; 
o, extensor carpi radial is hrevior; o', point of insertion of extensor carpi radia- 
lis brevior ; p, supinator brevis. — Fig. XIX. The inferior maxilla or lower 
jawbone : a, the body ; b, b, the rami ; c, d, symphysis menti or chin, which 
marks the place of union of the two halves of the bone in childhood ; d, the 
mental process ; e, mental fossa for the attachment of muscles: e, f, the ex- 
ternal maxillary line ; g, the mental foramen for transmitting the mental ves- 
sels and nerves ; c, h, anterior surface of alveolar arch ; a, a, smooth surface 
separated from the skin by the platysma myoides muscle ; k, the mylo-hyoidean 
line, called also the internal oblique or internal maxillary line ; d, n, the in- 
ferior border or base of the jaw; I, the posterior orifice of the inferior dental 
canal ; r, the anterior edge, marked by a groove, which is the continuation of 
the alveolar border ; n, o, sigmoid notch ; m, angle of the jaw ; n, the coronoid 
process ; p, the condyle ; o, neck of condyle. — Fig. XX. Side view of the 
human skeleton : 1, the frontal bone ; 2, the parietal suture ; 3, the lambdoidal 
suture ; 4, the occipital bone ; 5, the symphysis menti or chin ; 6, cervical 
vertebras ; 8, the dorsal vertebras ; 30, the lumbar vertebras ; 9, the humerus ; 
10, the ulna; 11, the radius ; 33, the elbow joint ; 26, the scapula or shoulder- 
blade ; 25, the sternum or breast bone ; 29. the ribs ; 28, the sacrum ; 12, the 
carpus or wrist ; 13, the metacarpus; 14, the phalanges; 15, the ilium; 16, 
the symphysis pubis ; 17, the tuberosity of the ischium ; 18, the femur or thigh 
bone; 19, the patella or knee-pan; 20, the tibia; 21, the fibula; 22, the 
tarsus ; 23, the metatarsus ; 24, the phalanges. — Fig. XXI. The vertebral 
column : a — b, the cervical vertebras ; b — c, the dorsal vertebras ; c — d, the 
lumbar vertebras ; d — e, the sacrum ; e— -f, the coccyx. 

Plate IV. — Fig. XXII. The superficial muscles of the body viewed from 
behind. — Fig. XXIII. The superficial muscles of the body viewed from be- 
fore : a, Fig. XXII., occipital portion of the occipito-frontalis muscle ; a, Fig. 
XXIII., frontal portion of the same muscle ; b, the muscles of the cheek ; c, 
the sterno-cleido-mastoid muscle ; d, the trapezius ; e, the pectoralis major ; f, 
the latissimus dorsi ; g, the external oblique muscle of the abdomen ; h, the 
gluteus .maximus ; k, the deltoid ; /, muscles on the posterior aspect of the 
upper arm ; I', muscles on the anterior aspect of the upper arm ; m, muscles 
on posterior aspect of fore-arm ; m', muscles on anterior aspect ; n', muscles 
of the ball of the thumb ; o, muscles of the thigh ; p, muscles of the front of 
the leg ; q, muscles of the calf ; r, the tendo Achillis ; s, the muscles on the 
upper surface of the foot. — Fig. XXIV. Vertical section through the skull 



992 APPENDIX. 

a little to the left of the median line : a, the frontal &inus ; b, c. the coronal 
suture ; b, d, f, c, the internal surface of the parietal bone and parietal fossa ; 
d, f, the larnbdoidal suture and superior occipital fossa ; b, i, the ramified 
grooves which traverse the internal surface of the cranium, — they are partly 
for the transmission of arteries, partly for veins ; h, the anterior condyloid 
foramen ; n, the crista galli ; u, the nasal bone ; 5, the sphenoidal sinus ; 8, the 
anterior nasal spine ; b, i, d, the temporo-parietal suture, which becomes continu- 
ous with lambdoiclal suture ; 3, the superior or sphenoidal border of the vomer ; 

3, 4, the anterior ethmoidal border ; t, 10, the posterior or guttural edge ; 1, 

4, 8, the deep notch in the front of the nasal septum, which in the fresh state 
is occupied by cartilage ; 8, anterior nasal spine ; 9, palate process of superior 
maxilla ; h, anterior condyloid foramen ; I, groove of the lateral sinus ; m, 
styloid process ; 6, external pterygoid process ; 7, internal pterygoid process. 
— Fig. XXV. Lateral view of the skull, with a portion of the lower jaw re- 
moved, so as to display the pterygo-maxillary region : a, the internal pterygoid 
muscle ; b, the external pterygoid muscle. 

Plate V. — Fig. XXVI. The veins of the head and neck : a, the frontal 
vein ; b, the nasal arch; c, the supra-orbital vein; (/, the angular vein; e, the 
facial vein ; f, the temporal vein ; g, the course of the middle temporal vein, 
indicated by the dotted lines; h, the external jugular; m, the anterior jugu- 
lar ; n, the internal jugular ; I, the supra-scapular and posterior scapular veins ; 
o, the subclavian vein ; r, the right innominate vein. — Fig. XXVII. Vertical 
section of a kidney, showing its internal structure : a, the external or cortical 
substance; b, the broad part of the pyramids; c, their apices projecting into 

d, d, the divisions of the pelvis of the kidney named calyces, or infundibula; 

e, the pelvis of the kidney; f, the ureter; g, the renal artery; h, the renal 
vein. The kidney is composed of two parts, an external or cortical portion, 
and an internal or medullary. The medullary portion consists of a number of 
pyramids, called the Malpighian pyramids. The bases of these pyramids are 
in contact with the cortical substance ; their apices project into the calyces, 
and form what are called the papillce. The cortical substance is surrounded by 
a fibrous envelope, which closely invests its surface. Each kidney receives its 
supply of blood from the renal artery, the branches of which enter at the 
sinus. — Fig. XXVIII. Represents a view of the heart or central organ of 
circulation with the whole circulatory apparatus : 1, the heart ; 2, the pulmonary 
artery ; the inferior or ascending vena cava ; 4, the superior or descending vena 
cava ; 5, the aorta; 6, point of division of the aorta into the right and left com- 
mon iliac arteries ; 7, point of division of the left common iliac artery into in- 
ternal and external iliac arteries ; 8, external iliac artery ; 9, internal iliac 
artery; 10, left common carotid artery, with internal jugular vein lying to its 
outer side ; 11, left subclavian artery, and the axillary artery, which is its direct 
continuation ; 12, the brachial artery ; 13, the radial artery, one of the divisions 
of the brachial at the bend of the elbow; 14, anterior tibial artery; 15, the 
long saphenous vein ; 16, cephalic vein of right arm ; 17, the basilic vein ; 18, 



ILLUSTRATIONS. 993 



the ramifications of the pulmonary vein and arteries, in the left lung. The 
direction of the blood current is indicated by the arrows. The veins are shaded 
in darker than the arteries. — Fig. XXIX. The posterior surface of the heart : 
c, c, the pulmonary veins ; k, k, the pulmonary artery ; f, the aorta ; d, the 
superior vena cava ; n, the left auricle ; m, the right auricle ; r, the inferior 
vena cava; o, the left ventricle; /, the right ventricle; b, the apex of the 
heart. — Fig. XXX. The right ventricle opened into so as to display the sig- 
moid or semilunar valves ; a, k, the pulmonary artery. 

Plate VI. — Fig. XXXI. The base of the brain: a, the anterior lobe; 
b, the middle lobe; c, the occipito-parietal fissure; d, the cerebellum; e, the 
medulla oblongata ; f, the pons Varolii ; g, optic commissure ; h, bulb of the 
olfactory nerve; i, cms cerebri. — Fig. XXXII. Vertical section through the 
skull displaying the right half of the brain : a, the frontal lobe ; b, the parietal 
lobe ; c, the occipital lobe ; d, the cerebellum ; e, the medulla oblongata ; fi the 
spinal cord; $> the pons Varolii; h, the corpus callosum or stratum of fibres 
connecting the two hemispheres of the brain ; i, the fifth ventricle lying be- 
tween the layers of the septum lucidum at the anterior part ; k, the third ven- 
tricle placed between the optic thalami and anterior to the corpora quadrigem- 
ina ; I, the tentorium cerebelli, which separates the cerebrum from the cere- 
bellum ; m, the frontal sinus ; n, the perpendicular plate of the ethmoid bone ; 
o, the nasal cartilage ; p, the superior maxillary bone ; r, the Eustachian tube 
or trumpet forming a communication between the ear and the upper part of 
the pharynx ; s, the soft palate; q, the pharynx. — Fig. XXXIII. The upper 
surface of the cerebellum : a, anterior or square lobe ; b, posterior superior 
lobe; c, posterior inferior lobe. : — Fig. XXXIV. Posterior view of the spinal 
cord with the roots of the nerves : a, the posterior pyramids; b, g, the filum 
terminale, or terminal filament of the spinal cord ; c, the origin of the cervical 
nerves ; d, of the dorsal nerves ; and e, of the lumbar nerves ; f, the cauda 
equina. The spinal cord is that portion of the cerebro-spinal axis which is 
contained in the spinal canal. It extends from the foramen magnum of the 
occipital bone to about the second lumbar vertebra, where it terminates in a 
slender filament of nervous matter called the jilum terminale, which is contin- 
ued onwards to the lower end of the sacral canal. The length of the spinal 
cord varies from fifteen to eighteen inches. It is closely invested by a very 
vascular membrane called the pia mater, while the canal in which it lies is 
lined by a strong fibrous membrane called the dura mater. There is a groove 
on the anterior aspect of the cord, dividing it nearly to its centre, and a similar 
groove on the posterior aspect. The former is called the anterior median fis- 
sure, the latter the posterior median fissure. Along each lateral aspect of the 
cord a series of nerves is given off. It consists of the spinal nerves, of which 
there are thirty-one pairs. Each nerve arises by two roots, an anterior and a 
posterior, so that the number of roots arising from each half of the cord is 
double that of the nerves. — Fig. XXXV. The spinal column looked at from 

fj- before, with the structures lying in immediate relationship to it : a, the 

I 63 



994 APPENDIX. 



vertebra; b, the odontoid, or tooth-like process of the axis vertebra ; c, the 
axis vertebra; d, e, the prevertebral muscles; f, the intercostal spaces; g, the 
left innominate vein ; h, the subclavian vein ; i, the internal jugular vein ; k, 
the vena azygos major; I, the receptaculum chyli; m, the thoracic duct open- 
ing into the veins at the junction of the internal jugular with the subclavian 
vein; n, the point of junction of the internal jugular with the subclavian vein ; 
o, the superior cervical ganglion of the sympathetic nerve ; p, the middle cer- 
vical ganglion ; q, the dorsal ganglia of the sympathetic nerve; r, the great 
splanchnic nerve, formed by branches from all the thoracic ganglia from the 
sixth to the tenth ; s, the external branches from the thoracic ganglia, which 
communicate with the dorsal spinal nerves. 

Platk VII. — Fig. XXXVI. View of the pancreas and the surrounding 
organs. The liver and stomaoh are turned, upwards to show the duodenum, 
the pancreas, and the spleen : a, the aorta ; b, the third or transverse portion 
of the duodenum ; c, the cardiac end of the stomach ; d, the crura or pillars 
of the diaphragm ; e, e, the descending portion of the duodenum ; p, the py- 
loric end of the stomach ; /, the left lobe of the liver ; V , the right lobe of the 
liver; q, the gall bladder; x, the hepatic duct; s, the under surface of the 
stomach; o, the pancreas; k f the spleen; i, the commencement of the jejunum 
or second portion of the small intestine ; m, the superior mesenteric artery ; 
t, the cceliac axis. — Fig. XXXVII. Diagram of the abdominal portion of the 
alimentary canal : s, the stomach ; a, the lower part of the oesophagus or gul- 
let; b, the duodenum ; c, the termination of the duodenum and commencement 
of the coils of the small intestine extending to d, which marks the termination 
of the ileum or third portion of the small intestine in the caput caecum, in which 
the large intestine begins ; v, the vermiform process ; e — -f, ascending portion 
of colon ; f— g, the transverse portion ; g — h, the descending portion ; h — i, 
the rectum. — Fig. XXXVIII. View of the oesophagus, the pharyngeal open- 
ing into the larynx, and the posterior surface of the trachea. In this figure 
the skull has been sawn through at the basilar process, and the vertebral col- 
umn along with the back wall of the chest has been removed, a, the interior 
of the skull ; b, the basilar process ; c, the internal carotid artery and internal 
jugular vein ; d, the posterior nares ; e, the palate ; /, the uvula ; g, the base 
of the tongue in the buccal aperture above the epiglottis ; h, the tonsil lying 
between the anterior and posterior pillars of the fauces ; i, the epiglottis ; 
k, the cricoid cartilage ; I, the side wall of the pharynx ; m, the oesophagus ; 
n, the trachea dividing at o into the right and left bronchi ; r, the aorta; t, the 
azygos vein ; u, the inferior vena cava opening into the lower part of the right 
auricle; s, the pericardium covering the heart; q and p, the right and left 
bronchi. — Fig. XXXIX. The abdominal viscera. In this figure the liver has 
been turned upwards to allow of tlie duodenum being seen, a, the oesophagus 
or gullet passing through the diaphragm ; b, c, the stomach ; d, the cardiac 
end where the oesophagus enters ; e, the left cul-de-sac ; s, the pyloric extrem- 
ity of the stomach ; g, the descending portion of the duodenum ; h, the right 



ILLUSTRATIONS. 995 



lobe of the liver ; i, the left lobe ; k, the gall bladder ; I, the common bile duct 
formed by the junction of the cystic and hepatic ducts ; m, m, the coils of the 
small intestine ; o, the caecum or widest part of the largest intestine ; s, the 
appendix vermiformis, a narrow worm-like portion of intestine attached to the 
lower and posterior part of the caecum ; n, the ileo-csecal valve, or valve which 
guards the opening of the small intestine into the large ; q, the ascending colon ; 
r, s, t, the transvei'se colon ; n, the sigmoid flexure of the colon ; v, the rectum, 
or lowest portion of the large intestine ; w, the bladder. 

Plate VIII. — Fig. XL. Front view of the heart and lungs : a, the crico- 
thyroid muscle ; j,f, the right and left common carotid arteries ; ^ the trachea 
or windpipe ; c', the right innominate vein ; c, the left innominate vein ; d, 
the right internal jugular vein ; e, the subclavian vein ; g, the arch of the 
aorta ; k, the innominate artery ; i, i', the right and left subclavian arteries ; s, 
the superior lobe of the right lung ; t, the middle, u, the inferior, lobe. The 
left lung is divided into a superior lobe, s, and an inferior lobe, u ; v, the inter- 
lobular fissure on the right lung ; v, the interlobular fissure on the left lung ; 
w, the fissure which causes a partial division of the superior lobe of the right 
lung to form the middle lobe ; p, p', the mediastinum ; r, r, the root of the lungs, 
the part at which they communicate with the trachea through the bronchi, 
and receive and emit their blood-vessels ; x, x, the convex surface of the dia- 
phragm ; q, the pericardium. — Fig. XLL Front view of the viscera of the 
thorax and abdomen : p,p, the lungs ; m, the mediastinum ; h, that portion of 
the lung which is not overlapped by the lung ; a, t, d, the ascending, transverse, 
and descending portions of the colon ; i, the various coils of the small intes- 
tine ; n, the upper part of the bladder seen rising above the pubis ; I, I', the 
liver ; s, the stomach ; k, the spleen ; g, the lower portion of the gall-bladder 
projecting from under the liver. — Fig. XLII. Front view of the viscera of the 
thorax and abdomen ; the pleura? covering the lungs : o, the thoracic portion of 
the oesophagus ; z, the vena azygos ; h, the thoracic aorta ; a, the ascending 
colon : t, the transverse ; d, the descending colon ; f, the sigmoid flexure ; v, the 
appendix vermiformis ; r, the rectum ; n, the bladder ; g, the gall bladder ; k, 
the spleen ; /, I', the liver ; s, the stomach ; 1 — 2, the falciform ligament which 
forms the line of separation between the right and left lobes of the liver ; 1, the 
coronary ligament ; 3, the left lateral ligament, with which the coronary liga- 
ment is continuous along the posterior border ; c, the caecum ; i, the termination 
of the ileum in the large intestine ; j, the duodenum; m, the mesentery or 
fold of peritoneum which supports the convolutions of the intestine. 

Plate IX. — Fig. XLIII. The left half of the human brain. In this fig- 
ure the brain has been divided by a median vertical section from before back- 
wards. /, the lateral wall of the third ventricle, formed by the optic thalamus ; 
e, d, f, the curve of the corpus callosum ; t, the septum lucidum ; Jc, the fornix ; 
z, the corpora albican tia or mammillary tubercles ; b, the tuber cinereum ; i, the 
infundibulum ; 2, the optic nerve ; c, section of the anterior commissure ; x, 
section of the posterior commissure ; p, the pineal gland ; s, the peduncle of 



996 APPENDIX. 



the pineal gland ; o, the pons Varolii ; g, the medulla oblongata ; y, opening 
in the lower part of the fourth ventricle ; /, v, aqueduct of Sylvius, a canal 
establishing a connection between the third and fourth ventricles ; f, g, the 
corpora quadrigemina ; s, the superior peduncles of the pineal gland ; n, above 
this is the posterior part of the floor of the third ventricle ; m, the anterior 
part of the floor of the third ventricle ; w, the arbor vitas of the middle lobe 
of the cerebellum ; y, opening establishing a communication between the gen- 
eral ventricular cavity and the spinal subarachnoid space. It is situated at the 
inferior angle of the fourth ventricle ; g, w, the valve of Vieussens, occupying 
the interval between the two superior peduncles of the cerebellum. — Fig. 
XLIV. Vertical sections of a kidney : a, the cortical portion ; b, the bases of 
the pyramids ; d, the apices of the pyramids ; c, the divisions of the pelvis of 
the kidney, called calyces, into which the apices of the pyramids open ; c', a 
calyx of the kidney unopened ; e, the papillae formed by the apices of the pyr- 
amids projecting into the calyces ; h, the hilus or fissure in the kidney ; p, the 
pelvis, or enlargement of the ureter within the sinus ; n, the ureter. — Fig. 
XLV. Section of the lung, showing its minute structure : b, is the same as is 
represented in a, only magnified about nine diamaters. A small bronchial 
tube is seen to enter a lobule of the lung, where it divides and subdivides into 
numerous twigs, t ; these as they approach the surface of the lobule have their 
calibre narrowed, but while this takes place they become more numerous. 
They end in close rounded extremities, c. These little rounded extremities 
are the pulmonary cells. The bronchial twigs and the pulmonary cells are 
distended with air ; d indicates the commencement of other twigs into which 
no air has passed. — Fig. XLVI. Vertical section through the trunk of the 
human female: 1, the innominate artery; 2, the left common carotid ; 4, the 
left subclavian ; 3 is placed in the interval between the left common carotid 
and left subclavian arteries ; 5, the arch of the aorta ; 6, the pulmonary 
artery; 7, the lung; 8, the phrenic nerve; 9, 10, the pulmonary veins; 11, 
the pericardium ; 12, 13, 14, the diaphragm ; 15, the liver; 16, the stomach; 
17, the transverse colon ; 18, the coils of the small intestine ; 19. the descend- 
ing colon ; 20, the sigmoid flexure of the colon ; 21, the uterus ; 22, the blad- 
der; 23, the vagina; 24, the rectum ; 25, the symphysis pubis; 2G, 27, the 
vertebral column ; 28, the breast; 29, 30, 31, the abdominal walls. 

Plate X. — Fig. XLVII. View of the aorta from its commencement to its 
termination : a, b, the arch of the aorta ; b, c, the thoracic portion ; e, the in- 
nominate artery ; f, the left common carotid ; g', the left subclavian ; f, the 
right common carotid; g, the right subclavian ; h, the oesophagus ; c, d, the 
abdominal aorta ; i', i, the right and left intercostal arteries, arising from the 
back of the aorta ; d, the point of bifurcation of the abdominal aorta ; o, the 
spermatic arteries, passing to the ovaries; n, the uterine arteries. — Fig. 
XLV1II. Diagramatic view of the circulation in the human body. The di- 
rection of the blood current is represented by the arrows. The portion that is 
shaded in darker than the rest represents the venous system ; the lighter part 



ILLUSTRATIONS. 997 



represents the arterial portion of the circulatory apparatus. The view is taken 
from before, so that what appears to the right of the person looking at the 
diagram corresponds with what is left in the body, and vice versa, a, the 
right auricle ; b, the right ventricle ; c, the pulmonary artery ; d, the lungs ; 
e, the pulmonary vein ; f, the left auricle ; g, the left ventricle ; h, the aorta ; 
i, vessels supplying the upper part of the body with blood ; I, m, vessels carry- 
ing blood to the lower parts of the body ; n, arteries going to supply the 
stomach, intestines, spleen, and pancreas ; o, the abdominal viscera already 
mentioned; p, the vena porta?, formed by the junction of the veins issuing 
from the viscera already alluded to ; q, the liver ; r, the hepatic vein ; s, the in- 
ferior vena cava ; k, the superior vena cava ; t, the terminal radicles. — Fig. 
XLIX. Side view of the viscera of the male pelvis ; h, the bladder ; b, the 
pubis; u, the peritoneum which retains the bladder in position; q, the anterior 
ligaments of the bladder ; o, the rectum ; t, the vas deferens ; s, the vesicula 
seminalis ; i, the prostate gland ; c, the membranous portion of the urethra ; g, 
gland of Cowper ; I, the spongy portion of the urethra ; below I is the bulb of 
the spongy portion of the urethra ; m, the corpus cavernosum of the penis ; a, 
the sphincter ani ; p, the anus ; c, the ischium. 

Plate XI. — Fig. L. The upper surface of the tongue, with the tonsils and 
fauces : a, the circumvallate papillae ; b, the foramen caecum, or blind opening. 
Between a and b, and near the foramen caecum, lie the lingual glands. The 
small, rounded eminences which are seen scattered about over the fore part of 
the dorsum of the tongue are the fungiform papillae. The fungiform papillae 
are intermediate in size between the circumvallate papillae and the filiform, 
which are the smallest and most numerous. — Fig. LI. Vertical section of the 
skin, showing the sweat glands : a, b, the epidermis, or cuticle ; e, the pig- 
mentum, or coloring matter of the skin ; d, the rete mucosum, or gelatiniform 
layer situated beneath the epidermis ; c, the corium ; f, the subcutaneous 
areolar or adipose tissue ; g, the sudoriferous glands ; h, the convoluted duct of 
the sudoriferous glands conveying the sweat; i, the free surface of the skin. — 
Fig. LII. Vertical section of the skin of a negro : a, the cutis, or true skin ; 
b, the pigmentum, or coloring matter ; b, the epidermis, or cuticle. — Fig. LIII. 
A section of skin from the head, showing the roots of the hair and the 
sebaceous follicles : a, the horny layer of the cuticle ; e, the mucous layer ; 
g, the sudoriferous glands ; h, the sweat ducts proceeding from the sudorifer- 
ous glands to open on the surface of the skin ; f, adipose cellular tissue ; b, a 
hair, showing its projection above the skin; c, the hair follicle. — Fig. LIV. 
Skin of the negro. The various parts in this figure are similar to those in 
Fig. LI., only more highly magnified. — Fig. LV. A hair magnified : a, the 
papilla, which goes by tlie name of the pulp of the hair, arising from the bot- 
tom of the pouch or sac, c, c. This pouch or sac opens upon the surface of 
the skin by a narrow orifice through which the hair, b, projects. There is no 
contact between the hair and the sac; e, the internal surface of this cavity, 
which is smooth and not adherent to the hair. It is separated from it by a 



998 APPENDIX. 



reddish liquid ; d, layer of epidermis lining the follicle : g, the subcutaneous 
cellular tissue in which the hair is imbedded. — Fig. LVI. Vertical section of 
the ungual portion of a finger, to show the appearance of the nail : a, the fold 
of epidermis at the base of the nail ; a', the epidermis, showing its conti- 
nuity with the deepest layer of the horny lamina ; b, the body of the nail ; c, 
the duplicature of the skin, into which the nail is received ; c', the thick dermis 
separating the nail from the phalanx. 

Plate XII. — Fig. LVII. Diagramatic view of the organ of hearing. In 
this figure a section has been made in the transverse direction through the 
side walls of the skull : a, the auricle or pinna ; b, the external auditory 
meatus ; c, the tympanic membrane ; d, the tympanic cavity ; e, the Eusta- 
chian tube ; f, the internal ear. — Fig. LVIII. The right foot viewed later- 
ally, showing the tarsus, the metatarsus, and the toes : a, the astragalus ; c, the 
os calcis; g, the scaphoid ; f, the cuboid ; i,j, I, the three cuneiform bones ; c, 
a,j, the convexity of the arch of the tarsus ; d, i, its concavity ; m, ni', the met- 
atarsus ; e, the sustentaculum tali ; i, the first cuneiform bone ; j, the second 
or middle cuneiform bone ; /, the third or external cuneiform bone ; m', the first 
or metatarsal bone of the great toe ; n, n', the first or metatarsal phalanx ; 

0, the middle phalanx ; r, r', the ungual phalanges ; d, the heel ; s, the sesa- 
moid bones of the metatarsal bone of the great toe. — Fig. LIX. The outer 
surface of the pinna or auricle : a, the concha ; b, the tragus ; c, the an ti tragus ; 

1, the lobule ; e, the autihelix ; f, the fossa of the antihelix ; g, the helix ; i, 
the fossa of the helix. — LX. Dissection representing the superficial distribu- 
tion of the facial, the fifth or trigeminal, and other nerves : a, the infraorbital 
nerve ; b, the external and internal frontal nerves ; c, the temporo-auricular 
nerve ; d, labial and mental branches of the inferior dental nerve ; e, trunk of 
the facial nerves after its exit from the stylomastoid foramen ; f, the great 
occipital nerve ; g, the superficial cervical, great auricular, and lesser occipital 
nerves. — Fig. LXI. A series of crania — the two first belonging to the 
human subject, the two last to the monkey — displaying the facial angle of 
Camper. By the facial angle is understood the angle that is formed by two 
lines, one drawn through the external auditory meatus and the base of the 
nose, and another from the most projecting parts of the forehead through the 
incisor edge of the upper jaw. This angle in the European adult was esti- 
mated by Camper at 80°. In the negro it is diminished to 70°. In the mon- 
key Camper found it to vary from 47° to 60°, being greater in the young 
ourang than in the old. 

Plate XIII. — Fig. LXII. The base of the brain: 1, the olfactory 
nerve ; 2, the optic nerve ; 3, the third pair of nerves ; 4, the fourth pair of 
nerves ; 5, the trigeminus ; 6, the sixth pair ; 7, the seventli pair ; 8. the 
eighth pair ; 9, the ninth pair ; a, superior convolution of the cerebrum ; c, 
middle convolution ; o, the occipital lobe ; d, the pons Varolii ; e, the medulla 
oblongata ; /, the crura cerebri ; g, the anterior part of the square lobe of the 
cerebellum ; h, the anterior perforated spot ; *, the infuudibulum ; u, the tuber 



ILLUSTEATIONS. 999 



cineriurn ; z, the corpora albicantia; t, the commissure; I, the under surface 
of the cerebellum ; x, the longitudinal fissure ; m, the flocculus or sub-pedun- 
cular lobule of the cerebellum ; n, the notch between the hemispheres ; y, con- 
volutions of the cerebrum. — Fig. LXIIL The thoracic viscera looked at 
from behind : a, the arytenoideus ; b, the trachea ; p, the bronchi ; g, the 
crico-arytenoideus posticus muscle ; k, k', the pulmonary arteries ; I, m, the 
pulmonary veins ; f, the arch of the aorta divided ; o, the posterior surface of 
the heart ; d, the internal jugular vein ; e, the subclavian ; c, the innominate 
vein ; h, the brachiocephalic or innominate artery ;j, the right common carotid 
artery ; f, the left common carotid artery ; i, the right subclavian artery ; i' 
the left subclavian artery ; s, the superior lobes of the lung ; v, the right in- 
terlobular fissure ; v', the left interlobular fissure ; x, the base of the lung. — 
Fig. LXIV. The arteries of the upper limb, a — a, the axillary artery ; a, 
the acromial thoracic branch of the axillary artery ; b, thoracic branches of 
the acromial thoracic artery ; c, the acromial branches ; d, the deltoid muscle ; 
e, the long thoracic artery ; f, the subscapular artery ; g, its thoracic branches ; 
i, the dorsalis scapulas branch ; I, the posterior, and n, the anterior, circumflex 
arteries ; a' — h, the brachial artery ; k, its superior profunda branch ; to, its 
inferior profunda branch ; o, the anastomotica? magnas ; h, the bicipital fascia ; 
p, the radial artery ; g, the ulnar artery ; s, the superficialis volaa branch of 
the radial artery ; t, the superficial palmar arch formed by the ulnar artery 
along with the superficialis voice branch of the radial ; y, the anterior interos- 
seous arteries ; v, the princeps pollicis ; x, the radialis indicis ; u, the digital 
branches. — Fig. LXV. The bones of the arm and fore-arm viewed laterally, 
with the coraco-brachialis muscle attached, and in a state of relaxation : a, the 
humerus ; b, the ulna ; c, the coraco-brachialis muscle. 

Plate XIV. — Fig. LX VI. The muscles of the left orbit viewed from 
the outer side by the removal of the outer wall of the orbit: a, the levator 
palpebral superiors ; b, the superior rectus ; c, the inferior rectus ; e, the ex- 
ternal rectus ; g, the inferior oblique muscle ; f, the superior oblique ; o, the 
optic nerve round which the muscles are arranged ; d, the internal rectus. — 
Fig. LXV1I. Vertical section of the left orbit with its contents : a, the leva- 
tor palpebral superioris ; b, the superior rectus ; o, the optic nerve ; e, the in- 
ferior rectus ; /, the elastic cushion of fat upon which the eye rests ; c', the 
tarsal cartilage ; d', the cornea ; b', the lower eyelid ; I, the crystalline lens ; 
c'', the anterior and inferior part of the sclerotic; c, the cornea. — Fig. 
LXVIII. Diagramatic view of the parts composing the organ of hearing: 
a, the pinna ; b, the external auditory meatus ; d, the head of the malleus, or 
hammer bone ; e, the processus gracilis, or slender process of the malleus ; f, 
its handle ; g, the incus ; h, its short process ; i, its long process ; k, the tuber- 
cle for articulation with the head, I, of the stapes ; m, the base of the stapes, 
or that portion which is placed in the fenestra ovalis ; n, the superior semi- 
circular canal ; o, the posterior canal ; p, the horizontal or external ; q, the 
first turn of the cochlea ; r, the apex of the cochlea. — Figs. LXIX., LXX., 



1000 APPENDIX. 



LXXI. The small bones of the ear viewed separately : 1, the malleus ; 2, the 
incus ; 3, the stapes. — Fig. LXXIL The organ of hearing shown diagram- 
atically by making a transverse section through the side wall of the skull : 
a, the pinna ; b, the external auditory meatus ; e, the membrana tyinpani ; d, 
the cavity of the tympanum ; /, the malleus ; g, the anterior semicircular 
canal; e, the Eustachian tube. — Fig. LXXIII. Vertical section through 
the head in the antero-posterior direction, showing the cavities of the mouth 
and nose in their relation to one another ; a, the arch of the palate ; c, the 
tongue ; e, the velum palati ; d, the lips ; e, the teeth ; f, the prominence cor- 
responding to the anterior margin of the internal pterygoid muscle, behind/, 
the anterior pillar of the fauces ; g, the posterior pillar ; n, the tonsil ;*«, the 
epiglottis ; u, the uvula; 1, the posterior opening of the nares; 4, opening of 
the Eustachian tube ; 2, the isthmus of the fauces ; 3, is placed opposite the 
superior opening of the larynx; 1, the nasal; 2, the guttural; 3, the laryn- 
geal portion of the larynx ; y, the oesophagus; v, the larynx; x, the trachea; 
t, the thyroid cartilage. 

Plate XV. — Fig. LXXIV. The bones of the upper extremity with the 
coraco-brachialis muscle attached, showing its action : a, the humerus ; b, the 
ulna ; c, the coraco-brachialis muscle in a state of contraction, and acting as a 
flexor of the fore-arm upon the upper arm. — Fig. LXXV. Finger in a state 
of partial contraction. — Fig. LXXVI. The abdomen, showing the artificial 
regions into which it is mapped out for the purposes of description. If two 
lines be drawn, one from the most prominent part of the lower costal carti- 
lage of one side to a corresponding point on the opposite side, and the other 
from the highest part of the crest of the ilium of one side to a corresponding 
point on the opposite side, and these carried circularly round the body till they 
meet where each began, the abdomen will be divided into three zones : o in 
the diagram represents the upper, and u tne lower of the two lines. If again 
two lines are drawn in a perpendicular direction from the cartilage of the 
eighth rib on either side to the centre of Poupart's ligament, each zone will 
undergo a subdivision into three parts, and the abdomen will thus be divided 
into nine compartments. These two perpendicular lines are marked in the 
diagrams I and I'. The regions are named as follows : 2, the epigastric ; 4, 
the umbilical ; 5, the hypogastric ; 3, the right and left hypochondriac ; 7, the 
right and left lumbar ; 6, the right and left inguinal. — Fig. LXXVII. Ver- 
tical section of the coats of the pig's stomach : /, the gastric glands ; m, the 
muscular layer of the mucous membrane ; b, the submucous coat ; //, m, the 
circular muscular layer ; I, m, the longitudinal muscular layer with the serous 
coat. — Fig. LXXVIII. Represents three lobuli from the lung. — Fig. 
LXXIX. The capillary network of the pulmonary blood-vessels in the human 
lung. 

Plate XVI. — Fig. LXXX. Reduction of dislocation of the shoulder- 
joint by the knee in the axilla. The surgeon is represented standing by the 
patient's side, with his foot resting upon a chair and his knee in the axilla. 



ILLUSTRATIONS. 1001 



His knee thus acts as a fulcrum, and the surgeon endeavors, by bending down 
the arm and bringing it across his knee, to reduce the dislocation. — Fig. 
LXXXI. Dislocation of the hip-joint upwards and backwards. In this form 
of dislocation the head of the thigh bone is driven upwards and backwards 
upon the dorsum of the ilium. The knee and foot are turned inwards, and 
the toes rest on the upper part of the tarsus of the opposite foot. — Fig. 
LXXXII. Dislocation of the hip-joint forwards and upwards. In this in- 
stance the head of the bone rests upon the pubis. There is shortening of the 
limb ; the foot and knee are turned out, and the head of the bone can be felt 
upon the pubis. — Fig. LXXXIII. Dislocation of the hip-joint downwards. 
In this instance the head of the bone occupies the obturator foramen. The 
symptoms of this dislocation are lengthening of the limb, with pointing of the 
foot downwards. 

Plate XVII. — Fig. LXXXIV. Reduction of dislocation of the shoul- 
der-joint by drawing the arm upwards. In this form of reduction, the sur- 
geon steadies the acromion process with one hand, while he grasps the arm 
above the elbow with the other, and draws it up by the side of the head. — 
Fig. LXXXV. Reduction of dislocation of the shoulder-joint by means of 
the heel in the axilla. This is the method of reduction that is most generally 
employed. The patient is placed in the recumbent position upon a couch or 
bed. The surgeon then seats himself beside him, and, having taken off his 
boot, places his foot in the axilla of the dislocated shoulder, making it act as 
a fulcrum. He then draws the arm steadily downwards, when in most cases 
the dislocation will be readily effected. — Fig. LXXXVI. Reduction of dis- 
location of the hip-joint. In this form of dislocation the head of the thigh 
bone is resting upon the pubis, and to reduce it the patient requires to be 
placed on his back, with his leg extended in a downward and backward direc- 
tion. Counter-extension is kept up by means of a band placed between the 
thigh and perineum. — Fig. LXXXVII. Single-headed truss. 

Plate XVIII. — Fig. XC. Fracture of the clavicle. In this accident 
the shoulder becomes flattened, and the arm being drawn in towards the side 
of the chest causes a lessening of the axilla to take place. — Fig. XCI. 
Apparatus for bracing back the shoulders in cases of fracture of the clavicle. 
— Fig. XCII. Dislocation of the shoulder joint, the head of the humerus 
being in the axilla. The round appearance presented by the shoulder in the 
natural state is seen to be lost. — Fig. XCIII. Special apparatus used in the 
treatment of fracture of the clavicle. Its object is to brace the shoulders well 
back and retain them in this position. 

Plate XIX. — Fig. XCIV. Fracture of the humerus above the condyles. 
The lower fragment is drawn upwards and backwards by the action of the 
brachialis anticus, the biceps, and the triceps muscles. — Fig. XCV. Angular 
arm splint for the treatment of fracture of the shaft of the humerus. — Fig. 
XCVI. Splints used in the treatment of fracture of the shaft of the humerus. 
There is an inner short splint, an outer long, and one for the arm. — Fig. 



1002 APPENDIX. 



XCVIL Form of splint used in the treatment of fracture of the bones of the 
leg. — Figs. XCVIII. and XCIX. represent two methods of treating trans- 
verse fracture of ihe patella. The object is to approximate the two ends of 
the bone together, and maintain them in as close proximity as possible. — Fig. 
C. Fracture of the lower end of the radius. 

Plate XX. — Fig. CI. Apparatus employed in the reduction of disloca- 
tion of the thumb. — Fig. CII. Dislocation of the wrist-joint. — Fig. CUT. 
Treatment of Pott's fracture by means of Dupuytren's splint. In this fracture 
the fibula or outer bone of the leg is broken about three inches above the 
ankle, while the tip of the internal malleolus is also broken off. The tendency 
of the muscular action in this fracture is to draw the foot outwards and up- 
wards, and to counteract this influence a splint is placed on the inner side of 
the leg, and well padded in the middle, so as to permit of the pad acting as a 
fulcrum, over which the foot can be drawn and its outward tendency to dis- 
placement counteracted. — Fig. CIV. Method of treating fracture of the 
olecranon process of the ulna. A splint is placed in front of the elbow-joint 
and fixed by a bandage. The arm is thus kept in an extended position and 
the broken surfaces are approximated to one another. — Fig. C V. Single- 
headed truss, for the treatment of right-sided hernia. — Fig. CVI. Double- 
headed truss. 

Plate XXI. — Fig. C VII. Salmon and Ody's truss. This truss has a 
ball and-socket arrangement. — Fig. CVIII. Fracture of the tibia or inner 
of the two bones of the leg, showing the resulting inversion of the foot. — 
Figs. CIX. and CX. represent Dr. Marshall Hall's method for the restoration 
of the apparently drowned. The former represents the act of inspiration, the 
latter that of expiration. When the patient is lying upon his side air enters 
the chest ; when turned upon his chest the weight of the body drives the air 
out. To restore breathing by this method the following directions should be 
attended to : (1.) Endeavor to clear the throat of mud, sand, or the like. For 
this purpose place the patient on the floor or ground with the face downwards, 
and one of the arms under the forehead, in which position all the fluids will 
more readily escape by the mouth, and the tongue itself will fall forward, 
leaving the entrance into the windpipe free. To aid the clearing of the throat 
the mouth should be wiped and cleansed. Should satisfactory breathing now 
commence, the attention must be directed to promote warmth ; but should the 
breathing be imperfect, or should there be no breathing, we must then try (2.) 
To excite breathing. Turn the patient well upon his side, at once supporting 
the head, and excite the nostrils with snuff, hartshorn, and smelling-salts, or 
tickle the throat with a feather, etc., if they are at hand. Rub the chest and 
face warm, and dash cold water, or cold and hot water alternately, on them. 
If the employment of these means prove unsuccessful, proceed at once (3.) 
To imitate breathing. Place the patient again on the face, and put a folded 
coat, or other article of dress under the chest to raise and support it. Turn 
the body very gently on the side, and a little beyond, and then briskly on the 



ILLUSTRATIONS. 1003 



face, back again, repeating these measures cautiously, efficiently, and perse- 
veringly, about fifteen times in the minute, or once every four or five seconds, 
varying, occasionally, the side. On each* occasion that the body is replaced 
on the face, make uniform but efficient pressure with brisk movement on the 
back between and below the shoulder-blades, or bones on each side, removing 
the pressure immediately before turning the body on the side. During the 
whole of this time one person must be attending solely to the movements of 
the head and the arm placed under it. Whilst the operations described above 
are being proceeded with, the hands and feet should be dried, and whenever 
dry clothing is procured begin to strip and gradually reclothe the patient, 
taking care, however, not to interfere in any way with the efforts that are 
being made to restore breathing. Should the above method of artificial respi- 
ration fail to produce the desired effect in from two to five minutes, proceed 
to imitate breathing by Dr. Sylvester's method. 

Plate XXII. — This method is illustrated in Figs. CXI. and CXIL, the 
former representing the act of inspiration, the latter that of expiration. The 
patient should be placed on a flat surface, inclined a little upwards from the 
feet. The head and shoulders should be raised and supported on a small firm 
cushion, or folded article of dress, placed under the shoulder-blades. The 
tongue should then be drawn forwards, and kept in that position by means of 
an elastic band passing over the tongue and under the chin. A piece of string 
or tape will answer quite as well if an elastic band cannot be procured. All 
tight clothing must be removed from the neck and chest. In order to imitate 
the movements of breathing, the operator must stand at the patient's head, 
and, grasping the arms just above the elbows draw them gently and steadily 
upwards above the head, keeping them in this position for two seconds. Then 
turn down the patient's arms, and press them gently and firmly for two 
seconds against the sides of the chest. These measures must be repeated 
deliberately and perseveringly about fifteen times in a minute, until a spon- 
taneous effort to inspire is perceived, upon which efforts must be made to in- 
duce circulation and warmth. In order to do this the limbs must be rubbed 
upwards with a firm grasping pressure and energy, handkerchiefs and flannels 
being made use of. Hot flannels, bottles, heated bricks, etc., should be applied 
to the pit of the stomach, the arm-pits, and soles of the feet. On life being 
restored a teaspoonful of warm water should be given ; and then, if the power 
of swallowing have returned, small quantities of wine, warm brandy and 
water, or coffee should be administered. The patient should be kept in bed 
and encouraged to sleep. The foregoing rules as to the treatment of the 
apparently drowned are copied with slight alteration from those issued by the 
National Life-boat Institution. — Fig. CXIII. Magneto-electric machine. 

Plate XXIII. — Fig. CXIV. Dr. RoweV vaginal syringe. — Fig. CXV. 
Odorator. — Fig. CXVI. Perfume spray, with india-rubber ball. — Fig. 
CXVII. Throat spray with india-rubber ball. — Fig. CXVIII. Enema 
mounted, bone mounts. — Fig. CXIX. Urethra or ear syringe, mounted. — 



1004 APPENDIX. 



Fig. CXX. Glass invalid feeder. — Fig. CXXI. Glass syringe for the ear. 

— Fig. CXXII. Feeding bottle, upright shape. — Fig. CXXIII. Glass 
syringe for the ear for self-use. 

Plate XXIV. — Fig. CXXIV. Air-tight cushion. — Fig. CXXV. The 
cotton-wool respirator, silver or gold plated. — Fig. CXXVI. The manifold 
respirator, of variable power, containing six metallic plates, four of which are 
movable. Gold-plated oval. This respirator may be worn with or without 
the plates a and b. — Fig. CXXVII. Silver-plated wire respirator, elastic 
silk mouthpiece. — Fig. CXXVIII. Ladies' miniature silver or gold plated 
respirator. — Fig. CXXIX. Orinasal silver-plated wire respirator, square. — 
Fig. CXXX. Brass enema apparatus. 

Plate XXV. — Fig. CXXXI. Perfume spray, with india-rubber ball and 
tube. — Fig. CXXXII. Throat spray, with india-rubber ball and tube. — 
Fig. CXXXIII. Stomach pump and enema combined. The tube of the 
stomach pump is represented in the figure as inserted into the stomach of a 
patient. The syringe has been filled and the stop-cock closed, so that none of 
the fluid can again return to the stomach, a represents the handle so turned 
as to admit of the fluid passing away from the body of the syringe out at the 
extremity of the second tube, d; b, the handle. — Fig. CXXXIV. Single- 
headed truss, circular. 

Plate XXVI. — Fig. CXXXV. Kennedy's enema apparatus, with elas- 
tic vagina pipe. — Fig. CXXXVI. India-rubber inflated pessary. — Fig. 
CXXXVII. Dr. Taylor's inhaler. — Fig. CXXXVIII. Breast exhauster, 
with india-rubber ball, glass mount, and glass receiver. — Fig. CXXXIX. 
Glass syringe for the ear, ivory-mounted. — Fig. CXL. Chest protector 
made of felt. — Fig. CXLI. The "Bon-Ton" chest protector, quilted satin. 

— Fig. CXLII. Invalid feeder.— Fig. CXLIII. Floating light. 

[Fig. CXLIV. to Fig. CLXXXVIII. represent plants which are of 
some service in medicine. In the following lines we merely indicate their 
names, and must refer the reader for particulars as to their properties and 
uses to any trustworthy work on medical botany.] 

Plate XXVII. — Fig. CXLIV. The Castor Oil plant (Ricinus commu- 
nis). 

Plate XXVIII. — Fig. CXLV. Flower of Aconitum napellus or common 
Monkshood. Aconite is employed medicinally for various purposes : thus it is 
used externally in neuralgia, and given internally in inflammatory diseases 
and for the relief of pain. — Fig. CXLVL Flower of the Corn Blue Bottle 
(Centaurea cyanus). — Fig. CXLVII. Unexpanded head (Capitellum) of the 
Dandelion (Leontokon taraxacum). — Fig. CXLVIII. Head of flowers when 
fully expanded. — Fig. CXLIX. The same before the seeds are fully ripe, 
representing a head of silky whiteness. — Fig. CL. Single detached seed from 
the head. — Fig. CLI. The Scarlet or Common Poppy {Papaver Rhoeas). — 
Fig. CLII. Seed of Poppy. —Fig. CLIII. Capsular fruit of Poppy. — Fig. 
CLIV. Flower of Indian Cress. — Fig. CLV. Spurred calyx of Indian Cress. 



ILLUSTRATIONS. 1005 



— Fig. CLVI. Three-celled capsule of Aconite. See under Fig. CXLV. — 
Fig. CLVII. Proliferous flower of the Eose. — Fig. CLVIII. Cultivated Nar- 
cissus. 

Plate XXIX. — Fig. CLIX. Flower of the Pot Marigold ( Calendula 
officinalis). — Fig. CLX. Transverse section of an apple. — Fig. CLXI. 
Apple-blossom. — Fig. CLXII. The Little Centaury (Gentiana Centaurium) 
belongs to the natural order Gentianacece. — Fig. CLXIII. Pod or siliqua of 
Wild Mustard. — Fig. CLXIV. The same, showing the manner in which 
the pods open. — Fig. CLXV. Single seed of Wild Mustard. — Fig. CLXVI. 
Pistil of Indian Cress, showing its different parts, — the ovary, style. — Fig. 
CLXVII. Vertical section of apple. 

Plate XXX. — Fig. CLXVIII. Flower of White Hellebore ( Veratrum 
album). — Fig. CLXIX. Branch of the Yew (Taxus baccata), with fruit 
attached. — Fig. CLX X. Female flower of Yew. — Fig. CLXXI. The same 
more advanced. — Fig. CLXXII. Male flower of Yew. — Fig. CLXXIII. 
The Hop. — Fig. CLXXIV. Branch displaying leaves and cones, or catkins, 
of the female flowers of the Hop. — Fig. CLXXV. Section of the fruit of 
the Indian Cress. — Fig. CLXXVI. Fruit of the Indian Cress. 

Platk XXXI. — Fig. CLXXVII. Male flower of Nettle. — Fig. 
CLXVIII. Female flower of Nettle seen in section, showing the penicillate 
stigma and single erect ovale. — Fig. CLXXIX. — Fig. CLXXX. Fruit of 
the Meadow Saffron. — Fig. CLXXXI. Mendow Saffron. — Fig. CLXXXII. 
Vertical section of the flower and stem of Meadow Saffron. — Fig. CLXXXIII. 
Male and female inflorescence of Hemp. 

Plate XXXII. — Fig. CLXXXIV. Periwinkle. — Fig. CLXXXV. 
Chestnut. — Fig. CLXXXVI. Section of Chestnut. — Fig. CLXXXVII. 
Shell or husk of Chestnut. — Fig. CLXXXVIII. Wild Mustard. See Figs. 
CLXIII. and CLXIV. 



TABULAR VIEW 



OF SUBJECTS AND THEIR TREATMENT CONTAINED IN THE APPENDICES 

RELATING TO SICK-NURSING AND MATERNAL 

MANAGEMENT. 



I. SICK-NURSING. 

PAGE 

I. Having Special Reference to Adults 831 

Ventilation 832 

How the Air of an Apartment is rendered impure. — How Thorough Ventilation 
may be accomplished. — Night Air. 

Light 835 

Temperature 836 

Furnishing of the Sick-Room 837 

Food 839 

Cleanliness 841 

Tranquillity 844 

Gossip 846 

Influence of Mind on Body 848 

Observation 850 

Convalescence 854 

II. Having Special Reference to Children 857 

Incautious Use of Medicines 858 

Sigusof Disease in Children 861 

The Condition of the Body. — Altered Demeanor. — The Cry. — Pain. — Ap- 
pearance of Face. — Position. — Remarks upon Measles, Scarlet Fever, Small- 
Pox, Chicken-Pox, and their Sequela?; also on Cough, Whooping-Cough, 
Croup, Vomiting, and Diarrhoea. 

III. Baths 873 

Sponge Bath. — Cold Affusion. — Shower Bath.— Hip Bath. — Foot Baih. — Hot 
Douche Bath. — Cold Douche. — Cold Bath. — Hot Bath.— Vapor Bath. 

IV. Applications 876 

Fomentaiions. — Poultices. — Sinapisms.— Blisters. — Leeches. 

V. Diet during Disease and Convalescence 881 

Solid Alimenis 882 

Milk. — Eggs. — Fish. — Bread. — Meat. — Vegetables. — Fruit. — Jelly. 

Fluid Aliments 885 

Water. — Toast-Water. — Barley-Water. — Gruel. — Rice-Water. — Tea. 

VI. Cookery for the Sick-Room 886 

Arrowroot Mucilage. — Tous-les Mois. — Sago. — Tapioca. — Grit Gruel. — Oat- 
meal Gruel. — Iceland Moss Jelly. — Irish Moss Jelly. —Ground Rice Milk. 
— Bread Panada. — Beef-Tea. — Essence of Beef. — Chicken-Tea. —Mutton- 
Tea. — Veal-Tea. — Toast-Water. — Barlev-Water. — Linseed-Tea. — Rennet 



TABULAR VIEW. 1007 



Whey. — White Wine Whey. — Egg Brandy. — Milk and Soda- Water. — Sago 
Posset. — Boiled Flour and Milk. — Arrowroot Pudding. — Arrowroot Blanc 
Mange. — Oatmeal Porridge. — Rice and Apples. — Boiled Bread Pudding. — 
Simple Bice Pudding. — Macaroni Pudding. — Batter Pudding. — Tapioca 
Pudding. — Mashed Carrots and Turnips. — Vermicelli or Macaroni Soup. — 
Chicken Broth. — Bice and Gravy. — Sago Milk. — Mutton Broth with Vegeta- 
bles. — Tripe. — Water Souchy. 

VII. Domestic Medicines 894 

Castor Oil. — Rhubarb. — Magnesia. — Epsom Salts. — Dill-Water. — Lime- 
Water. — Aromatic Spirit of Ammonia. — Ipecacuanha Wine. — Tincture of 
Perchloride of Iron. — Spirit of Mindererus. — Sweet Spirit of Nitre. — Lauda- 
num. 

VIII. Accidents 898 

Burns and Scalds. — Bruises. — Sprains. — Cuts. 

II. MATERNAL MANAGEMENT. 

Introductory Remarks 903 

I. Menstruation 904 

II. Pregnancy 906 

1. Signs of Pregnancy 906 

Ceasing to be Unwell. — Morning Sickness. —Changes occurring in the Breasts. 

— Quickening. — Changes in the Abdomen. — Longings. — Mental Peculiari- 
ties. 

2. Duration of Pregnancy 910 

3. Management of the Health during Pregnancy 911 

Food and Drink. — Clothing. — Exercise. — Ablutions. — Sleep. — Ventilation. — 
The Mind. 

4. Diseases of Pregnancy 915 

Excessive Vomiting. — Heart-Burn. — Constipation. — Diarrhoea. — Piles. — Sal- 
ivation. — Toothache. — Palpitation. — Fainting. — Headache. — Sleeplessness. 

— Swelling of Feet and Legs, and Varicose Veins. — Pain in the Side. — Leu- 
corrhoea or Whites. — Pruritus. — Bladder Affections. — Cramps in the Legs, 
etc. 

5. Miscarriage 925 

Symptoms. — Treatment. — To prevent its Occurrence. — The After-Treatment. 

— To prevent its Becurrence. 

6. False Pains 931 

III. Confinement 931 

1. Preparations for Labor 932 

The Breasts. —Attendants. —The Bedroom. — The Bed. — The Dress of the Fe- 
male. — Position during Labor. 

2. The Period of Actual Labor 937 

Duration of Labor. — Food during Labor. — Character of the Pains. 

3. Hints to Attendants should the Doctor not be present 939 

4. The Mother 941 

5. The Child 943 

6. After-Pains 945 

7. Cleansings 945 

8. Treatment after Delivery 947 

Rest. — Diet. 

IV. Nursing . ^ 952 

Nursing during the First Few Days. — Nursing during the First Month. — Nurs- 
ing from the First Month till the Appearance of the Teeth. 



1008 TABULAR VIEW. 



Weaning 956 

The Breasts 957 

Those who ought not to Suckle 958 

Management of the Mother's Health during the Period of Suckling 959 

Diet. — Exercise. — Baths. — Clothing. — Occupation. 

How to dry up the Milk 961 

Bringing up by Hand 963 

Position of the Infant during Feeding 966 

Health of the Infant and Young Child 966 

Cleanliness. — Sleep. — Air and Exercise. — Ventilation. — Teething. — Vaccina- 
tion. — Revaccination. — The Nurseiy. — Medicines. — To feel the Pulse of a 
Baby. — Some of the Things you are never to do to a Young Child. 



PRACTICAL SUGGESTIONS, 

FOR USE IN THE SICK-ROOM, IN THE CARE OF THE FAMILY, AND IN 
ALLEVIATING CERTAIN DISEASES. 

Sand-Bag for the Sick-Room 980 

Ready Method for Hot Fomentations 980 

Convenient Remedy for Cuts and Bruises 980 

Milk Diet in Heart Disease 980 

An Absolute Remedy for Boils and Carbuncles 981 

The Treatment of Burns 981 

How to make Savory Beef-Tea 982 

The Japanese Method of Cooking Rice 982 

How to serve the Food of an Invalid 983 

Boracic Acid in Erysipelas 983 

How to make a Spice-Bag 983 

The Diarrhoea of Infants ^ .... 984 

Turpentine Vapor in Whooping-Cough 984 

Chloroform Vapor in Earache 984 

How to relieve the "Pain of Cancer 984 

Black Walnut Leaves as a Remedy in Diphtheria 984 

To prevent Pitting in Small-Pox 985 

A Remedy for Sea-Sickness 985 

A Cure for Hiccough 985 

Formula for making Koumiss 985 

Simple Plan for the Preservation of Ice in the Sick-Room 986 

To Arrest the Vomiting of Cholera Infantum 986 









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